Share：
Share this content in WeChat
X
[Chinese] [PDF] 33 1
• Clinical Article •
Feasibility study of magnetization transfer imaging for predicting the pathological grade of pancreatic ductal adenocarcinoma
LI Wenyi  QIANG Jing  LI Cheng  ZHOU Dan  JIA Peng 

DOI:10.12015/issn.1674-8034.2026.02.015.


[Abstract] Objective To investigate the correlation between the magnetization transfer ratio (MTR) of tumor tissue and the pathological grade in pancreatic ductal adenocarcinoma (PDAC).Materials and Methods A total of 75 patients who underwent pancreaticoduodenectomy and were pathologically diagnosed with PDAC at the Affiliated BenQ Hospital of Nanjing Medical University from August 2024 to November 2025 were retrospectively enrolled. All patients underwent preoperative magnetization transfer imaging (MTI) to measure the MTR values within the tumor region. Other clinical and imaging parameters were also collected. Based on the degree of pathological differentiation and tumor biological behavior, patients were classified into low-grade and high-grade groups. The correlation between various parameters and PDAC pathological grade was analyzed. Categorical variables were compared using the Chi-square test; normally distributed continuous variables were analyzed with the independent samples t-test, while non-normally distributed variables were assessed using the Mann-Whitney U test. Variables with statistical significance in univariate analysis were incorporated into a binary logistic regression model. Variable selection was performed using the forward likelihood ratio method to establish a combined predictive model. The diagnostic performance of each parameter and the combined model for predicting PDAC pathological grade was evaluated using receiver operating characteristic curves.Results The MTR value was significantly higher in the high-grade group than in the low-grade group (0.269 ± 0.059 vs. 0.196 ± 0.056), with a statistically significant inter-group difference (P < 0.001). Both age and MTR value were identified as independent predictors of PDAC pathological grade (all P < 0.05). The combined model incorporating both factors demonstrated the highest diagnostic performance, with an AUC of 0.844 (95% CI: 0.742 to 0.918), sensitivity of 76.0%, and specificity of 86.0%. This combined model was significantly superior to the age-alone model (AUC = 0.683, sensitivity = 56.0%, specificity = 78.0%, P = 0.007). Although there was no statistically significant difference in diagnostic performance compared to the MTR-alone model (AUC = 0.830, sensitivity = 84.0%, specificity = 74.0%, P = 0.563), the combined model improved specificity by 12.0%.Conclusions MTR is significantly correlated with the pathological grade of PDAC, with higher MTR values indicating poorer tumor differentiation. The combined model suggesting its potential as a non-invasive imaging biomarker for preoperatively assessing the differentiation degree of PDAC.
[Keywords] pancreatic ductal adenocarcinoma；pancreatic fibrosis；magnetic resonance imaging；magnetization transfer imaging；magnetization transfer ratio；quantitative analysis

LI Wenyi   QIANG Jing   LI Cheng   ZHOU Dan   JIA Peng*  

Department of Radiology, Nanjing BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China

Corresponding author: JIA P, E-mail: iambone66@163.com

Conflicts of interest   None.

Received  2025-09-29
Accepted  2026-01-14
DOI: 10.12015/issn.1674-8034.2026.02.015
DOI:10.12015/issn.1674-8034.2026.02.015.

