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Pancreas Malignant Lesions
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Park, Seoul, KR","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/412_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/412_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/5B02ED9F.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/412_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/412_1p-thumbnails.vtt"}]},{"name":"SS 3.3 - Pancreatic cancer diagnosis in patients with chronic pancreatitis with a new approach of mathematical postprocessing 128-row MDCT results","mode":"playlist","public":true,"info":{"id":701,"presentation":"SS 3.3 - Pancreatic cancer diagnosis in patients with chronic pancreatitis with a new approach of mathematical postprocessing 128-row MDCT results","session":"SS 3 - Diagnosis and staging of pancreatic cancer: new trends","presenter":"K. Lesko, Moscow, RU","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/701_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/701_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/29C1453C.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/701_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/701_1p-thumbnails.vtt"}]},{"name":"SS 3.4 - MRI screening in hereditary pancreatic cancer: findings in early pancreatic cancer","mode":"playlist","public":true,"info":{"id":783,"presentation":"SS 3.4 - MRI screening in hereditary pancreatic cancer: findings in early pancreatic cancer","session":"SS 3 - Diagnosis and staging of pancreatic cancer: new trends","presenter":"B. Boekestijn, Leiden, NL","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/783_3p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/783_3p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/9DF44152.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/783_3p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/783_3p-thumbnails.vtt"}]},{"name":"SS 3.7 - Can CT texture analysis predict resectability and surgical outcomes after neoadjuvant radiotherapy in pancreatic cancer patients?","mode":"playlist","public":true,"info":{"id":974,"presentation":"SS 3.7 - Can CT texture analysis predict resectability and surgical outcomes after neoadjuvant radiotherapy in pancreatic cancer patients?","session":"SS 3 - Diagnosis and staging of pancreatic cancer: new trends","presenter":"R. De Robertis, Verona, IT","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/974_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/974_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/1B891622.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/974_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/974_1p-thumbnails.vtt"}]},{"name":"SS 3.8 - MR in the identification of mural nodules of intraductal papillary mucinous neoplasms of the pancreas","mode":"playlist","public":true,"info":{"id":611,"presentation":"SS 3.8 - MR in the identification of mural nodules of intraductal papillary mucinous neoplasms of the pancreas","session":"SS 3 - Diagnosis and staging of pancreatic cancer: new trends","presenter":"G. Giannotti, Verona, IT","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/611_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/611_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/D1783A41.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/611_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/611_1p-thumbnails.vtt"}]},{"name":"SS 3.10 - Prediction of early recurrence after surgery in patients with pancreatic neuroendocrine tumour using preoperative MRI","mode":"playlist","public":true,"info":{"id":432,"presentation":"SS 3.10 - Prediction of early recurrence after surgery in patients with pancreatic neuroendocrine tumour using preoperative MRI","session":"SS 3 - Diagnosis and staging of pancreatic cancer: new trends","presenter":"S. Han, Seoul, KR","photo":""},"playlist":[{"name":"","source":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/432_1p.mp4","source_path":"s3:\/\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/432_1p.mp4","cover":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/75F4C519.jpg","data":[],"tracks":[],"chapters":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/432_1p.vtt","thumbnails":"https:\/\/s3.eu-central-1.amazonaws.com\/eu-cslide-prod-recordings\/esgar2020\/25\/v\/432_1p-thumbnails.vtt"}]}]
{"type":2,"code":"7E32WM0r"}
[session]
[presentation]
[presenter]
SS 3.2 - Prediction of survival in pancreas cancer patients who underwent surgery after neoadjuvant FOLFIRINOX therapy using CT and histopathological findings
Presentation Number
SS 3.2
Channel
On-demand channel 4
Purpose
To investigate important factors for recurrence-free survival (RFS) and overall survival (OS) in pancreas cancer with neoadjuvant therapy.
Material and methods
69 patients with pancreas cancer underwent FOLFIRINOX therapy before surgery were retrospectively included. All patients performed baseline and follow-up CT. Two reviewers assessed CT findings. They also graded extra-pancreatic perineural invasion (EPI) using a 3-point scale focused on 5 routes. Clinical characteristics and histopathological results including tumor regression, using College of American Pathology (CAP) grade system, were investigated as well. Kaplan-Meier methods were used for RFS and OS. Cox proportional hazard regression model was used to find out significant predictive factors.
