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Open AccessArticle

Diffusion Kurtosis Imaging—A Superior Approach to Assess Tumor–Stroma Ratio in Pancreatic Ductal Adenocarcinoma

1
Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
2
Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
3
Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
4
Clinical Pathology, Klinikum Darmstadt GmbH, 64283 Darmstadt, Germany
5
Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
6
Institute of Pathology, University Medical Center Mainz, JGU-Mainz, 55131 Mainz, Germany
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(6), 1656; https://doi.org/10.3390/cancers12061656
Received: 27 April 2020 / Revised: 31 May 2020 / Accepted: 18 June 2020 / Published: 22 June 2020
(This article belongs to the Special Issue A Special Issue on Tumor Stroma )
Extensive desmoplastic stroma is a hallmark of pancreatic ductal adenocarcinoma (PDAC) and contributes to tumor progression and to the relative resistance of tumor cells towards (radio) chemotherapy. Thus, therapies that target the stroma are under intense investigation. To allow the stratification of patients who would profit from such therapies, non-invasive methods assessing the stroma content in relation to tumor mass are required. In the current prospective study, we investigated the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI), a radiologic method that measures the random motion of water molecules in tissue, in the assessment of PDAC lesions, and more specifically in the desmoplastic tumor stroma. We made use of a sophisticated DW-MRI approach, the so-called diffusion kurtosis imaging (DKI), which possesses potential advantages over conventional and widely used monoexponential diffusion-weighted imaging analysis (cDWI). We found that the diffusion constant D from DKI is highly negatively correlated with the percentage of tumor stroma, the latter determined by histology. D performed significantly better than the widely used apparent diffusion coefficient (ADC) from cDWI in distinguishing stroma-rich (>50% stroma percentage) from stroma-poor tumors (≤50% stroma percentage). Moreover, we could prove the potential of the diffusion constant D as a clinically useful imaging parameter for the differentiation of PDAC-lesions from non-neoplastic pancreatic parenchyma. Therefore, the diffusion constant D from DKI could represent a valuable non-invasive imaging biomarker for assessment of stroma content in PDAC, which is applicable for the clinical diagnostic of PDAC. View Full-Text
Keywords: pancreatic cancer; diffusion-weighted magnetic resonance imaging; diffusion kurtosis imaging pancreatic cancer; diffusion-weighted magnetic resonance imaging; diffusion kurtosis imaging
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MDPI and ACS Style

Mayer, P.; Jiang, Y.; Kuder, T.A.; Bergmann, F.; Khristenko, E.; Steinle, V.; Kaiser, J.; Hackert, T.; Kauczor, H.-U.; Klauß, M.; Gaida, M.M. Diffusion Kurtosis Imaging—A Superior Approach to Assess Tumor–Stroma Ratio in Pancreatic Ductal Adenocarcinoma. Cancers 2020, 12, 1656.

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