Comparison of the Diagnostic Performances of Three Techniques of ROI Placement for ADC Measurements in Pancreatic Adenocarcinoma

Rationale and objectives: To prospectively investigate and compare three techniques of region of interest (ROI) placement for apparent diffusion coefficient (ADC) measurements in patients with pancreatic ductal adenocarcinoma (PDAC).

Materials and methods: Twenty-one patients with surgical pathology-proven PDAC and 18 healthy volunteers were included. Respiratory-triggered single-shot echo-planar diffusion-weighted imaging (b values = 0, 600 s/mm(2)) was used to calculate the ADC maps across all participants. Three readers independently measured the ADCs according to three ROI methods: whole-volume, single-slice, and small solid samples of tumor. Mean ADCs for the healthy pancreas were calculated using three measurements from pancreatic head to tail, and ADCs of distal pancreas to the tumor were also measured. The interobserver variability for the three techniques was measured using the interclass correlation coefficient. The diagnostic performances were calculated and compared using the receiver operating characteristic curves (ROC).

Results: All the ADCs measured from the three ROI placements on PDAC were significantly lower than that from the normal pancreas. ADCs of solid tumor samples were significantly lower than that measured from whole volume or single slice (both P < .001). Only the ADCs measured from the solid sample ROI placements on tumor were observed significantly lower than the ADC of distal pancreatic parenchyma (P = .005). Areas under the ROC for the identification of PDAC, based on small solid samples, single-slice and whole-volume ROIs, respectively, were 0.939, 0.791, and 0.735.

Conclusions: ADC based on the small solid samples of tumor provided the highest diagnostic performance in assessing PDAC and was more accurate than ADCs measured from single-slice or whole-volume ROI.