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T2* mapping in magnetic resonance imaging for stratifying the hypoxic microenvironment in pancreatic ductal
Qi Jiang1,2,3, Feng Chen4, Siyuan Ouyang1,2,3
1Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
Background:
T2* mapping provides a noninvasive approach for quantifying tissue oxygenation via the detection of the paramagnetic effects associated with deoxyhemoglobin, with validated correlations to hypoxia in other cancers. However, its application in stratifying hypoxic microenvironments in pancreatic ductal adenocarcinoma (PDAC) remains limited. This preliminary study aimed to evaluate T2* mapping as a quantitative imaging biomarker for hypoxia levels in PDAC in order to offer a potential tool for the noninvasive characterization of the tumor microenvironment and the development of personalized treatment strategies.
Methods:
This retrospective study enrolled 50 patients with PDAC pathologically confirmed between June 2022 and July 2023. Hypoxia-inducible factor-1α (HIF-1α) expression was used to evaluate PDAC hypoxia levels, and patients were stratified into low and high hypoxia groups. T2* values and other clinicoradiological indicators were compared between the two groups via binary logistic regression analysis. A logistic regression model was built with independent factors related to hypoxia levels. The predictive performance of the model was evaluated with area under the curve (AUC) and leave-one-out cross-validation (LOOCV). The correlation between the PDAC HIF-1α expression and T2* values was assessed via the Spearman rank correlation coefficient, and hypoxia levels were compared with pathological findings.
Results:
T2* values differed significantly between the low and high hypoxia groups (62.63±3.33 vs. 59.16±3.97 ms; P=0.002), as did rim enhancement (P<0.001). Multivariate analysis identified the independent predictors of hypoxia to be T2* values [odds ratio (OR) =0.819; 95% confidence interval (CI): 0.674-0.994; P=0.044] and rim enhancement (OR =6.261; 95% CI: 1.532-25.581; P=0.011). The logistic regression model achieved an initial AUC of 0.822, retaining diagnostic performance after LOOCV (AUC =0.785). T2* values exhibited a significant inverse correlation with HIF-1α expression (r=-0.463; P<0.001). High-hypoxia tumors were associated with poorer differentiation (P<0.001).
Conclusions:
T2* mapping may serve as a noninvasive imaging biomarker for stratifying the hypoxic microenvironment in PDAC.
