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European Radiology

, Volume 29, Issue 1, pp 411–421 | Cite as

Apparent diffusion coefficient as a potential marker for tumour differentiation, staging and long-term clinical outcomes in gallbladder cancer

  • Ji Hye Min
  • Tae Wook KangEmail author
  • Dong Ik Cha
  • Seong Hyun Kim
  • Kyung Sook Shin
  • Jeong Eun Lee
  • Kee-Taek Jang
  • Soo Hyun Ahn
Gastrointestinal

Abstract

Objectives

To evaluate the correlation between tumour differentiation or stage of gallbladder cancer (GBC) and the apparent diffusion coefficient (ADC), as well as to assess whether ADC value can predict long-term disease-free survival (DFS) after surgery.

Methods

This retrospective study was approved by the institutional review board and the requirement for informed consent was waived. Between March 2008 and June 2016, 79 patients who underwent magnetic resonance (MR) imaging with diffusion-weighted image and subsequent surgery for GBC were included in this study. Correlations between quantitative ADC values and tumour differentiation or stage based on the American Joint Committee on Cancer (AJCC) were assessed using Spearman’s correlation analysis. Prognostic factors for DFS were identified with multivariate Cox regression analysis using imaging and clinical characteristics.

Results

All patients were classified as having well- (n = 18), moderately (n = 35) or poorly differentiated GBCs (n = 26). The ADC value of GBCs was significantly correlated with tumour differentiation and AJCC stage (p < 0.001 and p < 0.001, respectively). Sixty-nine patients were followed up for 2.0–92.4 months (median, 23.5 months). On multivariate analysis, the significant prognostic factor for DFS was not tumour differentiation or AJCC stage but a binary tumour ADC value (hazard ratio, 4.29; p = 0.009). DFS rates were significantly different according to the classification of tumour ADC value (cut-off value = 1.04 × 10−3 mm2/s; p = 0.004).

Conclusion

The ADC value of GBCs was significantly correlated with tumour differentiation as well as AJCC stage. In addition, it predicted long-term outcomes after surgery in patients with GBC.

Key points

• ADC values of GBC and tumour differentiation were negatively correlated.

• Lower ADC values of GBC were significantly correlated with higher tumour stage.

• Tumour ADC value could be useful for risk stratification of GBC patients.

Keywords

Gallbladder neoplasms Diffusion Magnetic resonance imaging Treatment outcome 

Abbreviations

ADC

Apparent diffusion coefficient

AJCC

American Joint Committee on Cancer

CI

Confidence interval

DFS

Disease-free survival

DWI

Diffusion-weighted imaging

GBC

Gallbladder cancer

HR

Hazard ratio

MR

Magnetic resonance

NCCN

National Comprehensive Cancer Network

PACS

Picture archiving and communication system

ROI

Region-of-interest

TNM

Tumour, node and metastasis

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Won Jae Lee.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Soo Hyun Ahn) has significant statistical expertise.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• Retrospective

• Prognostic study

• Performed at one institution

Supplementary material

330_2018_5602_MOESM1_ESM.docx (5.7 mb)
ESM 1 (DOCX 5792 kb)

