Multifrequency magnetic resonance elastography for predicting pancreatic cancer aggressiveness and patient survival

To evaluate the spatial heterogeneity of viscoelastic properties in pancreatic cancer, to correlate MR elastography (MRE) parameters with clinicopathological factors indicating tumor aggressiveness, and to identify risk factors for patient survival.

This retrospective study included 96 treatment-naive pancreatic cancer patients undergoing multifrequency MRE between September 2018 and May 2024. High-resolution parametric maps were generated to measure stiffness and fluidity in central, peripheral, and whole-tumor regions. Correlations between MRE parameters and tumor stage, grade, vascular and perineural invasion, regional lymphadenopathy, and distant metastasis were analyzed. Kaplan-Meier and Cox proportional hazards models were used to identify prognostic factors in patients with and without R0 resection, respectively.

Peripheral fluidity of the tumor was higher than central fluidity (1.23 ± 0.25 vs 0.95 ± 0.19 rad, p < 0.001), whereas stiffness showed no zonal difference (p = 0.07). Tumor stiffness correlated positively with vascular invasion (ρ = 0.21, p = 0.04). Peripheral tumor fluidity correlated positively with tumor stage (ρ = 0.28, p = 0.007), perineural invasion (ρ = 0.31, p = 0.02), regional lymphadenopathy (ρ = 0.29, p = 0.005), and distant metastasis (ρ = 0.26, p = 0.01). In 48 R0-resected patients, higher peripheral fluidity was associated with shorter disease-free survival (DFS) (9.1 vs 19.4 months, p = 0.009) and was identified as an independent predictor of shorter DFS (hazard ratio, 2.15; 95% confidence interval: 1.03, 4.50; p = 0.04).

Tumor biomechanical properties quantified by in vivo multifrequency MRE predict pancreatic cancer aggressiveness and patient survival.

Question Pretreatment identification of aggressive pancreatic cancer remains challenging. Non-invasive imaging biomarkers are needed to stratify patient risk and optimize individualized treatment strategies. Findings Peripheral tumor fluidity quantified by multifrequency MRE correlates with pancreatic cancer aggressiveness and independently predicts DFS in patients with R0-resected pancreatic cancer. Clinical relevance MRE-derived peripheral fluidity provides a biophysical marker for pancreatic cancer aggressiveness. This facilitates risk stratification and identifying high-risk candidates for targeted neoadjuvant therapy.