Work

MRI-derived extracellular volume fraction as a prognostic biomarker for early recurrence after R0 resection of pancreatic ductal adenocarcinoma

Year: 2025

Type: article

Abstract: Objectives Pancreatic ductal adenocarcinoma (PDAC) has a high recurrence risk after R0 resection. This study aimed to evaluate the prognostic value of preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) pharmacokinetic parameters, including volume transfer constant (K trans ), rate constant (k ep ), extracellular extravascular volume fraction (v e ), and MRI-derived extracellular volume (ECV) fraction, for predicting early recurrence and survival after surgery. Methods In this retrospective cohort study, 61 patients (mean age 60.7 ± 9.7 years; 35 males) with histologically confirmed PDAC underwent preoperative 3 T MRI between January 2017 and May 2024, including DCE-MRI and dual-time-point T1 mapping. Two radiologists independently measured K trans , k ep , v e , and ECV. Inter-observer agreement (ICC), associations with pathological features, and prognostic value for recurrence-free survival (RFS) and overall survival (OS) were analyzed using Cox regression, Kaplan–Meier analysis with log-rank tests, and time-dependent ROC curves. Results ECV demonstrated excellent reproducibility (ICC = 0.99) and independently predicted shorter RFS (HR = 1.020; 95 % CI: 1.003–1.038; p = 0.022). An optimal ECV cutoff of 31.99 % effectively stratified patients into high- and low-risk groups with significantly different median RFS (10.9 vs. 17.4 months, p = 0.012). However, other DCE-MRI parameters (K trans , k ep , v e ) showed poor reproducibility and lacked independent prognostic value for RFS or OS. Conclusion MRI-derived tumor ECV is a robust, reproducible biomarker for predicting early recurrence after R0 resection in PDAC patients, potentially assisting in preoperative risk stratification.

Source: European Journal of Radiology Open

DOI: 10.1016/j.ejro.2025.100711