MR Elastography of the Pancreas: Bowel Preparation and Repeatability Assessment in Pancreatic Cancer Patients and Healthy Controls.
magnetic resonance elastography
observer variation
pancreas
pancreatic ductal carcinoma
reproducibility of results
tumor microenvironment
Journal
Journal of magnetic resonance imaging : JMRI
ISSN: 1522-2586
Titre abrégé: J Magn Reson Imaging
Pays: United States
ID NLM: 9105850
Informations de publication
Date de publication:
24 Jul 2023
24 Jul 2023
Historique:
revised:
05
07
2023
received:
19
05
2023
accepted:
07
07
2023
medline:
24
7
2023
pubmed:
24
7
2023
entrez:
24
7
2023
Statut:
aheadofprint
Résumé
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. To assess effects of four bowel preparation regimens on MRE quality and to evaluate repeatability and differentiate patients from healthy controls. Prospective. 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. 3-T, spin-echo echo-planar-imaging, turbo spin-echo, and fast field echo gradient-echo. 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. 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. 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). The proposed bowel preparation regimens may not influence MRE quality. MRE may be able to differentiate between healthy tissue-tumor and tumor-nontumor. 2 TECHNICAL EFFICACY STAGE: 2.
Sections du résumé
BACKGROUND
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
OBJECTIVE
To assess effects of four bowel preparation regimens on MRE quality and to evaluate repeatability and differentiate patients from healthy controls.
STUDY TYPE
METHODS
Prospective.
POPULATION
METHODS
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
UNASSIGNED
3-T, spin-echo echo-planar-imaging, turbo spin-echo, and fast field echo gradient-echo.
ASSESSMENT
RESULTS
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
METHODS
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
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
CONCLUSIONS
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
METHODS
2 TECHNICAL EFFICACY STAGE: 2.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : KWF Kankerbestrijding
ID : 10698
Informations de copyright
© 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.
Références
Steinkohl E, Bertoli D, Hansen TM, Olesen SS, Drewes AM, Frokjaer JB. Practical and clinical applications of pancreatic magnetic resonance elastography: A systematic review. Abdom Radiol (NY) 2021;46(10):4744-4764.
Guo J, Savic L, Hillebrandt K, Sack I. MR Elastography in cancer. Invest Radiol 2023;58(8):1-9.
Aier I, Semwal R, Sharma A, Varadwaj PK. A systematic assessment of statistics, risk factors, and underlying features involved in pancreatic cancer. Cancer Epidemiol 2019;58:104-110.
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin 2022;72(1):7-33.
Stopa KB, Kusiak AA, Szopa MD, Ferdek PE, Jakubowska MA. Pancreatic cancer and its microenvironment-Recent advances and current controversies. Int J Mol Sci 2020;21(9):3218.
Coppola S, Carnevale I, Danen EHJ, et al. A mechanopharmacology approach to overcome chemoresistance in pancreatic cancer. Drug Resist Updat 2017;31:43-51.
Piersma B, Hayward MK, Weaver VM. Fibrosis and cancer: A strained relationship. Biochim Biophys Acta Rev Cancer 2020;1873(2):188356.
Wang H, Mislati R, Ahmed R, et al. Elastography can map the local inverse relationship between shear modulus and drug delivery within the pancreatic ductal adenocarcinoma microenvironment. Clin Cancer Res 2019;25(7):2136-2143.
Li J, Zormpas-Petridis K, Boult JKR, et al. Investigating the contribution of collagen to the tumor biomechanical phenotype with noninvasive magnetic resonance Elastography. Cancer Res 2019;79(22):5874-5883.
Mostafaei F, Tai A, Omari E, et al. Variations of MRI-assessed peristaltic motions during radiation therapy. PloS One 2018;13(10):e0205917.
McGee KP, Hubmayr RD, Ehman RL. MR elastography of the lung with hyperpolarized 3He. Magn Reson Med 2008;59(1):14-18.
Ji R, Li J, Yin Z, et al. Pancreatic stiffness response to an oral glucose load in obese adults measured by magnetic resonance elastography. Magn Reson Imaging 2018;51:113-119.
