Special Issue "Advances in Pancreatic Cancer Imaging"

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 January 2022.

Special Issue Editor

Dr. Masakatsu Tsurusaki
E-Mail Website
Guest Editor
Department of Radiology, Kindai University, Faculty of Medicine, 377-2 Ohnohigashi, Osaka-sayama, Osaka 589-8511, Japan
Interests: hepatobiliary imaging; MR; CT; ultrasound; liver cancer; pancreatic cancer

Special Issue Information

Dear Colleagues,

Pancreatic cancer is the fourth most common cause of cancer-related deaths in developed countries. To improve outcomes, there is a critical need for improved tools for detection, accurate staging, and resectability assessment. This could improve patient stratification for the most optimal primary treatment modality. Current clinical imaging protocols of pancreatic cancer include transabdominal ultrasound, computed tomography (CT) and/or magnetic resonance (MR) imaging for disease staging and prediction of resectability. Currently, multidetector CT is the technique of choice for the study of pancreatic tumors. On the other hands, MR imaging plays an important role in the assessment of pancreatic cancer. Its superior soft tissue contrast is useful in the detection of small, non-contour-deforming tumors and for characterizing indeterminate pancreatic findings at computed tomography. Such techniques may include magnetic resonance imaging with diffusion-weighted sequences or hepatobiliary contrast agents, perfusion imaging, or molecular imaging with radiolabelled tracers. Endoscopic ultrasound (EUS) can complement these imaging methods with valuable staging information as well as the opportunity of tissue diagnosis by fine-needle aspiration. Molecular functional imaging has the potential to play an important role in pancreatic cancer management.

This Special Issue of Cancers will cover state-of-the-art and future developments in clinical imaging of pancreatic cancer. We are inviting original research articles, reviews, and perspectives, to address some of these challenges for imaging of pancreatic cancer. We hope to discuss their current application to the management of patients with pancreatic cancer, and anticipate future developments within this field.

Dr. Masakatsu Tsurusaki
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hepatobiliary cancer
  • imaging
  • early diagnosis
  • CT/ MRI
  • preoperative imaging
  • tumor grading/heterogeneity
  • tumor progression
  • post-therapeutic changes
  • treatment response

Published Papers (7 papers)