Results
57 patients (82.6%, 57/69) had no residual tumor (R0) and 12 patients (17.4%, 12/69) had residual tumor (R1 or R2). Median RFS was 13 months (range 0–22). The RFS rates for 1 and 2 years were 53.1% and 35.9%, respectively. For RFS, EPI in the baseline CT (odds ratio (OR) 2.53, 95% CI: 1.116–5.733, p=0.026) and tumor regression grade (OR 1.76, 95% CI: 1.000–3.076, p=0.046) were important predictors of early recurrence in multivariate analysis. Mean OS was 48 months (range 11–35). The OS rates for 1 and 2 years were 98.5% and 72.5%, respectively. For OS, tumor regression grade (OR 1.05, 95% CI: 1.251–6.559, p=0.013) was significant factor. However, there were no independent predictors for residual tumor in CT findings.
Conclusion
EPI in the baseline CT was an important prognostic factor for tumor recurrence. Especially, CAP was an important prognostic factor for not only RFS but also OS.
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{"status_url":"https:\/\/cslide.ctimeetingtech.com\/play\/8E22WM087\/status","status":20,"track_url":"https:\/\/cslide.ctimeetingtech.com\/play\/8E22WM087\/track","track":60,"provider":"CTI","provider_live":0,"type":1,"code":"8E22WM087"}
[session]
[presentation]
[presenter]
SS 3.3 - Pancreatic cancer diagnosis in patients with chronic pancreatitis with a new approach of mathematical postprocessing 128-row MDCT results
Presentation Number
SS 3.3
Channel
On-demand channel 4
Purpose
To explore the diagnostic value of a new approach of pancreatic cancer (PC) diagnosis in patients with chronic pancreatitis (CP) by mathematical postprocessing of 128-row MDCT results.
Material and methods
We analyzed results of contrast-enhanced MDCT from 122 patients with CP: 71 (58.2%) males and 51 (41.8%) females, mean age 53.7±13.03 (30-83), who underwent MDCT from January 2018 to October 2019. All cases were pathologically proved by core biopsy or surgery. We calculated the median of enhancement gradient in Hounsfield units (HU) between the region of interest and intact parenchyma (Mgrad) based on multiphase MDCT results. Correlation was assessed by Pearson’s correlation coefficient (r). The receiver operating characteristic (ROC) curves were performed to evaluate the diagnosis potential of Mgrad.
Results
There were 46 (37.7%) patients with PC and 76 (62.3%) patients with only CP. Mean Mgrad value was higher in PC group—26.5±8.6 HU—than in CP group—13.9±5.1 HU (р=0.0001); Mgrad cut-off value for PC was 20 HU (p=0.001). There was positive correlation of Mgrad in patients with PC (r=0.68, p=0.0001) and negative correlation in patients with CP (r=-0.68, p=0.0001). Sensitivity, specificity, accuracy, positive and negative predictive value of PC diagnosis were 89.1%, 96.1%, 93.4%, 93.2%, 93.6% for Mgrad and 69.5%, 92.1%, 83.6%, 84.2%, 83.3% for MDCT, respectively; area under ROC for Mgrad was higher (0.927) than for MDCT (0.863).
Conclusion
Mgrad assessment based on MDCT results is more effective than only MDCT for PC diagnosis in patients with CP. Mgrad value positively correlates with PC existence; therefore, it could be useful for PC diagnosis.
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{"status_url":"https:\/\/cslide.ctimeetingtech.com\/play\/7E22WM0d6\/status","status":20,"track_url":"https:\/\/cslide.ctimeetingtech.com\/play\/7E22WM0d6\/track","track":60,"provider":"CTI","provider_live":0,"type":1,"code":"7E22WM0d6"}
[session]
[presentation]
[presenter]
SS 3.4 - MRI screening in hereditary pancreatic cancer: findings in early pancreatic cancer
Presentation Number
SS 3.4
Channel
On-demand channel 4
Purpose
In CDKN2A-p16-Leiden mutation carriers with 15-20% lifetime risk of pancreatic ductal adenocarcinoma (PDAC), annual MRI surveillance is able to detect PDAC at an early stage. In a retrospective study, findings on different MRI sequences were analysed, including a T1-weighted turbo field echo (TFE) with inversion recovery.
