Pancreatic Intraepithelial Neoplasia Revealed by Diffusion-Tensor MRI.

IF 7 1区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Investigative Radiology Pub Date : 2024-12-13 DOI:10.1097/RLI.0000000000001142
Carlos Bilreiro, Francisca F Fernandes, Rui V Simões, Rafael Henriques, Cristina Chavarrías, Andrada Ianus, Mireia Castillo-Martin, Tânia Carvalho, Celso Matos, Noam Shemesh
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Abstract

Objectives: Detecting premalignant lesions for pancreatic ductal adenocarcinoma, mainly pancreatic intraepithelial neoplasia (PanIN), is critical for early diagnosis and for understanding PanIN biology. Based on PanIN's histology, we hypothesized that diffusion tensor imaging (DTI) and T2* could detect PanIN.

Materials and methods: DTI was explored for the detection and characterization of PanIN in genetically engineered mice (KC, KPC). Following in vivo DTI, ex vivo ultrahigh-field (16.4 T) MR microscopy using DTI, T2* was performed with histological validation. Sources of MR contrasts and histological features were investigated, including histological scoring for disease burden (lesion span) and severity (adjusted score). To test if findings in mice can be translated to humans, human pancreas specimens were imaged.

Results: DTI detected PanIN and pancreatic ductal adenocarcinoma in vivo (6 KPC, 4 KC, 6 controls) with high discriminative ability: fractional anisotropy (FA) and radial diffusivity with area under the curve = 0.983 (95% confidence interval: 0.932-1.000); mean diffusivity and axial diffusivity (AD) with area under the curve = 1 (95% confidence interval: 1.000-1.000). MR microscopy with histological correlation (20 KC/KPC; 5 controls) revealed that sources of MR contrasts likely arise from microarchitectural signatures: high FA, AD in fibrotic areas surrounding lesions, high diffusivities within cysts, and high T2* within lesions' stroma. The strongest histological correlations for lesion span and adjusted score were obtained with AD (R = 0.708, P < 0.001; R = 0.789, P < 0.001, respectively). Ex vivo observations in 5 human pancreases matched our findings in mice, revealing substantial contrast between PanIN and normal pancreas.

Conclusions: DTI and T2* are useful for detecting and characterizing PanIN in genetically engineered mice and in the human pancreas, especially with AD and FA. These are encouraging findings for future clinical applications of pancreatic imaging.

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扩散张量MRI显示胰腺上皮内瘤变。
目的:检测胰腺导管腺癌,主要是胰腺上皮内瘤变(PanIN)的癌前病变,对早期诊断和了解PanIN生物学至关重要。基于PanIN的组织学特征,我们假设弥散张量成像(DTI)和T2*可以检测PanIN。材料与方法:采用DTI法对基因工程小鼠(KC, KPC)的PanIN进行检测和表征。在体内DTI后,使用DTI进行离体超高场(16.4 T) MR显微镜,T2*进行组织学验证。研究了MR对比的来源和组织学特征,包括疾病负担(病变范围)和严重程度(调整评分)的组织学评分。为了检验在老鼠身上的发现是否也适用于人类,研究人员对人类胰腺标本进行了成像。结果:DTI检出体内PanIN和胰腺导管腺癌(6例KPC, 4例KC, 6例对照),鉴别能力强:分数各向异性(FA)和径向扩散率曲线下面积= 0.983(95%可信区间:0.932-1.000);平均扩散系数和轴向扩散系数(AD),曲线下面积= 1(95%置信区间:1.000-1.000)。MR显微镜组织学相关性(20 KC/KPC;5例对照)显示MR对比的来源可能来自微结构特征:高FA,病变周围纤维化区域的AD,囊肿内高弥漫性,病变间质内高T2*。病变范围和调整评分与AD的组织学相关性最强(R = 0.708, P < 0.001;R = 0.789, P < 0.001)。在5个人类胰腺中的离体观察结果与我们在小鼠中的发现相吻合,揭示了PanIN与正常胰腺之间的实质性差异。结论:DTI和T2*可用于基因工程小鼠和人胰腺中PanIN的检测和表征,尤其是AD和FA。这些发现对未来胰腺影像学的临床应用具有鼓舞人心的意义。
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来源期刊
Investigative Radiology
Investigative Radiology 医学-核医学
CiteScore
15.10
自引率
16.40%
发文量
188
审稿时长
4-8 weeks
期刊介绍: Investigative Radiology publishes original, peer-reviewed reports on clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, and related modalities. Emphasis is on early and timely publication. Primarily research-oriented, the journal also includes a wide variety of features of interest to clinical radiologists.
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