Emerging non-invasive imaging biomarkers of Ki-67 in pancreatic cancer: Toward predictive precision oncology

Figure 1 Imaging modalities and their contribution to Ki-67 assessment. An integrated clinical pathway for tumor management involves initial screening via ultrasound to assess boundary and rigid features, followed by contrast-enhanced ultrasound biomarker testing. This testing includes quantitative parameters such as rise slope 10%-90%, maximum intensity, and falling slope 50%. Contrast-enhanced ultrasound testing serves as a trigger for multiparametric magnetic resonance imaging, which is used for apparent diffusion coefficient and Ki-67 assessment. Treatment is stratified by Ki-67 expression: High expression mandates neoadjuvant therapy, while low expression proceeds directly to surgical evaluation. The employment of advanced quantification techniques and positron emission tomography metabolic assessment further reinforces the precision oncology decision-making process throughout the pathway. US: Ultrasound; CEUS: Contrast-enhanced ultrasound; Rs1090: Rise slope 10%-90%; IMAX: Maximum intensity; Fs50: Falling slope 50%; MRI: Magnetic resonance imaging; PET: Positron emission tomography.