Evaluation of the FOCUS Diffusion's Added Clinical Value Compared to Conventional MRI

Cancer of Pancreas Clinical Trial

Official title:

Evaluation of the FOCUS Diffusion's Added Clinical Value Compared to Conventional MRI With Wide Field View Diffusion in Focal Pancreatic Lesions Characterization

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03961646
• Other study ID #: Diffusion Focus
• Status: Completed
• Start date: February 1, 2019
• Est. completion date: December 31, 2020

Study information

• Verified date: April 2023
• Source: Groupe Hospitalier Paris Saint Joseph
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The radiologist plays a key role in the management of pancreatic tumours, which are potentially serious.

While the scanner, with its high spatial resolution, plays a major role in pancreatic pathology, and in particular in the assessment of operability, MRI, with its good contrast resolution, has proven its contribution to the detection and characterization of focal lesions.

Each MRI examination consists of several series of images called sequences, each with its own particularity, to highlight different types of abnormalities such as edema, bleeding, tumor content or vascularization. All the sequences performed constitute a "protocol". The diffusion sequence is a technology that allows the microscopic random movements of water molecules to be translated into images. It thus makes it possible to differentiate between certain aggressive tumours which are characterised by a higher cell density than healthy tissue, in which water molecules do not circulate freely, benign lesions such as cysts in which the circulation of water molecules is not hindered. The calculation of the Apparent Diffusion Coefficient (ADC), an estimate of the diffusion rate of water molecules, is a quantitative diagnostic tool validated in many fields of application and in particular in oncology.

Description:

This diffusion sequence has shown its usefulness in pancreatic pathology in the detection and characterization of focal pancreatic lesions, particularly for neuroendocrine tumors, the evaluation of chronic and autoimmune pancreatitis or the early detection of malignant transformation of certain high-risk cystic lesions. The diffusion sequence usually performed is called "wide field" because it covers the entire abdomen. The radiologist can thus analyse the neighbouring organs and in particular the liver, which makes it essential when a pancreatic tumour is suspected because of the risk of liver metastases.

This wide-field sequence suffers from several limitations: difficulty in differentiating adenocarcinomas from chronic pseudo-mass pancreatitis due to the overlap of CDA values and difficulty in defining the boundaries of cephalic or corporal adenocarcinomas due to the hypersignal of upstream chronic obstructive pancreatitis (9)(10). Technically, it is subject to movement artifacts related to respiration, adjacent organs and in particular the duodenum, and to an average spatial resolution of the pancreas.

Over the last 10 years, a diffusion sequence called "FOCUS" has been developed allowing a reduction of the field of view in the direction of phase coding and therefore a "zoomed" image with higher resolution. This sequence has shown interest in neuroradiology and prostate cancer detection in reducing artifacts and achieving better spatial resolution than the usual "wide field" diffusion sequence. 3 minutes and 30 seconds more are required to complete this sequence.

The pancreas is a good candidate for FOCUS diffusion imaging because of its small size, susceptibility to movement artifacts and spatial orientation, allowing antero-posterior reduction of the field of view. Initial work has established the feasibility of this FOCUS diffusion in pancreatic imaging and shown an improvement in image quality (more accurate and less artefacts) in FOCUS diffusion compared to the usual "wide field".

Due to its potential in pancreatic imaging, the FOCUS diffusion sequence has been performed in current practice since 2014 in the imaging department of the Groupe Hospitalier Paris Saint-Joseph (GHPSJ) in addition to the "wide field" diffusion sequence. The protocol thus created is called "combined protocol" as opposed to "standard protocol" which does not contain the FOCUS broadcast sequence.

