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MR Elastography of the Pancreas: Bowel Preparation and Repeatability Assessment in Pancreatic Cancer Patients and
Nienke P M Wassenaar1,2, Anne-Sophie van Schelt1,2, Eric M Schrauben1
1Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Background:
Pancreatic ductal adenocarcinoma (PDAC) stromal viscoelasticity can be measured using MR elastography (MRE). Bowel preparation regimens could affect MRE quality and knowledge on repeatability is crucial for clinical implementation.
Purpose:
To assess effects of four bowel preparation regimens on MRE quality and to evaluate repeatability and differentiate patients from healthy controls.
Study Type:
Prospective.
Population:
15 controls (41 ± 16 years; 47% female), 16 PDAC patients (one excluded, 66 ± 12 years; 40% female) with 15 age-/sex-matched controls (65 ± 11 years; 40% female). Final sample size was 25 controls and 15 PDAC.
Field Strength/Sequence:
3-T, spin-echo echo-planar-imaging, turbo spin-echo, and fast field echo gradient-echo.
Assessment:
Four different regimens were used: fasting; scopolaminebutyl; drinking 0.5 L water; combination of 0.5 L water and scopolaminebutyl. MRE signal-to-noise ratio (SNR) was compared between all regimens. MRE repeatability (test-retest) and differences in shear wave speed (SWS) and phase angle (ϕ) were assessed in PDAC and controls. Regions-of-interest were defined for tumor, nontumorous (n = 8) tissue in PDAC, and whole pancreas in controls. Two radiologists delineated tumors twice for evaluation of intraobserver and interobserver variability.
Statistical Tests:
Repeated measures analysis of variance, coefficients of variation (CoVs), Bland-Altman analysis, (un)paired t-test, Mann-Whitney U-test, and Wilcoxon signed-rank test. P-value<0.05 was considered statistically significant.
Results:
Preparation regimens did not significantly influence MRE-SNR. Therefore, the least burdensome preparation (fasting only) was continued. CoVs for tumor SWS were: intrasession (12.8%) and intersession (21.7%), and intraobserver (7.9%) and interobserver (10.3%) comparisons. For controls, CoVs were intrasession (4.6%) and intersession (6.4%). Average SWS for tumor, nontumor, and healthy tissue were: 1.74 ± 0.58, 1.38 ± 0.27, and 1.18 ± 0.16 m/sec (ϕ: 1.02 ± 0.17, 0.91 ± 0.07, and 0.85 ± 0.08 rad), respectively. Significant differences were found between all groups, except for ϕ between healthy-nontumor (P = 0.094).
Data Conclusion:
The proposed bowel preparation regimens may not influence MRE quality. MRE may be able to differentiate between healthy tissue-tumor and tumor-nontumor.
Level Of Evidence:
2 TECHNICAL EFFICACY STAGE: 2.
Insights
Bowel preparation regimens do not significantly impact MR elastography (MRE) quality for pancreatic cancer. MRE can differentiate between tumor and healthy tissues, supporting its clinical use.
Area of Science:
- Medical imaging
- Biophysics
- Oncology
Background:
- Pancreatic ductal adenocarcinoma (PDAC) involves measuring stromal viscoelasticity using MR elastography (MRE).
- Bowel preparation regimens may influence MRE quality, necessitating research into their repeatability for clinical application.
Purpose of the Study:
- To evaluate the impact of four distinct bowel preparation regimens on MRE quality.
- To assess the repeatability of MRE and its ability to differentiate between PDAC patients and healthy controls.
Main Methods:
- Prospective study involving 25 controls and 15 PDAC patients.
- Four bowel preparation regimens were tested: fasting, scopolaminebutyl, water intake, and a combination.
- MRE signal-to-noise ratio (SNR), shear wave speed (SWS), and phase angle (ϕ) were assessed, along with repeatability and inter/intra-observer variability.
Main Results:
- Bowel preparation regimens did not significantly affect MRE-SNR, leading to the adoption of the simplest regimen (fasting only).
- Repeatability coefficients of variation (CoVs) for tumor SWS were 12.8% (intrasession) and 21.7% (intersession).
- Significant differences in SWS and ϕ were observed between tumor, nontumor, and healthy pancreatic tissues, except for ϕ between healthy and nontumor tissue.
Conclusions:
- The evaluated bowel preparation regimens do not appear to compromise MRE quality.
- MRE demonstrates potential in distinguishing between healthy pancreatic tissue, tumor tissue, and nontumorous tissue in PDAC patients.
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