Material and methods
Sixteen subjects were included with PDAC detected during an observation period from January 2012 until March 2019 out of 218 mutation carriers enrolled in the program since 2000. MRI at 3.0T included T2-weighted, fat-suppressed T1-weighted dynamic contrast-enhanced (DCE), MRCP and T1-TFE sequences. Diffusion-weighted imaging (DWI) was added in 2015. Two readers independently analysed the current and past MRI examinations for lesions and other findings.
Results
Fourteen of 16 PDAC were seen on T1-TFE and T1-DCE by both readers. Thirteen tumors demonstrated increased enhancement in the delayed phase of T1-DCE. Dilatation of the pancreatic duct was present in 5 subjects. One PDAC was in proximity to an intraductal papillary mucinous neoplasm. DWI was available in 11 subjects, with restricted diffusion in 7 subjects. In 9 of 13 subjects with an incident tumor, a measurable lesion was detected on previous imaging. The average growth rate of those lesions was 6.7 mm/year (s = 3.0) with an estimated volume doubling time of 157.5 days (s = 62.7).
Conclusion
Knowledge of imaging features and recognition of subtle changes could improve detection of hereditary pancreatic cancer in a screening setting. Relatively slow growth rates of PDAC justify short-term follow-up in uncertain MRI findings.
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{"status_url":"https:\/\/cslide.ctimeetingtech.com\/play\/9E22WM0ev\/status","status":20,"track_url":"https:\/\/cslide.ctimeetingtech.com\/play\/9E22WM0ev\/track","track":60,"provider":"CTI","provider_live":0,"type":1,"code":"9E22WM0ev"}
[session]
[presentation]
[presenter]
SS 3.7 - Can CT texture analysis predict resectability and surgical outcomes after neoadjuvant radiotherapy in pancreatic cancer patients?
Presentation Number
SS 3.7
Channel
On-demand channel 4
Purpose
To evaluate changes in texture analysis parameters of CT images after adjuvant stereotactic body radiation therapy (SBRT) in patients with locally advanced pancreatic adenocarcinoma.
Material and methods
Pre- and post-SBRT contrast-enhanced CT examinations of 54 patients with locally advanced pancreatic adenocarcinoma were retrospectively evaluated. 3D regions of interest were manually drawn on arterial- and portal-phase CT images to comprise the whole tumor; 47 texture parameters were analyzed. Baseline and post-SBRT tumor volumes and texture parameters were compared between groups (resected versus non-resected and R0 versus R1-2 resection) using Wilcoxon test.
Results
Forty patients (72.7%) underwent surgical resection after SBRT; among them, 25 had R0 resection (62.5%). Baseline tumor volume was not significantly different between groups (p>.05). Resected and R0 patients had significant tumor volume change after SBRT compared to non-resected and R1/2 patients (-39.7% vs +22.6%, p=.005; and -47.1% vs -17.3%, p=.017). Texture analysis identified 31 arterial-phase parameters and 27 portal-phase parameters significantly different before and after SBRT in resected tumors (p<.05). Among resected tumors, 22 arterial-phase parameters and 28 portal-phase parameters were significantly different after SBRT compared to baseline (p<.05).
Conclusion
Texture analysis of contrast-enhanced CT images can identify changes after SBRT in locally advanced tumors that could be predictive of resectability and R0 resection.
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{"status_url":"https:\/\/cslide.ctimeetingtech.com\/play\/aE22WM0hN\/status","status":20,"track_url":"https:\/\/cslide.ctimeetingtech.com\/play\/aE22WM0hN\/track","track":60,"provider":"CTI","provider_live":0,"type":1,"code":"aE22WM0hN"}
[session]
[presentation]
[presenter]
SS 3.8 - MR in the identification of mural nodules of intraductal papillary mucinous neoplasms of the pancreas
Presentation Number
SS 3.8
Channel
On-demand channel 4
Purpose
To evaluate the diagnostic accuracy of MRI with diffusion-weighted imaging (DWI) sequences in the identification of mural nodules in pancreatic intraductal papillary mucinous neoplasms (IPMN).
