Is magnetic resonance diffusion-weighted imaging superior in the diagnosis of pancreatic adenocarcinoma and does it have a prognostic value?

Abstract

Aim: To assess how beneficial is adding Magnetic Resonance Diffusion-Weighted Imaging (DWI) to conventional MRI in the identification, characterization, and prognostic assessment of pancreatic duct adenocarcinoma (PDAC). Materials and Methods: We included 34 consecutive patients with pancreatic malignancies who had conventional MRI and DWI performed and were followed up after treatment. Results: The apparent diffusion coefficient (ADC) values of malignant pancreatic mass lesions ranged from 0.9 to 1.5 × 10−3s/mm2 at b-1000, with a mean of 1.2 ± 0.18093. For the surrounding parenchyma, the ADC values were from 1.8 to 2.9 × 10−3s/mm2 at b-1000, with a mean of 2.3 ± 0.35506. These values showed a statistically significant difference (P < 0.001). The ADC cut-off value for the differentiation of malignant pancreatic masses from surrounding normal tissue, in this group of patients was, 1.7 × 10−3 s/mm2 with a sensitivity of 97% and a specificity 93%.In PDAC, a statistically significant difference in survival was found according to ADC (p = 0.026), as patients with high ADC had better survival. Conclusion: DWI added to conventional imaging is a superior modality that aids in differentiating PDAC from the unaffected parenchyma, but not from other malignancies, with a recommended b-value 1000 s/mm2. Higher ADC may also be associated with better survival for PDAC patients. Keywords: Diffusion weighted MRI, Pancreatic ductal adenocarcinoma, Identification, Prognosis