Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2015; 21(22): 6794-6808
Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6794
Prognostication and response assessment in liver and pancreatic tumors: The new imaging
Riccardo De Robertis, Paolo Tinazzi Martini, Emanuele Demozzi, Gino Puntel, Silvia Ortolani, Sara Cingarlini, Andrea Ruzzenente, Alfredo Guglielmi, Giampaolo Tortora, Claudio Bassi, Paolo Pederzoli, Mirko D’Onofrio
Riccardo De Robertis, Emanuele Demozzi, Gino Puntel, Mirko D’Onofrio, Department of Radiology, Verona Comprehensive Cancer Network, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy
Paolo Tinazzi Martini, Department of Radiology, Casa di Cura Pederzoli, 37019 Peschiera del Garda, Italy
Silvia Ortolani, Sara Cingarlini, Giampaolo Tortora, Department of Oncology, Verona Comprehensive Cancer Network, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy
Andrea Ruzzenente, Alfredo Guglielmi, Department of Hepato-Biliary Surgery, Verona Comprehensive Cancer Network, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy
Claudio Bassi, Department of Pancreatic Surgery, Verona Comprehensive Cancer Network, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy
Paolo Pederzoli, Department of Pancreatic Surgery, Casa di Cura Pederzoli, 37019 Peschiera del Garda, Italy
Author contributions: All authors contributed equally to this work; Tinazzi Martini P, Ruzzenente A, Guglielmi A, Cingarlini S, Tortora G, Bassi C, Pederzoli P and D’Onofrio M designed the research; Demozzi E, Puntel G and Ortolani S performed the research and analyzed the data; and De Robertis R, Demozzi E and Puntel G wrote the paper.
Conflict-of-interest: The authors declare no potential conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Riccardo De Robertis, MD, Department of Radiology, Verona Comprehensive Cancer Network, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy. riccardo.derobertis@hotmail.it
Telephone: +39-45-8124301 Fax: +39-45-8027490
Received: January 28, 2015
Peer-review started: January 28, 2015
First decision: March 10, 2015
Revised: March 25, 2015
Accepted: May 2, 2015
Article in press: May 4, 2015
Published online: June 14, 2015
Processing time: 141 Days and 14.5 Hours
Abstract

Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term “functional imaging” is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive “one-step” morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring.

Keywords: Diffusion magnetic resonance imaging; Perfusion imaging; Hepatocellular carcinoma; Liver neoplasms; Pancreatic neoplasms

Core tip: Diffusion-weighted imaging and perfusion imaging could add functional information to the morphological evaluation of hepatic and pancreatic tumors. Diffusion-weighted imaging findings seem to be correlated with pathological features and could predict the clinical outcome of hepatocellular carcinomas and pancreatic tumors, especially neuroendocrine neoplasms. Apparent diffusion coefficient quantification and perfusion techniques can be of value for the evaluation of response to ablative treatments, loco-regional therapies and anti-angiogenic therapies, even at an early stage.