[1]
SIEGEL R L, GIAQUINTO A N, JEMAL A. Cancer statistics, 2024[J]. CA Cancer J Clin, 2024, 74(1): 12-49. DOI: 10.3322/caac.21820.
[2]
GHEORGHE G, BUNGAU S, ILIE M, et al. Early diagnosis of pancreatic cancer: The key for survival[J/OL]. Diagnostics (Basel), 2020, 10(11): 869 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/33114412/. DOI: 10.3390/diagnostics10110869.
[3]
NAPPO G, DONISI G, CAPRETTI G, et al. Early recurrence after upfront surgery for pancreatic ductal adenocarcinoma[J]. Curr Oncol, 2023, 30(4): 3708-3720. DOI: 10.3390/curroncol30040282.
[4]
ORTH M, METZGER P, GERUM S, et al. Pancreatic ductal adenocarcinoma: biological hallmarks, current status, and future perspectives of combined modality treatment approaches[J/OL]. Radiat Oncol, 2019, 14(1): 141 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/31395068/. DOI: 10.1186/s13014-019-1345-6.
[5]
SHI S, LIANG C, XU J, et al. The strain ratio as obtained by endoscopic ultrasonography elastography correlates with the stroma proportion and the prognosis of local pancreatic cancer[J]. Ann Surg, 2020, 271(3): 559-565. DOI: 10.1097/SLA.0000000000002998.
[6]
YANG J B, ZENG L T, CHEN R W, et al. Leveraging tumor microenvironment infiltration in pancreatic cancer to identify gene signatures related to prognosis and immunotherapy response[J/OL]. Cancers, 2023, 15(5): 1442 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/36900234/. DOI: 10.3390/cancers15051442.
[7]
SHEN Z Q, YANG M M, LÜ J X, et al. A feasibility study of magnetization transfer imaging on the evaluation of fibrosis in pancreatic duct adenocarcinoma[J]. Chin J Magn Reson Imaging, 2025, 16(5): 44-48. DOI: 10.12015/issn.1674-8034.2025.05.007.
[8]
LAKLAI H, MIROSHNIKOVA Y A, PICKUP M W, et al. Genotype tunes pancreatic ductal adenocarcinoma tissue tension to induce matricellular fibrosis and tumor progression[J]. Nat Med, 2016, 22(5): 497-505. DOI: 10.1038/nm.4082.
[9]
TIRKES T, SAEED O A, OSUJI V C, et al. Histopathologic correlation of pancreatic fibrosis with pancreatic magnetic resonance imaging quantitative metrics and Cambridge classification[J]. Abdom Radiol (NY), 2022, 47(7): 2371-2380. DOI: 10.1007/s00261-022-03532-2.
[10]
DUNET V, HALKIC N, SEMPOUX C, et al. Prediction of tumour grade and survival outcome using pre-treatment PET- and MRI-derived imaging features in patients with resectable pancreatic ductal adenocarcinoma[J]. Eur Radiol, 2021, 31(2): 992-1001. DOI: 10.1007/s00330-020-07191-z.
[11]
MACÍAS N, SAYAGUÉS J M, ESTEBAN C, et al. Histologic tumor grade and preoperative bilary drainage are the unique independent prognostic factors of survival in pancreatic ductal adenocarcinoma patients after pancreaticoduodenectomy[J/OL]. J Clin Gastroenterol, 2018, 52(2): e11-e17 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/28059940/. DOI: 10.1097/mcg.0000000000000793.
[12]
FUKUI H, ONISHI H, OTA T, et al. Pancreatic fibrosis assessment and association with pancreatic cancer: comparison with the extracellular volume fraction[J/OL]. Clin Radiol, 2024, 79(11): e1356-e1365 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/39266374/. DOI: 10.1016/j.crad.2024.08.007.
[13]
CHEN W Y, LIN G H, LI X, et al. Dual-energy computed tomography for predicting histological grading and survival in patients with pancreatic ductal adenocarcinoma[J]. Eur Radiol, 2025, 35(5): 2818-2832. DOI: 10.1007/s00330-024-11109-4.
[14]
CEN C Y, WANG C Y, WANG S Q, et al. Clinical-radiomics nomogram using contrast-enhanced CT to predict histological grade and survival in pancreatic ductal adenocarcinoma[J/OL]. Front Oncol, 2023, 13: 1218128 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/37731637/. DOI: 10.3389/fonc.2023.1218128.
[15]
SONG Q K, ZHONG S L, LIU Y Y, et al. MR elastography for evaluation of pathological grade of pancreatic ductal adenocarcinoma[J]. Chin J Magn Reson Imaging, 2022, 13(3): 26-30. DOI: 10.12015/issn.1674-8034.2022.03.006.
[16]
KIM D K, JEONG J, LEE D S, et al. PD-L1-directed PlGF/VEGF blockade synergizes with chemotherapy by targeting CD141+ cancer-associated fibroblasts in pancreatic cancer[J/OL]. Nat Commun, 2022, 13(1): 6292 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/36272973/. DOI: 10.1038/s41467-022-33991-6.
[17]