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Research

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Article
Impact of FAPI-PET/CT on Target Volume Definition in Radiation Therapy of Locally Recurrent Pancreatic Cancer
Cancers 2021, 13(4), 796; https://doi.org/10.3390/cancers13040796 - 14 Feb 2021
Cited by 3 | Viewed by 573
Abstract
(1) Background: A new radioactive positron emission tomography (PET) tracer uses inhibitors of fibroblast activation protein (FAPI) to visualize FAP-expressing cancer associated fibroblasts. Significant FAPI-uptake has recently been demonstrated in pancreatic cancer patients. Target volume delineation for radiation therapy still relies on often [...] Read more.
(1) Background: A new radioactive positron emission tomography (PET) tracer uses inhibitors of fibroblast activation protein (FAPI) to visualize FAP-expressing cancer associated fibroblasts. Significant FAPI-uptake has recently been demonstrated in pancreatic cancer patients. Target volume delineation for radiation therapy still relies on often less precise conventional computed tomography (CT) imaging, especially in locally recurrent pancreatic cancer patients. The need for improvement in precise tumor detection and delineation led us to innovatively use the novel FAPI-PET/CT for radiation treatment planning. (2) Methods: Gross tumor volumes (GTVs) of seven locally recurrent pancreatic cancer cases were contoured by six radiation oncologists. In addition, FAPI-PET/CT was used to automatically delineate tumors. The interobserver variability in target definition was analyzed and FAPI-based automatic GTVs were compared to the manually defined GTVs. (3) Results: Target definition differed significantly between different radiation oncologists with mean dice similarity coefficients (DSCs) between 0.55 and 0.65. There was no significant difference between the volumes of automatic FAPI-GTVs based on the threshold of 2.0 and most of the manually contoured GTVs by radiation oncologists. (4) Conclusion: Due to its high tumor to background contrast, FAPI-PET/CT seems to be a superior imaging modality compared to the current gold standard contrast-enhanced CT in pancreatic cancer. For the first time, we demonstrate how FAPI-PET/CT could facilitate target definition and increases consistency in radiation oncology in pancreatic cancer. Full article
(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)
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Article
Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy?
Cancers 2020, 12(10), 2814; https://doi.org/10.3390/cancers12102814 - 30 Sep 2020
Viewed by 477
Abstract
(1) Background: preoperative biliary drainage before pancreaticoduodenectomy (PD) is associated with bacterial biliary contamination (>85%) and a significant increase in global and infectious complications. In view of the lack of published data, the aim of our study was to investigate the impact of [...] Read more.
(1) Background: preoperative biliary drainage before pancreaticoduodenectomy (PD) is associated with bacterial biliary contamination (>85%) and a significant increase in global and infectious complications. In view of the lack of published data, the aim of our study was to investigate the impact of fungal biliary contamination after biliary drainage on the complication rate after PD. (2) Methods: a multicentric retrospective study that included 224 patients who underwent PD after biliary drainage with intraoperative biliary culture. (3) Results: the global rate of positive intraoperative biliary sample was 92%. Respectively, the global rate of biliary bacterial contamination and the rate of fungal contamination were 75% and 25%, making it possible to identify two subgroups: bacterial contamination only (B+, n = 154), and bacterial and fungal contamination (BF+, n = 52). An extended duration of preoperative drainage (62 vs. 49 days; p = 0.08) increased the risk of fungal contamination. The overall and infectious complication rates were not different between the two groups. In the event of postoperative infectious or surgical complications, the infectious samples taken did not reveal more fungal infections in the BF+ group. (4) Conclusions: fungal biliary contamination, although frequent, does not seem to increase the rate of global and infectious complications after PD, preceded by preoperative biliary drainage. Full article
(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)
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Article
Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or following Pancreatic Surgery
Cancers 2020, 12(10), 2733; https://doi.org/10.3390/cancers12102733 - 23 Sep 2020
Cited by 1 | Viewed by 619 | Correction
Abstract
Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy. Materials and Methods: This retrospective study included 42 consecutive patients (38 males and 4 females; mean [...] Read more.
Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy. Materials and Methods: This retrospective study included 42 consecutive patients (38 males and 4 females; mean age, 60 years; range, 33–80 years) who underwent TAE for bleeding visceral artery pseudoaneurysms between March 2004 and December 2018. The technical and clinical success rates, incidence of recurrent bleeding and complications, including pancreatitis, were evaluated. Results: Of the 42 enrolled patients, 23 had bleeding due to a complication of pancreatectomy and 19 had bleeding as a complication of pancreatitis. TAE with N-butyl cyanoacrylate (NBCA) or NBCA plus microcoils recurrent bleeding or inability to control bleeding was 15.8% (3 of 19) following TAE with NBCA and 17.4% (4 of 23) following TAE with coils. No clinically significant ischemic events of the pancreas or duodenum were observed in the embolized areas. Serum amylase did not increase compared with the initial levels after any of the procedures. At 30 days after TAE, 32 patients were alive. Conclusion: TAE has a high success rate for the management of hemorrhage, with few complications. The procedure appears to be safe and effective for pseudoaneurysms associated with either pancreatitis or pancreatectomy. Full article
(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)
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Article
Assessment of Liver Metastases Using CT and MRI Scans in Patients with Pancreatic Ductal Adenocarcinoma: Effects of Observer Experience on Diagnostic Accuracy
Cancers 2020, 12(6), 1455; https://doi.org/10.3390/cancers12061455 - 03 Jun 2020
Cited by 2 | Viewed by 689
Abstract
The aim of this study was to investigate the impact of radiologic experience on the diagnostic accuracy of computed tomography (CT) vs. magnetic resonance imaging (MRI) reporting on the liver metastases of pancreatic ductal adenocarcinoma (LM of PDAC). Intra-individual CT and MRI examinations [...] Read more.
The aim of this study was to investigate the impact of radiologic experience on the diagnostic accuracy of computed tomography (CT) vs. magnetic resonance imaging (MRI) reporting on the liver metastases of pancreatic ductal adenocarcinoma (LM of PDAC). Intra-individual CT and MRI examinations of 112 patients with clinically proven LM of PDAC were included. Four radiologists with varying years of experience (A > 20, B > 5, C > 1 and D < 1) assessed liver segments affected by LM of PDAC, as well as associated metastases occurring in each patient. Their sensitivity and specificity in evaluating the segments were compared. Cohen’s Kappa (κ) for diagnosed liver segments and Intra-class Correlation Coefficients (ICC) for the number of metastatic lesions in each patient were calculated. The radiologists’ sensitivity and specificity for the CT vs. MRI were, respectively: Reader A—94.4%, 90.3% vs. 96.6%, 94.8%; B—86.7%, 79.7% vs. 83.9%, 82.0%; C—78.0%, 76.7% vs. 83.3%, 78.9% and D—71.8%, 79.2% vs. 64.0%, 69.5%. Reviewers A and B achieved greater agreement in assessing results from the MRI (κ = 0.72, p < 0.001; ICC = 0.73, p < 0.001) vs. the CT (κ = 0.58, p < 0.001; ICC = 0.61, p < 0.001), in contrast to readers C and D (MRI: κ = 0.34, p < 0.001; ICC = 0.42, p < 0.001, and CT: κ = 0.48, p < 0.001; ICC = 0.59, p < 0.001). Our results indicate that the accurate diagnosis of LM of PDAC depends more on radiologic experience in MRI over CT scans. Full article
(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)
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Review

