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Evaluation of Occult Liver Metastases in Pancreatic Adenocarcinoma by Diffusion-Weighted Related Magnetic Resonance

Fangqing Wang1, Xinghua Xu1, Yinghui Chen1

  • 1Department of Radiology, Qilu Hospital, Shandong University, Jinan, China.

Journal of Magnetic Resonance Imaging : JMRI
|March 10, 2025
PubMed
Summary

Diffusion-weighted imaging (DWI) parameters, specifically the pure diffusion coefficient (D), combined with neutrophil-to-lymphocyte ratio (NLR) and carbohydrate antigen 19-9 (CA 19-9) levels, can predict occult liver metastases in pancreatic ductal adenocarcinoma (PDAC) patients.

Keywords:
biomarkerdiffusion‐weighted related parametersoccult liver metastasispancreatic adenocarcinoma

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Area of Science:

  • Radiology and Medical Imaging
  • Oncology
  • Gastroenterology

Background:

  • Occult liver metastases are a significant challenge in managing pancreatic ductal adenocarcinoma (PDAC), impacting treatment decisions and patient outcomes.
  • Diffusion-weighted imaging (DWI) shows potential in assessing tumor biology and detecting subtle metastatic disease.

Purpose of the Study:

  • To determine the diagnostic accuracy of DWI parameters in predicting the presence of occult liver metastases in patients diagnosed with PDAC.
  • To identify key imaging and clinical factors that contribute to the prediction of liver metastases.

Main Methods:

  • A prospective study involving 115 patients with pathologically confirmed PDAC.
  • Diffusion-weighted imaging (DWI), including intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) sequences, was performed at 1.5 T.
  • Logistic regression and receiver operating characteristic (ROC) curve analysis were used to evaluate the predictive value of various parameters.

Main Results:

  • 20% of PDAC patients in the study cohort had occult liver metastases.
  • Multivariable analysis identified the pure diffusion coefficient (D) from DWI, neutrophil-to-lymphocyte ratio (NLR), and carbohydrate antigen 19-9 (CA 19-9) level as independent predictors of occult liver metastases.
  • A combined model incorporating D, NLR, and CA 19-9 achieved an area under the ROC curve (AUC) of 0.848, demonstrating strong predictive performance.

Conclusions:

  • The combination of the pure diffusion coefficient (D) from DWI, NLR, and CA 19-9 levels offers a valuable tool for predicting occult liver metastases in PDAC patients.
  • Integrating advanced DWI techniques with clinical markers may improve early detection and management strategies for PDAC with liver involvement.