Shadi A Esfahani ¹, Cody Callahan², Nicholas M Rotile¹, Peter D Caravan ¹, Aaron K Grant ², and Yi-Fen Yen^1
1Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States, ²Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, United States

Personalized treatment of gastric cancer remains a major challenge mainly due to lack of an optimal imaging method for detection of early response to treatment. We evaluated the role of Hyperpolarized [1-13C] Pyruvate Magnetic Resonance Spectroscopic Imaging (HP-13C MRSI) for quantitative measurement of early changes in glycolytic metabolism of gastric cancer models upon initiation of afatinib, a pan-receptor tyrosine kinase inhibitor. We showed that HP-13C MRSI is more sensitive for detection of early metabolic changes in gastric cancer after starting treatment with afatinib compared to 18F-FDG PET/MRI, and therefore can be used for early prediction of response to targeted therapies.

Jeremy W Gordon¹, Hsin-Yu Chen¹, Philip Lee¹, Robert Bok¹, Michael Ohliger¹, Andrew Ko², Eric Collisson², Margaret Tempero², Pelin Cinar², Peder Larson^1,3, and Zhen Jane Wang^1,3
1Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States, ²Department of Medicine, University of California, San Francisco, San Francisco, CA, United States, ³UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA, United States

Metabolic imaging of hyperpolarized [1-¹³C]pyruvate was performed in four patients with pancreatic ductal adenocarcinoma prior to chemotherapy. Compared to the normal appearing pancreas, higher lactate/pyruvate and lower alanine/pyruvate ratios were seen in the primary tumors. The alanine/lactate ratio, which reflects the relative enzymatic activity and metabolite pool sizes, was reduced 2- to 20-fold in the tumors and provided improved contrast between tumor and normal appearing pancreas over either the lactate/pyruvate or alanine/pyruvate ratio. These results indicate the potential for HP ¹³C MRI to be a novel tool to stage disease and assess treatment response in pancreatic cancer patients

Jingjing Liu¹, Jingliang Cheng¹, and Jinxia Zhu^2
1Department of MR Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, ²MR Collaboration, Siemens Healthcare Ltd, Beijing, China

We evaluated the efficacy of a zoomed diffusion-weighted echo-planar imaging (z-EPI) sequence to diagnose periampullary carcinoma compared with a conventional single-shot EPI (c-EPI) sequence. Better delineation of lesion conspicuities and margins were observed, as well as enhanced diagnostic confidence with z-EPI. The diagnostic accuracy increased by combining magnetic resonance cholangiopancreatography (MRCP) and z-EPI together. These findings showed remarkable image quality improvements for periampullary carcinomas using z-EPI. The ability to detect and delineate lesions using z-EPI was superior to that of c-EPI. Diagnostic accuracy was also attained, especially for small lesions. 

Nienke P.M. Wassenaar¹, Esther N. Pijnappel², Remy Klaassen², Femke Struik¹, Jaap Stoker¹, Jurgen H. Runge¹, Hanneke W.M. van Laarhoven², Johanna W. Wilmink², Aart J. Nederveen¹, and Oliver J. Gurney-Champion^1
1Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands, ²Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands

Stromal deposition can become a physical and biological barrier that prevents chemotherapy from reaching pancreatic ductal adenocarcinoma (PDAC). In this study, 34 patients were treated with LDE225, which specifically targets tumour stroma, gemcitabine and nab-paclitaxel. Pancreatic tumour response was assessed using intravoxel incoherent motion (IVIM) MRI. We found that the diffusion in PDAC increased after chemotherapy, which may be explained by reduction of stroma or tumour necrosis. Furthermore, a positive correlation was found between overall survival and the change in tumour perfusion, underlining the fact that reperfusion of PDAC by LDE225 improves prognosis.

Alexandra W. Acher¹, Joseph Krenzer¹, Krisztian Kovacs¹, Soudabeh Kargar¹, Ali Pirasteh¹, Jitka Starekova¹, TJ Colgan¹, Victoria Rendell¹, Daniel E. Abbott¹, Erin Brooks¹, Rashmi Agni¹, Emily Winslow², and Scott B. Reeder^1
1University of Wisconsin School of Medicine and Public Health, Madison, WI, United States, ²Georgetown University, Washington DC, MD, United States

The purpose of this study was to assess the feasibility of a novel radiologic-histologic correlation device RHCD and ex vivo MRI to facilitate direct correlation of radiologic and histologic features of pancreas cancer. Our approach is based on previous radiologic-histologic correlation of pancreatic anatomy using cadaveric pancreas specimens. The final protocol was applied to co-localize pancreas cancer margins radiologically and histologically, as well as nodal burden in pancreaticoduodenectomy specimens.

