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British Journal of Radiology (2009) 82, 28-34
© 2009 British Institute of Radiology
doi: 10.1259/bjr/43911400
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British Journal of Radiology 82 (2009),28-34 ©2009 The British Institute of Radiology

Advanced pancreatic cancer: the use of the apparent diffusion coefficient to predict response to chemotherapy

T NIWA, MD 1 M UENO, MD 2 S OHKAWA, MD 2 T YOSHIDA, MD 1 T DOIUCHI, MD 1 K ITO, MD 1 and T INOUE, MD 3

Departments of 1 Radiology and, 2 Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Centre, 1-1-2 Nakao, Asahi-ku, Yokohama, 241-0815 and 3 Department of Radiology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

Correspondence: Tetsu Niwa, Department of Radiology, Kanagawa Children's Medical Centre, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan. E-mail: tniwa{at}kcmc.jp

The purpose of this study was to determine if the apparent diffusion coefficient (ADC) on diffusion-weighted MRI could predict the response of patients with advanced pancreatic cancer to chemotherapy. Diffusion-weighted MRI was performed in 63 consecutive patients with advanced pancreatic cancer who were subsequently treated with chemotherapy. The ADC values of the primary tumour with a middle b-value (400 s mm–2) and a high b-value (1000 s mm–2) were determined; cystic or necrotic components were avoided. The patients were classified into two groups: (i) those with progressive disease and (ii) those who were stable 3 months and 6 months after initial treatment. The groups were compared with respect to the ADC and clinical factors, including gender, age, Union International Contre le Cancer (UICC ) stage, initial tumour size and chemotherapy agents used. Local tumour progression rates were evaluated using the Kaplan–Meier method. The middle b-value ADC of the pancreatic cancers ranged from 0.93–2.42 x10–3 mm2 s–1 (mean, 1.50 x10–3 mm2 s–1), and the high b-value ADC ranged from 0.72–1.88 x10–3 mm2 s–1 (mean, 1.20 x10–3 mm2 s–1). The high b-value ADC was significantly different between the progressive and stable groups at 3 months' and 6 months' follow-up (p = 0.03 and p = 0.04, respectively). The rate of tumour progression was significantly higher in those with a lower high b-value ADC than in those with a higher b-value ADC (median progression time, 140 days vs 182 days; p = 0.01). In conclusion, a lower high b-value ADC in patients with advanced pancreatic cancer may be predictive of early progression in chemotherapy-treated patients.






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