Dynamic susceptibility contrast MRI in advanced pancreatic cancer: semi‐automated analysis to predict response to chemotherapy

The purpose of this study was to assess whether dynamic susceptibility contrast magnetic resonance imaging (DSC‐MRI) can predict response to chemotherapy in advanced pancreatic cancer. DSC‐MRI was performed using gradient‐echo echo‐planar imaging after bolus injection of contrast material. Fifty‐four patients with advanced pancreatic cancer who were scheduled for chemotherapy were enrolled. ΔR2* was calculated using semi‐automated computer analysis capable of tracking moving lesions during DSC‐MRI. Pre‐treatment maximum ΔR2* and clinical factors including gender, age, tumor stage (UICC III/IV), initial tumor size, and chemotherapy regimen were compared between patients with progressive disease and patients with stable disease as was determined at 3‐month follow‐up, and between patients with progressive disease and patients with stable disease as was determined at 6‐month follow‐up. Receiver operating characteristic (ROC) analysis and the Kaplan–Meier method with log‐rank test were used to assess the relationship between the pre‐treatment maximum ΔR2* and early progression (i.e. at 3‐month follow‐up). The pre‐treatment maximum ΔR2* of patients with disease progression at 3‐month follow‐up (10.68 ± 3.88 s^?1) was significantly different (p < 0.01) from that of patients with stable disease at 3‐month follow‐up (6.94 ± 3.12 s^?1). Pre‐treatment maximum ΔR2* of patients with disease progression at 6‐month follow‐up was not significantly different from that of patients with stable disease at 6‐month follow‐up, although a trend was noted (p = 0.08). Pre‐treatment clinical factors were not significantly different between progressive and stable patients at 3‐ and 6‐month follow‐up. Tumor progression rate was significantly higher in patients with a higher pre‐treatment maximum ΔR2* than in those with a lower pre‐treatment maximum ΔR2* (median progression time, 38 vs 138 days, p < 0.01, using a cut‐off value of 8.13 s^?1 as determined by ROC analysis). In conclusion, DSC‐MRI may predict early progression in patients with advanced pancreatic cancer undergoing chemotherapy. Copyright © 2009 John Wiley & Sons, Ltd.