Material and methods
91 preoperative MRI scans with histopathological diagnosis of IPMN were reviewed by two radiologists. The following parameters were evaluated: presence, number and size of mural nodule, lesional signal intensity on T1-WI after contrast administration and on DWI (b 800 s/mm2), size of the cystic lesion and dilation of MPD. Each case was reviewed by two pathologists. They evaluated presence, number, size of papillary structures and the degree of epithelial dysplasia. Qualitative and quantitative analyses were performed. Inter-observer agreement was calculated.
Results
Statistically significant differences (p<0.0001) were found for the following correlation: presence of nodules >5mm and confirmation by pathological review, size and number of mural nodule evaluated on pathological review and the degree of dysplasia, size and number of mural nodule evaluated and tumoral dysplasia, presence of nodule >5mm with enhancement and hyperintensity on DWI and the degree of dysplasia, dilation of MPD and tumoral dysplasia. Interobserver agreement was moderate for the presence of mural nodule (K=0.56), the presence of high signal intensity on DWI (K=0.60) and enhancement of mural nodule (K= 0.58). Histogram analysis of ADC map showed a correlation between entropy of the entire cystic lesion and the degree of dysplasia (p<0.0001).
Conclusion
Dynamic MRI with DWI has good accuracy in the detection of IPMN mural nodule >5mm. DWI and T1-WI after contrast medium administration can be useful in the evaluation of malignancy of IPMN.
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{"status_url":"https:\/\/cslide.ctimeetingtech.com\/play\/7E22WM0bx\/status","status":20,"track_url":"https:\/\/cslide.ctimeetingtech.com\/play\/7E22WM0bx\/track","track":60,"provider":"CTI","provider_live":0,"type":1,"code":"7E22WM0bx"}
[session]
[presentation]
[presenter]
SS 3.10 - Prediction of early recurrence after surgery in patients with pancreatic neuroendocrine tumour using preoperative MRI
Presentation Number
SS 3.10
Channel
On-demand channel 4
Purpose
To investigate important MRI features for predicting early recurrence in patients with pancreatic neuroendocrine tumor (PNET) after surgery.
Material and methods
A total of 100 patients (mean age 55.8 years; M:F, 49:51) with PNET who underwent MRI and first-line surgery from 2000 to 2018 were included. Two radiologists independently assessed MRI findings including size, location, margin, T1- and T2-signal intensity, enhancement patterns, CBD and pancreatic duct dilatation, vascular invasion, LN enlargement, DWI, ADC value, retrospectively. Survival and clinicopathologic data including underlying disease, tumor grade, TNM stage, resection margin and postoperative complications were collected. Image findings associated with disease-free survival and overall survival were assessed with Kaplan-Meier survival analysis and multivariate Cox proportional hazard regression analysis.
Results
The mean disease-free survival and overall survival of the patients were 115.3 [96.8-133.9] and 130.0 [119.4-140.7] months, respectively. Among the variables, arterial iso- to hypo-enhancement, portal iso- to hypo-enhancement, ductal dilatation, arterial invasion, venous invasion, lymph node enlargement, larger tumor size and higher histologic grade showed significant early recurrence (p< 0.05) and poor overall survival (p< 0.05) in univariate analysis. In multivariate analysis, portal iso- to hypo-enhancement (HR 23.12 [2.72-196.4] (p=0.004)), ductal dilatation (HR 4.76 [1.13-19.95] (p=0.033)), arterial invasion (HR 72.13 [4.63-1123.31] (p=0.002)), venous invasion (HR 6.35 [1.80-22.43] (p=0.004)) and tumor size (HR 1.03 [1.00-1.07] (p=0.046)) showed significant effect on early recurrence. However, there was no significant variable for overall survival.
Conclusion
MRI features including size, enhancement pattern, vascular invasion and ductal dilatation are useful in predicting early recurrence after surgery in patients with PNET.
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[session]
[presentation]
[presenter]