References

  1. 1.
    Kanthan R, Senger JL, Ahmed S, Kanthan SC (2015) Gallbladder cancer in the 21st century. J Oncol 2015:967472CrossRefGoogle Scholar
  2. 2.
    Cubertafond P, Gainant A, Cucchiaro G (1994) Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey. Ann Surg 219:275–280CrossRefGoogle Scholar
  3. 3.
    Lim H, Seo DW, Park DH et al (2013) Prognostic factors in patients with gallbladder cancer after surgical resection: analysis of 279 operated patients. J Clin Gastroenterol 47:443–448CrossRefGoogle Scholar
  4. 4.
    Henson DE, Albores-Saavedra J, Corle D (1992) Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates. Cancer 70:1493–1497CrossRefGoogle Scholar
  5. 5.
    Bartlett DL (2000) Gallbladder cancer. Semin Surg Oncol 19:145–155CrossRefGoogle Scholar
  6. 6.
    Kayahara M, Nagakawa T, Nakagawara H, Kitagawa H, Ohta T (2008) Prognostic factors for gallbladder cancer in Japan. Ann Surg 248:807–814CrossRefGoogle Scholar
  7. 7.
    Alizadeh AA, Aranda V, Bardelli A et al (2015) Toward understanding and exploiting tumor heterogeneity. Nat Med 21:846–853CrossRefGoogle Scholar
  8. 8.
    Kim M, Kang TW, Kim YK et al (2016) Pancreatic neuroendocrine tumour: Correlation of apparent diffusion coefficient or WHO classification with recurrence-free survival. Eur J Radiol 85:680–687CrossRefGoogle Scholar
  9. 9.
    Jang KM, Kim SH, Lee SJ, Choi D (2014) The value of gadoxetic acid-enhanced and diffusion-weighted MRI for prediction of grading of pancreatic neuroendocrine tumors. Acta Radiol 55:140–148CrossRefGoogle Scholar
  10. 10.
    Kang TW, Kim SH, Jang KM et al (2015) Gastrointestinal stromal tumours: correlation of modified NIH risk stratification with diffusion-weighted MR imaging as an imaging biomarker. Eur J Radiol 84:33–40CrossRefGoogle Scholar
  11. 11.
    Akashi M, Nakahusa Y, Yakabe T et al (2014) Assessment of aggressiveness of rectal cancer using 3-T MRI: correlation between the apparent diffusion coefficient as a potential imaging biomarker and histologic prognostic factors. Acta Radiol 55:524–531CrossRefGoogle Scholar
  12. 12.
    Shankar S, Kalra N, Bhatia A et al (2016) Role of diffusion weighted imaging (DWI) for hepatocellular carcinoma (HCC) detection and its grading on 3T MRI: a prospective study. J Clin Exp Hepatol 6:303–310CrossRefGoogle Scholar
  13. 13.
    Irie H, Kamochi N, Nojiri J, Egashira Y, Sasaguri K, Kudo S (2011) High b-value diffusion-weighted MRI in differentiation between benign and malignant polypoid gallbladder lesions. Acta Radiol 52:236–240CrossRefGoogle Scholar
  14. 14.
    Lee NK, Kim S, Kim TU, Kim DU, Seo HI, Jeon TY (2014) Diffusion-weighted MRI for differentiation of benign from malignant lesions in the gallbladder. Clin Radiol 69:e78–e85CrossRefGoogle Scholar
  15. 15.
    Lee NK, Kim S, Moon JI et al (2016) Diffusion-weighted magnetic resonance imaging of gallbladder adenocarcinoma: analysis with emphasis on histologic grade. Clin Imaging 40:345–351CrossRefGoogle Scholar
  16. 16.
    Kang TW, Kim SH, Park HJ et al (2013) Differentiating xanthogranulomatous cholecystitis from wall-thickening type of gallbladder cancer: added value of diffusion-weighted MRI. Clin Radiol 68:992–1001CrossRefGoogle Scholar
  17. 17.
    Kim SJ, Lee JM, Kim H, Yoon JH, Han JK, Choi BI (2013) Role of diffusion-weighted magnetic resonance imaging in the diagnosis of gallbladder cancer. J Magn Reson Imaging 38:127–137CrossRefGoogle Scholar
  18. 18.
    Kang TW, Rhim H, Lee J et al (2016) Magnetic resonance imaging with gadoxetic acid for local tumour progression after radiofrequency ablation in patients with hepatocellular carcinoma. Eur Radiol 26:3437–3446CrossRefGoogle Scholar
  19. 19.
    Hwang JA, Kang TW, Kim YK et al (2017) Association between non-hypervascular hypointense nodules on gadoxetic acid-enhanced MRI and liver stiffness or hepatocellular carcinoma. Eur J Radiol 95:362–369CrossRefGoogle Scholar
  20. 20.
    Haradome H, Grazioli L, Tsunoo M et al (2010) Can MR fluoroscopic triggering technique and slow rate injection provide appropriate arterial phase images with reducing artifacts on gadoxetic acid-DTPA (Gd-EOB-DTPA)-enhanced hepatic MR imaging? J Magn Reson Imaging 32:334–340CrossRefGoogle Scholar
  21. 21.
    Chun KA, Ha HK, Yu ES et al (1997) Xanthogranulomatous cholecystitis: CT features with emphasis on differentiation from gallbladder carcinoma. Radiology 203:93–97CrossRefGoogle Scholar
  22. 22.
    Kim SJ, Lee JM, Lee ES, Han JK, Choi BI (2015) Preoperative staging of gallbladder carcinoma using biliary MR imaging. J Magn Reson Imaging 41:314–321CrossRefGoogle Scholar
  23. 23.
    Levy AD, Murakata LA, Rohrmann CA Jr (2001) Gallbladder carcinoma: radiologic-pathologic correlation. Radiographics 21:295-314; questionnaire, 549-255Google Scholar
  24. 24.
    Shirai Y, Sakata J, Wakai T, Ohashi T, Hatakeyama K (2012) “Extended” radical cholecystectomy for gallbladder cancer: long-term outcomes, indications and limitations. World J Gastroenterol 18:4736–4743CrossRefGoogle Scholar
  25. 25.
    Fluss R, Faraggi D, Reiser B (2005) Estimation of the Youden index and its associated cutoff point. Biom J 47:458–472CrossRefGoogle Scholar
  26. 26.
    Sun Y, Tong T, Cai S, Bi R, Xin C, Gu Y (2014) Apparent diffusion coefficient (ADC) value: a potential imaging biomarker that reflects the biological features of rectal cancer. PLoS One 9:e109371CrossRefGoogle Scholar
  27. 27.
    Murakami Y, Uemura K, Sudo T et al (2011) Prognostic factors of patients with advanced gallbladder carcinoma following aggressive surgical resection. J Gastrointest Surg 15:1007–1016CrossRefGoogle Scholar
  28. 28.
    Takada T, Amano H, Yasuda H et al (2002) Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomised controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer 95:1685–1695CrossRefGoogle Scholar
  29. 29.
    Mantripragada KC, Hamid F, Shafqat H, Olszewski AJ (2016) Adjuvant therapy for resected gallbladder cancer: analysis of the National Cancer Data Base. J Natl Cancer Inst 109  https://doi.org/10.1093/jnci/djw202

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Ji Hye Min
    • 1
    • 2
  • Tae Wook Kang
    • 1
    Email author
  • Dong Ik Cha
    • 1
  • Seong Hyun Kim
    • 1
  • Kyung Sook Shin
    • 2
  • Jeong Eun Lee
    • 2
  • Kee-Taek Jang
    • 3
  • Soo Hyun Ahn
    • 4
  1. 1.Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiology, Chungnam National University HospitalChungnam National University College of MedicineDaejeonRepublic of Korea
  3. 3.Department of Pathology and Translational Genomics, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  4. 4.Department of MathematicsAjou UniversitySuwonRepublic of Korea

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