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Review
Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma
Cancers 2021, 13(5), 945; https://doi.org/10.3390/cancers13050945 - 24 Feb 2021
Viewed by 599
Abstract
Pancreatic ductal adenocarcinoma (PDAC) arises from precursor lesions, such as pancreatic intra-epithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN). The prognosis of high-grade precancerous lesions, including high-grade PanIN and high-grade IPMN, without invasive carcinoma is good, despite the overall poor prognosis of [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) arises from precursor lesions, such as pancreatic intra-epithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN). The prognosis of high-grade precancerous lesions, including high-grade PanIN and high-grade IPMN, without invasive carcinoma is good, despite the overall poor prognosis of PDAC. High-grade PanIN, as a lesion preceding invasive PDAC, is therefore a primary target for intervention. However, detection of localized high-grade PanIN is difficult when using standard radiological approaches. Therefore, most studies of high-grade PanIN have been conducted using specimens that harbor invasive PDAC. Recently, imaging characteristics of high-grade PanIN have been revealed. Obstruction of the pancreatic duct due to high-grade PanIN may induce a loss of acinar cells replaced by fibrosis and lobular parenchymal atrophy. These changes and additional inflammation around the branch pancreatic ducts (BPDs) result in main pancreatic duct (MPD) stenosis, dilation, retention cysts (BPD dilation), focal pancreatic parenchymal atrophy, and/or hypoechoic changes around the MPD. These indirect imaging findings have become important clues for localized, high-grade PanIN detection. To obtain pre-operative histopathological confirmation of suspected cases, serial pancreatic-juice aspiration cytologic examination is effective. In this review, we outline current knowledge on imaging characteristics of high-grade PanIN. Full article
(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)
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Other

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Correction
Correction: Isao N., et al. Transcatheter Arterial Embolization Treatment for Bleeding Visceral Artery Pseudoaneurysms in Patients with Pancreatitis or Following Pancreatic Surgery. Cancers 2020, 12, 2733
Cancers 2021, 13(6), 1312; https://doi.org/10.3390/cancers13061312 - 15 Mar 2021
Viewed by 396
Abstract
The authors are sorry to report that the overall survival reported in their recently published paper was incorrect [...] Full article
(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)
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Systematic Review
Comparison of the Diagnostic Efficiency of Radial- and Convex-Arrayed Echoendoscopes for Indirect Findings of Pancreatic Cancer: A Retrospective Comparative Study Using Propensity Score Method
Cancers 2021, 13(6), 1217; https://doi.org/10.3390/cancers13061217 - 11 Mar 2021
Viewed by 507
Abstract
Endoscopic ultrasonography (EUS) is useful for detecting early-stage pancreatic cancer. Because the detection of small lesions is difficult, it is important to detect indirect findings, namely caliber change, retention cysts, and dilatation of the branch duct, during the procedure. Although two types of [...] Read more.
Endoscopic ultrasonography (EUS) is useful for detecting early-stage pancreatic cancer. Because the detection of small lesions is difficult, it is important to detect indirect findings, namely caliber change, retention cysts, and dilatation of the branch duct, during the procedure. Although two types of EUS endoscopes are frequently used, there is no comparative study on their efficacy for detecting indirect findings. Therefore, we aimed to compare the diagnostic efficacy of these two types for indirect findings. We retrospectively analyzed 316 consecutive patients who had undergone EUS for pancreaticobiliary disease at a single center between January 2017 and December 2018. The main outcome was the detection rate of indirect findings and its comparison between the two echoendoscope types. This outcome was achieved using the inverse probability of treatment weighting (IPTW) analysis. The detection rate of indirect findings was higher for the radial-arrayed endoscope than for the convex-arrayed echoendoscope (9.2% vs. 2.3% (p = 0.02)). The univariate analysis also revealed that the radial-arrayed echoendoscope was significantly superior to the convex-arrayed echoendoscope in terms of the detection of indirect findings (odds ratio, 5.94; 95% confidence interval, 1.68–21.10; p = 0.01) after IPTW. After adjustment for magnetic resonance imaging (MRI) and computed tomography (CT), radial-arrayed echoendoscope remained an independent factor for indirect finding detection (odds ratio, 6.04; 95% confidence interval, 1.74–21.00; p = 0.01). Finally, five patients who had indirect EUS findings were diagnosed with pancreatic cancer. Our results indicate that the radial-arrayed echoendoscope is useful for the detection of indirect findings. Full article
(This article belongs to the Special Issue Advances in Pancreatic Cancer Imaging)
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