Identification of intratumoral fluid–containing area by magnetic resonance imaging to predict prognosis in patients with pancreatic ductal adenocarcinoma after curative resection

Objectives: To compare the prognosis of pancreatic ductal adenocarcinoma (PDAC) after curative resection according to the type of intratumoral fluid–containing area identified on MRI. Methods: This retrospective study included 112 consecutive patients who underwent upfront surgery with margin-negative resection between 2012 and 2019. All patients underwent MRI within 1 month before surgery. Three radiologists independently assessed the MRI findings, determined whether intratumoral fluid–containing areas were present, and classified all intratumoral fluid-containing areas by type (i.e., imaging necrosis or neoplastic mucin cysts). Recurrence-free survival (RFS) and overall survival (OS) were evaluated by the Kaplan–Meier method and the Cox proportional hazards model. Histopathological differences according to the type of intratumoral fluid–containing area were assessed. Results: Of the 112 PDAC patients, intratumoral fluid–containing areas were identified on MRI in 33 (29.5%), among which 18 were classified as imaging necrosis and 15 as neoplastic mucin cysts. PDAC patients with imaging necrosis demonstrated significantly shorter RFS (mean 6.1 months versus 47.3 months; p <.001) and OS (18.4 months versus 55.0 months, p =.001) than those with neoplastic mucin cysts. Multivariable analysis showed that only the type of intratumoral fluid–containing area was significantly associated with RFS (hazard ratio, 2.25 and 0.38; p =.009 and p =.046 for imaging necrosis and neoplastic mucin cysts, respectively). PDAC with imaging necrosis had more frequent histological necrosis, more aggressive tumor differentiation, and higher tumor cellularity than PDAC with neoplastic mucin cysts (p ≤.02). Conclusion: The detection and discrimination of intratumoral fluid–containing areas on preoperative MRI may be useful in predicting the prognosis of PDAC patients after curative resection. Key Points: • Pancreatic ductal adenocarcinoma (PDAC) patients with imaging necrosis demonstrated significantly shorter survival than those with neoplastic mucin cysts after curative resection. • Multivariable analysis showed that only the type of intratumoral fluid–containing area identified on MRI was significantly associated with recurrence-free survival. • PDAC with imaging necrosis had more frequent histological necrosis, more aggressive tumor differentiation, and higher tumor cellularity than PDAC with neoplastic mucin cysts.