Open Access

Diffusion kurtosis imaging and conventional diffusion weighted imaging to assess electrochemotherapy response in locally advanced pancreatic cancer

Vincenza Granata
Vincenza Granata
, 
Roberta Fusco
Roberta Fusco
, 
Sergio Venanzio Setola
Sergio Venanzio Setola
, 
Raffaele Palaia
Raffaele Palaia
, 
Vittorio Albino
Vittorio Albino
, 
Mauro Piccirillo
Mauro Piccirillo
, 
Robert Grimm
Robert Grimm
, 
Antonella Petrillo
Antonella Petrillo
 and 
Francesco Izzo
Francesco Izzo
   | Jan 19, 2019
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Article Category: Research Article
Published Online: Jan 19, 2019
Page range: 15 - 24
Received: Sep 24, 2018
Accepted: Nov 18, 2018
DOI: https://doi.org/10.2478/raon-2019-0004
© 2019 Vincenza Granata, Roberta Fusco, Sergio Venanzio Setola, Raffaele Palaia, Vittorio Albino, Mauro Piccirillo, Robert Grimm, Antonella Petrillo, Francesco Izzo published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Boxplot of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) parameters pre and post treatment values between responders and not responders. MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis
Boxplot of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) parameters pre and post treatment values between responders and not responders. MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis

Figure 2

Boxplot of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) parameters percentage change values between responders and not responders. Delta (Δ) = percentage change between pre and post treatment; MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis
Boxplot of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) parameters percentage change values between responders and not responders. Delta (Δ) = percentage change between pre and post treatment; MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis

Figure 3

ROC curve of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) features to assess electrochemotherapy (ECT) response. MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis
ROC curve of apparent diffusion coefficient (ADC) and diffusion kurtosis imaging (DKI) features to assess electrochemotherapy (ECT) response. MD = mean of diffusion coefficient; MK = mean of diffusional kurtosis

Figure 4

Adenocarcinoma of the pancreatic head. Before treatment in (A) (half-Fourier acquisition single-shot turbo spin-echo [HASTE] T2- Weighted [W] sequence), the lesion (arrow) appears hyperintense, in (B) (in-phase T1-W sequence) and (C) (out-phase T1-W sequence) appears hypointense and hypovascular in (D) (volumetric interpolated breath hold examination [VIBE] T1-W in equilibrium phase). After the treatment the lesion in (E) (HASTE T2-W sequence), (F) (in-phase T1-W sequence), (G) (out-phase T1-W sequence) and (H) (VIBE T1-W in equilibrium phase): there were not significant differences in size and signal compared to baseline. Apparent diffusion coefficient (ADC) map before and after treatment (I, J).
Adenocarcinoma of the pancreatic head. Before treatment in (A) (half-Fourier acquisition single-shot turbo spin-echo [HASTE] T2- Weighted [W] sequence), the lesion (arrow) appears hyperintense, in (B) (in-phase T1-W sequence) and (C) (out-phase T1-W sequence) appears hypointense and hypovascular in (D) (volumetric interpolated breath hold examination [VIBE] T1-W in equilibrium phase). After the treatment the lesion in (E) (HASTE T2-W sequence), (F) (in-phase T1-W sequence), (G) (out-phase T1-W sequence) and (H) (VIBE T1-W in equilibrium phase): there were not significant differences in size and signal compared to baseline. Apparent diffusion coefficient (ADC) map before and after treatment (I, J).

MRI protocol parameters

Sequence Orientation TR/TE/FA (ms/ms/deg.) FOV (mm2) Acquisition matrix Slice thickness/ gap (mm)
HASTE T2-W Axial 1500/90/180 380 × 380 320 × 320 5/0
FLASH T1-W, In-out phase Axial 160/4.87/70 285 × 380 192 × 256 5/0
FLASH T1-W, out phase Axial 178/2.3/80 325 × 400 416 × 412 3/0
DWI Axial 7500/91/90 340 × 340 192 × 192 3/0
VIBE T1-W Axial 4.89/2.38/10 325 × 400 320 × 260 3/0
TWIST T1-W, Pre and post contrast agent injection Axial 3.01/1.09/25 300 × 300 256 × 256 2/0

Electrochemotherapy (ECT) response classification for each patient

No. CT response according Choi DCE-MRI response according ΔWIS and ΔWOS PET response according PERCIST Consenssus among two modalities
1 PR PR PD PR
2 PR PR PR
3 PR PR PR PR
4 PR PR PR
10 PR CR PR
11 PR SD PR SD
12 SD PR SD SD
13 PR SD PR PR
14 PR PR PR PR
17 PR PR SD PR
18 PR PR SD PR
19 PR PR/SD PR PR
20 PR PR PR
21 SD SD SD

Diagnostic accuracy of MRI extracted parameters in discrimination of responders and not responders.

AUC 95% CI p value Sensitivity Specificity Cut-off
ΔADC 0,767 0,429–1,00 0,176 0,900 0,667 -25,775
ΔMK 0,533 0,229–0,837 0,866 0,500 1,000 14,555
ΔMD 0,933 0,782–1,000 0,028 0,800 1,000 -32,570
ADC PRE 0,667 0,292–1,000 0,398 0,700 0,667 1182,550
MK PRE 0,667 0,380–1,953 0,398 0,600 1,000 1348,700
MD PRE 0,700 0,360–1,000 0,310 0,400 1,000 2477,500
ADC POST 0,367 0,000–0,766 0,499 0,800 0,333 1177,825
MK POST 0,800 0,505–1,000 0,128 0,500 1,000 1299,075
MD POST 0,267 0,000–0,602 0,237 0,600 0,333 2020,725

Patients’ characteristics

Patients (n = 21)
Histotype, %
Adenocarcinoma 100 (21/21)
Location, %
Head 52.4 (11/21)
Body/tail 47.6 (10/21)
Largest diameter lesion, cm (range) 5.2 (2.2–9.9)
Venus involvement (superior mesenteric vein [SMV] or portal vein [PV]), %
Yes 81.0 (17/21)
No 19.0 (4/21)
Arterial encasement, %
Yes 57.1 (12/21)
No 42.9 (9/21)
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