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European Radiology

, Volume 26, Issue 6, pp 1835–1842

First Online: 19 September 2015Received: 12 March 2015Revised: 25 August 2015Accepted: 02 September 2015


ObjectivesTo investigate whether changes to the apparent diffusion coefficient ADC of primary tumour in the early period after starting chemotherapy can predict progression-free survival PFS or overall survival OS in patients with unresectable pancreatic adenocarcinoma.

MethodsSubjects comprised 43 patients with histologically confirmed unresectable pancreatic cancer treated with first-line chemotherapy. Minimum ADC values in primary tumour were measured using the selected area ADC sADC, which excluded cystic and necrotic areas and vessels, and the whole tumour ADC wADC, which included whole tumour components. Relative changes in ADC were calculated from baseline to 4 weeks after initiation of chemotherapy. Relationships between ADC and both PFS and OS were modelled by Cox proportional hazards regression.

ResultsMedian PFS and OS were 6.1 and 11.0 months, respectively. In multivariate analysis, sADC change was the strongest predictor of PFS hazard ratio HR, 4.5; 95 % confidence interval CI, 1.7–11.9; p = 0.002. Multivariate Cox regression analysis for OS revealed sADC change and CRP as independent predictive markers, with sADC change as the strongest predictive biomarker HR, 6.7; 95 % CI, 2.7–16.6; p = 0.001.

ConclusionRelative changes in sADC could provide a useful imaging biomarker to predict PFS and OS with chemotherapy for unresectable pancreatic adenocarcinoma.

Key Points• Relative change in ADC value can predict survival in unresectable pancreatic cancer.

• ADC change could determine a chemosensitivity of pancreatic cancer.

• ADC values should be measured by excluding cystic, necrotic areas and vessels.

KeywordsPancreatic cancer Apparent diffusion coefficient Biomarker Prognostic factor MRI  Download fulltext PDF



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