Hepatobiliary contrast uptake patterns on gadoxetic acid-enhanced MRI in liver metastases from pancreatic ductal adenocarcinoma. Can it predict prognosis?

To evaluate the relationship between the patterns of hepatobiliary phase (HBP) contrast uptake in liver metastases on gadoxetic acid–enhanced MR imaging and overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC). This retrospective study was approved by our institutional review board and written informed consent was waived. A total of 57 patients (30 men and 27 women; age range, 46–92 years; mean age, 64.9 ± 9.2 years) with PDAC and liver metastasis who had undergone gadoxetic acid–enhanced MR imaging were included. The internal morphologies of the nodules were classified as heterogeneous or homogeneous on HBP images (20 min). During patient-by-patient analysis, patients with both patterns of nodules were classified as belonging to the heterogeneous group. Kaplan–Meier analysis and log-rank test were conducted for univariate analysis and Cox proportional hazards regression was conducted for multivariate analysis to evaluate prognostic factors for OS in patients with PDAC and liver metastasis. A total of 199 liver metastases were analyzed, among which 138 nodules (69%) demonstrated heterogeneous hypointensity, while 61 nodules (31%) demonstrated homogeneous hypointensity. Homogeneous hypointense nodules were encountered in 18 patients (32%; homogeneous group), heterogeneous in 29 patients (51%), and both patterns co-existed in 10 patients (17%; heterogeneous group). The heterogeneous group exhibited lower OS rates than the homogeneous group (mean OS, 48.5 months vs 23.9 months; p = 0.032). Hepatobiliary contrast uptake pattern in liver metastasis on HBP images can be a potential imaging biomarker to predict OS in patients with PDAC and liver metastasis.