Yoshifumi Noda¹, Nobuyuki Kawai¹, Hiroyuki Tomita², Takuma Ishihara³, Yoshiki Tsuboi³, Masaya Kawaguchi¹, Tetsuro Kaga¹, Fuminori Hyodo⁴, Akira Hara², and Masayuki Matsuo^1
1Department of Radiology, Gifu University, Gifu, Japan, ²Department of Tumor Pathology, Gifu University, Gifu, Japan, ³Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan, ⁴Department of Frontier Science for imaging, Gifu University, Gifu, Japan

The use of texture analysis in clinical images can provide surrogate information on tumor microenvironment and predict the prognosis of patients. In this study, we evaluate the utility of texture analysis of tumor ADC values to predict the overall survival in patients with pancreatic cancer and to correlate with pathological evaluated massive intratumoral necrosis. Our results showed that the kurtosis of tumor ADC values obtained from texture analysis is correlated with massive intratumoral necrosis and is associated with poor prognosis in patients with pancreatic cancer.

Omar Kamal^1,2, Sean McTavish¹, Felix Harder¹, Anh T. Van¹, Johannes M. Peeters³, Kilian Weiss⁴, Marcus R. Makowski¹, Dimitrios C. Karampinos¹, and Rickmer F. Braren^1
1Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany, ²Department of Radiology, South Egypt Cancer Institute, Assiut, Egypt, ³Philips Healthcare, Best, Netherlands, ⁴Philips GmbH, Hamburg, Germany

DWI plays a growing role in the imaging of the pancreas. Current abdominal DWI scans have a large field of view with limited resolution. Approaches for a higher resolution single-shot DW-EPI with SENSE often suffer from g-factor-induced noise band-like artifacts from which the pancreas is significantly affected due to its central location. We use an L1-regularized iterative SENSE reconstruction to obtain high resolution single shot DW-EPI with reduced noise in patients with pancreatic cancer. The employed method reduces the noise band-like artifacts over the pancreas and eliminates the noise bias from the ADC measurements without lengthening scan times.

Meiyappan Solaiyappan¹, Santosh Kumar Bharti¹, Paul T Winnard Jr¹, Mohamad Dbouk², Michael G Goggins^2,3,4, and Zaver M Bhujwalla^1,3,5
1Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States, ²Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States, ³Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁴Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁵Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, United States

The insidious growth of pancreatic cancer is a major factor contributing to its lethality.  Only ~20% of pancreatic cancers are resectable by the time they are detected.  Early detection of pancreatic cancer through routine screening is clearly an unmet clinical need.  Here we have applied neural-network analysis to 1H magnetic resonance spectra of human plasma samples to differentiate between healthy subjects (control), subjects with benign lesions, and subjects with pancreatic ductal adenocarcinoma (PDAC).  Our data support developing a neural-network approach to identify PDAC from 1H MRS of plasma samples.

Mingxiao Wang¹, AIlian Liu¹, Yuhui Liu¹, Anliang Chen¹, wan Dong¹, Xinao Wang¹, Qingwei Song¹, Xinru Zhang¹, Liangjie Lin², and Jiazheng Wang^2
1The First Affiliated Hospital of Dalian Medical University, Dalian, China, Dalian, China, ²Philips Healthcare,Beijing,China, Beijing, China

The purpose of this study was to evaluate the value of amide proton transfer weighted (APTw) imaging in the identification of lymph node metastasis in rectal cancer. Results showed that, for patients with rectal cancer, the APTw value in group with lymph node metastasis was significantly lower than those in group without lymph node metastasis. APTw imaging can be used as a promising non-invasive method to predict the lymph node metastasis in rectal cancer.

 

Pratik Tripathi¹, Zhen Li¹, Yaqi Shen¹, Xuemei Hu¹, and Daoyu Hu^1
1Department of Radiology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

Our study got a step closer to probable cause of the poor prognosis in rectal cancer in obese patients. The correlation of the area within mesorectum with BMI and also the correlation between the mesorectal fat thickness and distant metastasis signifies the need of selection of optimum treatment modality for obese patients in rectal cancer. This preliminary study may shed some light on the current scenario and show probable direction for the solution. Selection of different treatment modalities and new surgical techniques may be required to improve the prognosis.