SEO N, JEONG H K, CHOI J Y, et al. Liver MRI with amide proton transfer imaging: feasibility and accuracy for the characterization of focal liver lesions[J]. Eur Radiol, 2021, 31(1): 222-231. DOI: 10.1007/s00330-020-07122-y.
[18]
FANG Z N, LI X H, LIN J J, et al. Magnetisation transfer imaging adds information to conventional MRIs to differentiate inflammatory from fibrotic components of small intestinal strictures in Crohn's disease[J]. Eur Radiol, 2020, 30(4): 1938-1947. DOI: 10.1007/s00330-019-06594-x.
[19]
JIANG B C, LIU F, FU H D, et al. Advances in imaging techniques to assess kidney fibrosis[J/OL]. Ren Fail, 2023, 45(1): 2171887 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/36723057/. DOI: 10.1080/0886022X.2023.2171887.
[20]
LI W G, ZHANG Z L, NICOLAI J, et al. Magnetization transfer MRI in pancreatic cancer xenograft models[J]. Magn Reson Med, 2012, 68(4): 1291-1297. DOI: 10.1002/mrm.24127.
[21]
SCHAWKAT K, ESHMUMINOV D, LENGGENHAGER D, et al. Preoperative evaluation of pancreatic fibrosis and lipomatosis: correlation of magnetic resonance findings with histology using magnetization transfer imaging and multigradient echo magnetic resonance imaging[J]. Invest Radiol, 2018, 53(12): 720-727. DOI: 10.1097/rli.0000000000000496.
[22]
NAGTEGAAL I D, ODZE R D, KLIMSTRA D, et al. The 2019 WHO classification of tumours of the digestive system[J]. Histopathology, 2020, 76(2): 182-188. DOI: 10.1111/his.13975.
[23]
DUAN K L, ZHOU H H, XU W N, et al. Evaluation of tumor fibrosis in pancreatic ductal adenocarcinoma by 2-D shear wave elastography: a pilot study[J]. Ultrasound Med Biol, 2023, 49(9): 2119-2125. DOI: 10.1016/j.ultrasmedbio.2023.06.003.
[24]
HUANG H Z, LU W Y, ZHANG X L, et al. Fibroblast subtypes in pancreatic cancer and pancreatitis: from mechanisms to therapeutic strategies[J]. Cell Oncol (Dordr), 2024, 47(2): 383-396. DOI: 10.1007/s13402-023-00874-x.
[25]
BAER J M, ZUO C, KANG L I, et al. Fibrosis induced by resident macrophages has divergent roles in pancreas inflammatory injury and PDAC[J]. Nat Immunol, 2023, 24(9): 1443-1457. DOI: 10.1038/s41590-023-01579-x.
[26]
SHI S Y, LUO Y J, WANG M, et al. Tumor fibrosis correlates with the survival of patients with pancreatic adenocarcinoma and is predictable using clinicoradiological features[J]. Eur Radiol, 2022, 32(9): 6314-6326. DOI: 10.1007/s00330-022-08745-z.
[27]
AL-HILAL T A, CHRYSOVERGI M A, GRASBERGER P E, et al. Durotaxis is a driver and potential therapeutic target in lung fibrosis and metastatic pancreatic cancer[J]. Nat Cell Biol, 2025, 27(9): 1543-1554. DOI: 10.1038/s41556-025-01697-8.
[28]
ADAMSKA A, DOMENICHINI A, FALASCA M. Pancreatic ductal adenocarcinoma: current and evolving therapies[J/OL]. Int J Mol Sci, 2017, 18(7): 1338 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/28640192/. DOI: 10.3390/ijms18071338.
[29]
KUNG H C, YU J. Targeted therapy for pancreatic ductal adenocarcinoma: Mechanisms and clinical study[J/OL]. MedComm, 2023, 4(2): e216 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/36814688/. DOI: 10.1002/mco2.216.
[30]
WOLFF S D, BALABAN R S. Magnetization transfer imaging: practical aspects and clinical applications[J]. Radiology, 1994, 192(3): 593-599. DOI: 10.1148/radiology.192.3.8058919.
[31]
CHANG N, CUI L L, LUO Y H, et al. Development and multicenter validation of a CT-based radiomics signature for discriminating histological grades of pancreatic ductal adenocarcinoma[J]. Quant Imaging Med Surg, 2020, 10(3): 692-702. DOI: 10.21037/qims.2020.02.21.
[32]
LI Q, YANG C, LI J Q, et al. The type I collagen paradox in PDAC progression: microenvironmental protector turned tumor accomplice[J/OL]. J Transl Med, 2025, 23(1): 744 [2025-09-28]. https://pubmed.ncbi.nlm.nih.gov/40616159/. DOI: 10.1186/s12967-025-06778-8.
[33]
BEN-AHARON I, ELKABETS M, PELOSSOF R, et al. Genomic landscape of pancreatic adenocarcinoma in younger versus older patients: does age matter [J]. Clin Cancer Res, 2019, 25(7): 2185-2193. DOI: 10.1158/1078-0432.CCR-18-3042.

PREV Study on the value of IVIM, DKI and their combination with ultrasound transient elastography in the staging of liver fibrosis in patients with chronic liver disease
NEXT Evaluation of placental stiffness in pregnancy-induced hypertension syndrome at high altitude using IVIM-DWI-based virtual MR elastography
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn