Correlation of MRI characteristics with KRAS mutation status in pancreatic ductal adenocarcinoma

To investigate MRI features associated with KRAS mutation status in PDAC and their clinical implications.

In our study, 1474 patients pathologically confirmed PDAC patients between January 2016 and December 2023 were evaluated. Patients with genetic testing (KRAS mutation status) and MRI examination were enrolled and grouped as KRAS-mutated PDAC and non-KRAS-mutated PDAC. Contrast-enhanced MRI features, clinicopathologic findings, and prognosis were compared between two groups.

A total of 308 surgically confirmed PDAC patients (median age, 67 years [IQR, 59, 72]; 183 male and 125 female) with genetic testing data were included, of which 258 had KRAS-mutated PDAC and 50 had non-KRAS-mutated PDAC. KRAS-mutated PDAC demonstrated distinct clinicopathological characteristics, including higher rates of diabetes (OR, 2.450, 95% CI, 1.151-5.212, P = 0.020), pathological peripheral nerve infiltration (OR, 2.296, 95% CI, 1.083-4.867, P = 0.030), and pN stage (OR, 2.006, 95% CI, 1.012-3.976, P = 0.046). The 1-, 3-, 5-year OS rate was worse for KRAS-mutated PDAC (89.9%, 45.4%, 23.2% vs. 95.1%, 60.4% 60.4%, P = 0.045). Rim enhancement (OR = 2.039, 95% CI: 1.053, 3.951, P = 0.035) and larger tumor size (OR = 3.286, 95% CI: 1.523, 7.089, P = 0.002) were identified as distinctive MRI features for KRAS-mutated PDAC.

KRAS-mutated PDAC presents unique clinical and pathological features and is associated with poorer prognosis. Rim enhancement and larger tumor size on MRI were identified as features associated with KRAS-mutated PDAC.