Improving preoperative detection of synchronous liver metastases in pancreatic cancer with combined contrast-enhanced and diffusion-weighted MRI

Abdom Radiol (NY). 2019 May;44(5):1756-1765. doi: 10.1007/s00261-018-1867-7.


Purpose: To explore the value of gadolinium-enhanced MRI combined with diffusion-weighted MRI (Gd-enhanced MRI with DWI) in addition to contrast-enhanced CT (CECT) for detection of synchronous liver metastases for potentially resectable pancreatic cancer.

Methods: By means of a retrospective cohort study we included patients with potentially resectable pancreatic cancer on CECT, who underwent Gd-enhanced MRI with DWI between January 2012 and December 2016. A single observer evaluated MRI and CT and was blinded to imaging, pathology, and surgery reports. Liver lesions were scored in both modalities, using a 3-point scale: 1-benign, 2-indeterminate, 3- malignant (i.e., metastasis). The primary outcome parameters were the presence of liver metastases on Gd-enhanced MRI with DWI and the sensitivity of Gd-enhanced MRI with DWI for synchronous liver metastases.

Results: We included 66 patients (42 men, 24 women; median age 65 years, range 36-82 years). In 19 patients, liver metastases were present, which were confirmed by histopathology (n = 12), 18FDG-PET (n = 6), or surgical inspection (n = 1). Gd-enhanced MRI with DWI showed metastases in 16/19 patients (24%), which resulted in a sensitivity of 84% (95% CI 60-97%). Contrast-enhanced MRI showed 156 and DWI 397 metastases (p = 0.051), and 339 were particularly small (< 5 mm).

Conclusions: In this study, Gd-enhanced MRI with DWI detected synchronous liver metastases in 24% of patients with potentially resectable pancreatic cancer on CECT with a sensitivity of 84%. Diffusion-weighted MRI showed a greater number of metastases than any other sequence, particularly small metastases (< 5 mm).

Keywords: Diffusion-weighted MRI; Liver; Metastases; Pancreatic cancer; Pancreatic ductal carcinoma.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Contrast Media
  • Diffusion Magnetic Resonance Imaging
  • Female
  • Humans
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / secondary*
  • Liver Neoplasms / surgery
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Neoplasms, Multiple Primary / diagnostic imaging*
  • Neoplasms, Multiple Primary / pathology*
  • Pancreatic Neoplasms / pathology*
  • Preoperative Period
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed


  • Contrast Media