Kim H et al showed an improvement in the subjective clinical utility of readers in the diagnosis of benign or malignant pancreatic lesions. However, it should be noted that in this study the authors compared the two sequences by opposing them rather than comparing the usual wide-field sequence with the combination of the two sequences.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 74
• Est. completion date: December 31, 2020
• Est. primary completion date: December 31, 2019
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Male or female whose age = 18 years old (Adult patient)

• Francophone patient

• Pancreatic MRI performed at the GHPSJ on 3 Tesla MRI between September 2014 (date of introduction of the FOCUS diffusion sequence) and April 2018

• Presence of at least one proven benign or malignant focal pancreatic lesion visible on at least one of the MRI sequences

Exclusion Criteria:

• Patient under guardianship or curatorship

• Patient deprived of liberty

• Patient objecting to the use of their data for this research

• Papillary and mucinous intra-channel tumour of pancreas (TIPMP) of secondary channels measuring less than 30mm.

Related Conditions & MeSH terms

• Cancer of Pancreas
• Pancreatic Neoplasms

Locations

Country	Name	City	State
France	Groupe Hospitalier Paris Saint-Joseph	Paris

Sponsors (1)

Lead Sponsor	Collaborator
Groupe Hospitalier Paris Saint Joseph

Country where clinical trial is conducted

France, 

References & Publications (17)

Andre JB, Zaharchuk G, Saritas E, Komakula S, Shankaranarayan A, Banerjee S, Rosenberg J, Nishimura DG, Fischbein NJ. Clinical evaluation of reduced field-of-view diffusion-weighted imaging of the cervical and thoracic spine and spinal cord. AJNR Am J Neuroradiol. 2012 Nov;33(10):1860-6. doi: 10.3174/ajnr.A3134. Epub 2012 May 3. — View Citation

Barral M, Taouli B, Guiu B, Koh DM, Luciani A, Manfredi R, Vilgrain V, Hoeffel C, Kanematsu M, Soyer P. Diffusion-weighted MR imaging of the pancreas: current status and recommendations. Radiology. 2015 Jan;274(1):45-63. doi: 10.1148/radiol.14130778. — View Citation

Bittencourt LK, Matos C, Coutinho AC Jr. Diffusion-weighted magnetic resonance imaging in the upper abdomen: technical issues and clinical applications. Magn Reson Imaging Clin N Am. 2011 Feb;19(1):111-31. doi: 10.1016/j.mric.2010.09.002. — View Citation

d'Assignies G, Fina P, Bruno O, Vullierme MP, Tubach F, Paradis V, Sauvanet A, Ruszniewski P, Vilgrain V. High sensitivity of diffusion-weighted MR imaging for the detection of liver metastases from neuroendocrine tumors: comparison with T2-weighted and dynamic gadolinium-enhanced MR imaging. Radiology. 2013 Aug;268(2):390-9. doi: 10.1148/radiol.13121628. Epub 2013 Mar 26. — View Citation

Kim H, Lee JM, Yoon JH, Jang JY, Kim SW, Ryu JK, Kannengiesser S, Han JK, Choi BI. Reduced Field-of-View Diffusion-Weighted Magnetic Resonance Imaging of the Pancreas: Comparison with Conventional Single-Shot Echo-Planar Imaging. Korean J Radiol. 2015 Nov-Dec;16(6):1216-25. doi: 10.3348/kjr.2015.16.6.1216. Epub 2015 Oct 26. — View Citation

Kim HW, Lee JC, Paik KH, Kang J, Kim YH, Yoon YS, Han HS, Kim J, Hwang JH. Adjunctive role of preoperative liver magnetic resonance imaging for potentially resectable pancreatic cancer. Surgery. 2017 Jun;161(6):1579-1587. doi: 10.1016/j.surg.2016.12.038. Epub 2017 Feb 23. — View Citation

Klauss M, Lemke A, Grunberg K, Simon D, Re TJ, Wente MN, Laun FB, Kauczor HU, Delorme S, Grenacher L, Stieltjes B. Intravoxel incoherent motion MRI for the differentiation between mass forming chronic pancreatitis and pancreatic carcinoma. Invest Radiol. 2011 Jan;46(1):57-63. doi: 10.1097/RLI.0b013e3181fb3bf2. — View Citation

Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol. 2007 Jun;188(6):1622-35. doi: 10.2214/AJR.06.1403. — View Citation

Ma C, Li YJ, Pan CS, Wang H, Wang J, Chen SY, Lu JP. High resolution diffusion weighted magnetic resonance imaging of the pancreas using reduced field of view single-shot echo-planar imaging at 3 T. Magn Reson Imaging. 2014 Feb;32(2):125-31. doi: 10.1016/j.mri.2013.10.005. Epub 2013 Oct 18. — View Citation

Motosugi U, Ichikawa T, Morisaka H, Sou H, Muhi A, Kimura K, Sano K, Araki T. Detection of pancreatic carcinoma and liver metastases with gadoxetic acid-enhanced MR imaging: comparison with contrast-enhanced multi-detector row CT. Radiology. 2011 Aug;260(2):446-53. doi: 10.1148/radiol.11103548. Epub 2011 Jun 21. — View Citation

Park MJ, Kim YK, Choi SY, Rhim H, Lee WJ, Choi D. Preoperative detection of small pancreatic carcinoma: value of adding diffusion-weighted imaging to conventional MR imaging for improving confidence level. Radiology. 2014 Nov;273(2):433-43. doi: 10.1148/radiol.14132563. Epub 2014 Jul 4. — View Citation

Reischauer C, Wilm BJ, Froehlich JM, Gutzeit A, Prikler L, Gablinger R, Boesiger P, Wentz KU. High-resolution diffusion tensor imaging of prostate cancer using a reduced FOV technique. Eur J Radiol. 2011 Nov;80(2):e34-41. doi: 10.1016/j.ejrad.2010.06.038. Epub 2010 Jul 16. — View Citation

Riffel P, Michaely HJ, Morelli JN, Pfeuffer J, Attenberger UI, Schoenberg SO, Haneder S. Zoomed EPI-DWI of the pancreas using two-dimensional spatially-selective radiofrequency excitation pulses. PLoS One. 2014 Mar 3;9(3):e89468. doi: 10.1371/journal.pone.0089468. eCollection 2014. — View Citation

Saritas EU, Cunningham CH, Lee JH, Han ET, Nishimura DG. DWI of the spinal cord with reduced FOV single-shot EPI. Magn Reson Med. 2008 Aug;60(2):468-73. doi: 10.1002/mrm.21640. — View Citation

Schima W. MRI of the pancreas: tumours and tumour-simulating processes. Cancer Imaging. 2006 Dec 20;6(1):199-203. doi: 10.1102/1470-7330.2006.0035. — View Citation

Wiggermann P, Grutzmann R, Weissenbock A, Kamusella P, Dittert DD, Stroszczynski C. Apparent diffusion coefficient measurements of the pancreas, pancreas carcinoma, and mass-forming focal pancreatitis. Acta Radiol. 2012 Mar 1;53(2):135-9. doi: 10.1258/ar.2011.100252. Epub 2012 Jan 19. — View Citation

Zins M, Matos C, Cassinotto C. Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy. Radiology. 2018 May;287(2):374-390. doi: 10.1148/radiol.2018171670. — View Citation

* Note: There are 17 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Diagnostic accuracy	Diagnostic accuracy difference between the standard protocol and the combined protocol.	Time of inclusion
Secondary	Diagnostic performances of benignity or malignancy	Differences between the standard protocol and the combined protocol in terms of sensitivity and specificity in the diagnosis of benign or malignant tumors.	Time of inclusion
Secondary	Diagnostic confidence of radiologist's benign or malignant condition	Confidence scores assigned by radiologist	Time of inclusion
Secondary	Lesions' detected number	Differences between the FOCUS diffusion sequence and the "wide field" sequence in terms of lesions' detected number	Time of inclusion
Secondary	Image quality	Differences between the FOCUS diffusion sequence and the "wide field" sequence in terms of image quality	Time of inclusion