Multiparametric PET/MR imaging biomarkers are associated with overall survival in patients with pancreatic cancer

  • Bang-Bin Chen
  • Yu-Wen Tien
  • Ming-Chu Chang
  • Mei-Fang Cheng
  • Yu-Ting Chang
  • Shih-Hung Yang
  • Chih-Horng Wu
  • Ting-Chun Kuo
  • I-Lun Shih
  • Ruoh-Fang Yen
  • Tiffany Ting-Fang Shih
Original Article



To correlate the overall survival (OS) with the imaging biomarkers of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy, and glucose metabolic activity derived from integrated fluorine 18 fluorodeoxyglucose positron emission tomography (18F–FDG PET)/MRI in patients with pancreatic cancer.


This prospective study was approved by the institutional review board and informed consent was obtained from all participants. Sixty-three consecutive patients (mean age, 62.7 ± 12 y; men/women, 40/23) with pancreatic cancer underwent PET/MRI before treatment. The imaging biomarkers were comprised of DCE-MRI parameters (peak, IAUC 60 , K trans , k ep , v e ), the minimum apparent diffusion coefficient (ADCmin), choline level, standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) of the tumors. The relationships between these imaging biomarkers with OS were evaluated with the Kaplan-Meier and Cox proportional hazard models.


Seventeen (27%) patients received curative surgery, with the median follow-up duration being 638 days. Univariate analysis showed that patients at a low TNM stage (≦3, P = 0.041), high peak (P = 0.006), high ADCmin (P = 0.002) and low TLG (P = 0.01) had better OS. Moreover, high TLG/peak ratio was associated with poor OS (P = 0.016). Multivariate analysis indicated that ADCmin (P = 0.011) and TLG/peak ratio (P = 0.006) were independent predictors of OS after adjustment for age, gender, tumor size, and TNM stage. The TLG/peak ratio was an independent predictor of OS in a subgroup of patients who did not receive curative surgery (P = 0.013).


The flow-metabolism mismatch reflected by the TLG/peak ratio may better predict OS than other imaging biomarkers from PET/MRI in pancreatic cancer patients.


PET/MR Pancreatic cancer Dynamic contrast-enhanced MRI Diffusion weighted MRI MR spectroscopy Overall survival 



The study is funded by National Taiwan University Hospital, Taipei, Taiwan: A1 project No. NTUH103-A124; Ministry of Science and Technology (MOST): No. 104–2314-B-002-080-MY3

Compliance with ethical standards

Conflict of interest


Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Bang-Bin Chen
    • 1
  • Yu-Wen Tien
    • 2
  • Ming-Chu Chang
    • 3
  • Mei-Fang Cheng
    • 4
  • Yu-Ting Chang
    • 3
  • Shih-Hung Yang
    • 5
  • Chih-Horng Wu
    • 1
  • Ting-Chun Kuo
    • 2
  • I-Lun Shih
    • 1
  • Ruoh-Fang Yen
    • 4
  • Tiffany Ting-Fang Shih
    • 1
  1. 1.Department of Medical Imaging and RadiologyNational Taiwan University College of Medicine and HospitalTaipeiTaiwan
  2. 2.Department of SurgeryNational Taiwan University College of Medicine and HospitalTaipeiTaiwan
  3. 3.Department of Internal MedicineNational Taiwan University College of Medicine and HospitalTaipeiTaiwan
  4. 4.Department of Nuclear Medicine and RadiologyNational Taiwan University College of Medicine and HospitalTaipeiTaiwan
  5. 5.Department of OncologyNational Taiwan University College of Medicine and HospitalTaipeiTaiwan

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