Imamura Y, Kumagi T, Kuroda T, et al. Pancreas stiffness in liver cirrhosis is an indicator of insulin secretion caused by portal hypertension and pancreatic congestion. Hepatol Res 2021;51(7):775-785.
Shi S-Y, Wang L, Peng Z, et al. Multi-frequency magnetic resonance elastography of the pancreas: Measurement reproducibility and variance among healthy volunteers. Gastroenterol Rep 2022;10:goac033.
Shi Y, Glaser KJ, Venkatesh SK, Ben-Abraham EI, Ehman RL. Feasibility of using 3D MR elastography to determine pancreatic stiffness in healthy volunteers. J Magn Reson Imaging 2015;41(2):369-375.
An H, Shi Y, Guo Q, Liu Y. Test-retest reliability of 3D EPI MR elastography of the pancreas. Clin Radiol 2016;71(10):1068.e7-1068.e12.
Marticorena Garcia SR, Zhu L, Gültekin E, et al. Tomoelastography for measurement of tumor volume related to tissue stiffness in pancreatic ductal adenocarcinomas. Invest Radiol 2020;55:769-774.
van Schelt AS, Gottwald LM, Wassenaar NPM, et al. Single breath-hold MR Elastography for fast biomechanical probing of pancreatic stiffness. J Magn Reson Imaging 2023;1-11. doi:10.1002/jmri.28773
Kolipaka A, Schroeder S, Mo X, Shah Z, Hart PA, Conwell DL. Magnetic resonance elastography of the pancreas: Measurement reproducibility and relationship with age. Magn Reson Imaging 2017;42:1-7.
Tzschätzsch H, Guo J, Dittmann F, et al. Tomoelastography by multifrequency wave number recovery from time-harmonic propagating shear waves. Med Image Anal 2016;30:1-10.
Bertalan G, Guo J, Tzschätzsch H, et al. Fast tomoelastography of the mouse brain by multifrequency single-shot MR elastography. Magn Reson Med 2019;81(4):2676-2687.
Manduca A, Bayly PJ, Ehman RL, et al. MR elastography: Principles, guidelines, and terminology. Magn Reson Med 2020;85:2377-2390.
Donoho D, Johnstone I, Picard D. Wavelet shrinkage: Asymptopia? J Roy Stat Soc Ser B 1999;57:301-369.
Buscopan®Ampoules. 20 mg/ml Solution for Injection. Professional Leaflet. Italy: Sanofi S.r.l; 2022.
Yushkevich PA, Piven J, Hazlett HC, et al. User-guided 3D active contour segmentation of anatomical structures: Significantly improved efficiency and reliability. Neuroimage 2006;31(3):1116-1128.
Martin Bland DGA. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;327:307-310.
Allescher HD, Neuhaus H, Hagenmüller F, Classen M. Effect of N-Butylscopolamine on sphincter of Oddi motility in patients during routine ERCP-a Manometric study. Endoscopy 1990;22(4):160-163.
Dittmann F, Tzschätzsch H, Hirsch S, et al. Tomoelastography of the abdomen: Tissue mechanical properties of the liver, spleen, kidney, and pancreas from single MR elastography scans at different hydration states. Magn Reson Med 2017;78:976-983.
Zhu L, Guo J, Jin Z, et al. Distinguishing pancreatic cancer and autoimmune pancreatitis with in vivo tomoelastography. Eur Radiol 2021;31:3366-3374.
Kpeglo D, Hughes MDG, Dougan L, et al. Modeling the mechanical stiffness of pancreatic ductal adenocarcinoma. Matrix Biol Plus 2022;14:100109.
Streitberger KJ, Lilaj L, Schrank F, et al. How tissue fluidity influences brain tumor progression. Proc Natl Acad Sci U S A 2020;117:128-134.
Shahryari M, Tzschatzsch H, Guo J, et al. Tomoelastography distinguishes noninvasively between benign and malignant liver lesions. Cancer Res 2019;79:5704-5710.