Pilot study of rapid MR pancreas screening for patients with BRCA mutation

Abstract

Purpose: To develop and optimize a rapid magnetic resonance imaging (MRI) screening protocol for pancreatic cancer to be performed in conjunction with breast MRI screening in breast cancer susceptibility gene (BRCA)-positive individuals.

Methods: An IRB-approved prospective study was conducted. The rapid screening pancreatic MR protocol was designed to be less than 10 min to be performed after a standard breast MRI protocol. Protocol consisted of coronal NT T2 SSFSE, axial NT T2 SSFSE and axial NT rFOV FOCUS DWI, and axial T1. Images were acquired with the patient in the same prone position of breast MRI using the built-in body coil. Image quality was qualitatively assessed by two radiologists with 12 and 13 years of MRI experience, respectively. The imaging protocol was modified until an endpoint of five consecutive patients with high-quality diagnostic images were achieved. Signal-to-noise ratio and contrast-to-noise ratio were assessed.

Results: The rapid pancreas MR protocol was successfully completed in all patients. Diagnostic image quality was achieved for all patients. Excellent image quality was achieved for low b values; however, image quality at higher b values was more variable. In one patient, a pancreatic neuroendocrine tumor was found and the patient was treated surgically. In four patients, small pancreatic cystic lesions were detected. In one subject, a hepatic mass was identified and confirmed as adenoma by liver MRI.

Conclusion: Rapid MR protocol for pancreatic cancer screening is feasible and has the potential to play a role in screening BRCA patients undergoing breast MRI.

Key point: • Develop and optimize a rapid magnetic resonance imaging (MRI) screening protocol for pancreatic cancer to be performed in conjunction with breast MRI screening in BRCA mutation positive individuals.

Keywords: Breast cancer; Early detection of cancer; Magnetic resonance imaging; Pancreatic neoplasm; Screening.

Figure 1 -

A: Positioning of patient for rapid pancreas MRI screening protocol at the conclusion of the breast MRI examination. B: Demonstrating location of the built-in body coil within the bore of the magnet during the rapid pancreas MRI screening protocol rather than the surface coil. C: Usual positioning of patient for magnetic resonance cholangiopancreatography (MRCP) demonstrating placement of surface coil.

Figure 2-. ROI placement on DWI (b=50 s/mm²).

Circular ROIs are of 5 mm of diameter are placed respectively on pancreatic head (light blue, avoiding main duct) and on visceral fat (white) by 3 radiologists. Average signal intensity (SI) and standard deviation (SD) are recorded

Figure 3–. Selected images from subject 37.

Patient with a suspicious lesion of pancreatic head: women 42 yo, enrolled to this study. Evidence of mass of 1.5 cm in the pancreatic head demonstrated as brightly hyperintense on DWI axial images, b=50 s/mm² (A, white arrows) and intermediate b values, b=500 s/mm² (B, white arrows). Low value in ADC map (C, white arrows). The mass is seen as slightly hyperintense on T2weighted axial images (D, white arrows), and in T2weighted coronal images (E, white arrows). A subsequent CT of the abdomen confirmed the presence of a mass within the pancreatic head (F, axial CT pancreatic phase; and G coronal CT, pancreatic phase).

Figure 4–

A) Endoscopic ultrasound (EUS) guided- fine needle biopsy (FNA), Papanicolau stain (magnification 100 ×) demonstrate presence of neoplastic cells. B) Gross pathology of pancreatic specimen after a Whipple procedure was performed. Tumour is seen within the head of pancreas (oval white marker). C) H&E stain, Magnification 150×, showing a well differentiated pNET. The ki67 index was < 1%.

Figure 5–. Selected images from subject 3.

Woman, 79 years old. Selected T2 SSFSE axial (A) and rFOV DWI, b=500 s/mm² (B) images from rapid MR screening examination demonstrating pancreatic body cyst (white arrows), which was confirmed at diagnostic MRCP on (C) T2 SSFSE axial and (D) MRCP images.