Metabolic Alterations in Pancreatic Cancer Detected by In Vivo

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Metabolic Alterations in Pancreatic Cancer Detected by In Vivo 1H-MR Spectroscopy: Correlation with Normal Pancreas, PET Metabolic Activity, Clinical Stages, and Survival Outcome

Chih-Kai Chang 1, Tiffany Ting-Fang Shih 1,2, Yu-Wen Tien 3, Ming-Chu Chang 4, Yu-Ting Chang 4 , Shih-Hung Yang 5, Mei-Fang Cheng 6 and Bang-Bin Chen 1,2,*

1 Department of Medical Imaging, National Taiwan University Hospital, Taipei 100, Taiwan;

kent90409@ (C.-K.C.); ttfshih@ntu.edu.tw (T.T.-F.S.) 2 Department of Radiology, College of Medicine, National Taiwan University, Taipei 100, Taiwan 3 Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan; ywtien5106@ntu.edu.tw 4 Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan;

mingchuchang@ntu.edu.tw (M.-C.C.); yutingchang@ntu.edu.tw (Y.-T.C.) 5 Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan; shyang0821@.tw 6 Department of Nuclear Medicine, National Taiwan University Hospital, Taipei 100, Taiwan;

meifang@.tw

* Correspondence: bangbin@; Tel.: +886-2-23123456 (ext. 65620); Fax: +886-2-23224552

Citation: Chang, C.-K.; Shih, T.T.-F.; Tien, Y.-W.; Chang, M.-C.; Chang, Y.-T.; Yang, S.-H.; Cheng, M.-F.; Chen, B.-B. Metabolic Alterations in Pancreatic Cancer Detected by In Vivo 1H-MR Spectroscopy: Correlation with Normal Pancreas, PET Metabolic Activity, Clinical Stages, and Survival Outcome. Diagnostics 2021, 11, 1541. https:// 10.3390/diagnostics11091541

Academic Editor: Keiji Hanada

Received: 8 July 2021 Accepted: 23 August 2021 Published: 25 August 2021

Publisher's Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract: Objective: To compare the metabolites of in vivo 1H- MRS in pancreatic cancer with normal pancreas, and correlate these metabolites with Positron Emission Tomography (PET) metabolic activity, clinical stages, and survival outcomes. Methods: The prospective study included 58 patients (mean age 62.7 ? 12.1 years, range 34?81 years; 36 men, 22 women) with pathological proof of pancreatic adenocarcinoma, and all of them received 18F-fluorodeoxyglucose (FDG) PET/MRI before treatment. The single-voxel MRS with a point-resolved selective spectroscopy sequence was used to measure metabolites (creatine, Glx (glutamine and glutamate), N-acetylaspartate (NAA), and lipid) of pancreatic cancer and adjacent normal parenchyma, respectively. FDG-PET parameters included SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Non-parametric tests were used to evaluate the differences of MRS metabolites between pancreatic cancer and those in normal pancreas, and their correlation with PET parameters and clinical stages. The correlation with progression-free survival (PFS) and overall survival (OS) was measured using the Kaplan?Meier and Cox proportional hazard models. Results: When compared with normal pancreas, the Glx, NAA, and lipid levels were significantly decreased in pancreatic cancer (all p < 0.05). Creatine, Glx, and lipid levels were all inversely correlated with both MTV (rho = -0.405~-0.454) and TLG (rho = -0.331~-0.441). For correlation with clinical stages, lower lipid levels were found in patients with T4 (vs. ................
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