Primovist^®-enhanced MRI and its' role in patients with PDAC

Primovist^®-enhanced MRI (EOB-MRI) has a well-established role in colorectal liver metastases, where it has shown increased lesion detection (particularly in lesions ≤1.0 cm), decreased need for additional imaging, reduced intra-operative modifications to surgical plans, and increased diagnostic confidence compared to CECT.¹ More recent research has highlighted the expanding role for Primovist^® in patients with pancreatic ductal adenocarcinoma (PDAC). Surgical resection is often the only curative treatment for this lethal cancer, but the presence of liver metastases precludes patients from this surgery.²

CECT is commonly used to stage PDAC and detect metastases but futile open-close laparotomies have been reported in up to 41% of CT-defined resectable patients due to unexpected intraoperative detection of liver metastases, and the patient is unable to receive curative resection.² Accurate pre-operative detection of liver metastases is critical as surgery is associated with risks related to morbidity and mortality, delays in alternative treatments, increased health care costs, and potential impacts on mental health.

A Canadian study from the University Health Network in Toronto examined the effect of EOB-MRI compared to CECT on lesion diagnoses and surgical planning in 66 patients.² Comparative analysis of the two modalities were based on clinical and radiology reports, as well as retrospective analysis of images by two blinded abdominal radiologists with histopathology, intraoperative observations and/or follow-up as the reference standard.

EOB-MRI showed higher sensitivity overall (71.7% vs. 34%, p = 0.009) with comparable specificity (98.6% vs. 100%).² In fact, the incremental lesion detection with Primovist excluded an additional 7.6% of patients from surgery compared to CECT, with the potential to reduce up to 13.6% of failed curative-intent surgeries. Similarly to what is observed for colorectal liver metastases, EOB-MRI showed increased detection of small lesions ≤1.0 cm, and a lower number of lesions categorized as “indeterminant” compared to CECT.

The value of Primovist^® in detecting pancreatic cancer liver metastases has also been shown in other literature, and may predict prognosis.^3,4,5 Overall, research has demonstrated Primovist^® can play a growing role in this patient population and increase the likelihood that surgical resection is selected for the right patient and reduce futile surgeries.

Abbreviations:

• CECT = contrast enhanced computed tomography
• EOB-MRI = Primovist-enhanced magnetic resonance imaging
• PDAC = pancreatic ductal adenocarcinoma
   

References:

1. Zech, C. J., Korpraphong, P., Huppertz, A., Denecke, T., Kim, M. J., Tanomkiat, W., ... & Ba-Ssalamah, A. (2014). Randomized multicentre trial of gadoxetic acid-enhanced MRI versus conventional MRI or CT in the staging of colorectal cancer liver metastases. Journal of British Surgery, 101(6), 613-621.
2. Jhaveri, K. S., Babaei Jandaghi, A., Thipphavong, S., Espin-Garcia, O., Dodd, A., Hutchinson, S., ... & Gallinger, S. (2021). Can preoperative liver MRI with gadoxetic acid help reduce open-close laparotomies for curative intent pancreatic cancer surgery?. Cancer Imaging, 21(1), 45.
3. Noda, Y., Goshima, S., Takai, Y., Kawai, N., Kawada, H., Tanahashi, Y., & Matsuo, M. (2020). Detection of pancreatic ductal adenocarcinoma and liver metastases: comparison of Gd-EOB-DTPA-enhanced MR imaging vs. extracellular contrast materials. Abdominal radiology, 45, 2459-2468.
4. Ito, T., Sugiura, T., Okamura, Y., Yamamoto, Y., Ashida, R., Aramaki, T., ... & Uesaka, K. (2017). The diagnostic advantage of EOB-MR imaging over CT in the detection of liver metastasis in patients with potentially resectable pancreatic cancer. Pancreatology, 17(3), 451-456.
5. Noda, Y., Tochigi, T., Baliyan, V., Kordbacheh, H., & Kambadakone, A. (2021). Hepatobiliary contrast uptake patterns on gadoxetic acid–enhanced MRI in liver metastases from pancreatic ductal adenocarcinoma: can it predict prognosis?. European Radiology, 31, 276-282.