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01-05-2021 | Autoimmune Pancreatitis | Hepatobiliary-Pancreas

Distinguishing pancreatic cancer and autoimmune pancreatitis with in vivo tomoelastography

Authors: Liang Zhu, Jing Guo, Zhengyu Jin, Huadan Xue, Menghua Dai, Wen Zhang, Zhaoyong Sun, Jia Xu, Stephan R. Marticorena Garcia, Patrick Asbach, Bernd Hamm, Ingolf Sack

Published in: European Radiology | Issue 5/2021

Abstract

Objectives

To prospectively investigate the stiffness and fluidity of pancreatic ductal adenocarcinoma (PDAC) and autoimmune pancreatitis (AIP) with tomoelastography, and to evaluate its diagnostic performance in distinguishing the two entities.

Methods

Tomoelastography provided high-resolution maps of shear wave speed (c in m/s) and phase angle (φ in rad), allowing mechanical characterization of the stiffness and fluidity properties of the pancreas. Forty patients with untreated PDAC and 33 patients with untreated AIP who underwent diagnostic pancreatic MRI at 3-T together with multifrequency MR elastography and tomoelastography data processing were prospectively enrolled. Ten healthy volunteers served as controls. Two radiologists and a technician measured pancreatic stiffness and fluidity independently. The two radiologists also independently evaluated the patients’ conventional MR sequences using the following diagnostic score: 1, definitely PDAC; 2, probably PDAC; 3, indeterminate; 4, probably AIP; and 5, definitely AIP. Interobserver agreement was assessed. Stiffness and fluidity of PDAC, AIP, and healthy pancreas, as well as diagnostic performance of tomoelastography and conventional MRI, were compared.

Results

AIP showed significantly lower stiffness and fluidity than PDAC and significantly higher stiffness and fluidity than healthy pancreas. Pancreatic fluidity was not influenced by secondary obstructive changes. The intraclass correlation coefficient for pancreatic stiffness and fluidity by the 3 readers was near-perfect (0.951–0.979, all p < 0.001). Both stiffness and fluidity allowed distinguishing PDAC from AIP. AUCs were 0.906 for stiffness, 0.872 for fluidity, and 0.842 for conventional MRI.

Conclusions

Pancreatic stiffness and fluidity both allow differentiation of PDAC and AIP with high accuracy.

Key Points

• AIP showed significantly lower stiffness and fluidity than PDAC and significantly higher stiffness and fluidity than healthy pancreas.

• Both stiffness and fluidity allowed distinguishing PDAC from AIP.

• Pancreatic fluidity could distinguish malignancy from non-malignant secondary obstructive changes.

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Moffat GT, Epstein AS, O'Reilly EM (2019) Pancreatic cancer-a disease in need: optimizing and integrating supportive care. Cancer. 125(22):3927–3935CrossRef

Dickerson LD, Farooq A, Bano F et al (2019) Differentiation of autoimmune pancreatitis from pancreatic Cancer remains challenging. World J Surg 43(6):1604–1611CrossRef

Saavedra-Perez D, Vaquero EC, Ayuso JR et al (2014) Autoimmune pancreatitis: a surgical dilemma. Cir Esp 92(10):645–653CrossRef

Khandelwal A, Inoue D, Takahashi N (2020) Autoimmune pancreatitis: an update. Abdom Radiol 45(5):1359–1370CrossRef

Luo G, Liu C, Guo M et al (2017) Potential biomarkers in Lewis negative patients with pancreatic cancer. Ann Surg 265(4):800–805CrossRef

Ballehaninna UK, Chamberlain RS (2012) The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: an evidence based appraisal. J Gastrointest Oncol 3(2):105–119PubMedPubMedCentral

Martins C, Lago P, Sousa P et al (2017) Type 2 autoimmune pancreatitis: a challenge in the differential diagnosis of a pancreatic mass. GE Port J Gastroenterol 24(6):296–300CrossRef

Ngwa T, Law R, Hart P et al (2015) Serum IgG4 elevation in pancreatic cancer: diagnostic and prognostic significance and association with autoimmune pancreatitis. Pancreas 44(4):557–560CrossRef

Ghazale A, Chari ST, Smyrk TC et al (2007) Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer. Am J Gastroenterol 102(8):1646–1653CrossRef

10.

Zaheer A, Singh VK, Akshintala VS et al (2014) Differentiating autoimmune pancreatitis from pancreatic adenocarcinoma using dual-phase computed tomography. J Comput Assist Tomogr 38(1):146–152PubMedPubMedCentral

11.

Furuhashi N, Suzuki K, Sakurai Y et al (2015) Differentiation of focal-type autoimmune pancreatitis from pancreatic carcinoma: assessment by multiphase contrast-enhanced CT. Eur Radiol 25(5):1366–1374CrossRef

12.

Muhi A, Ichikawa T, Motosugi U et al (2012) Mass-forming autoimmune pancreatitis and pancreatic carcinoma: differential diagnosis on the basis of computed tomography and magnetic resonance cholangiopancreatography, and diffusion-weighted imaging findings. J Magn Reson Imaging 35(4):827–836CrossRef

13.

Sun GF, Zuo CJ, Shao CW et al (2013) Focal autoimmune pancreatitis: radiological characteristics help to distinguish from pancreatic cancer. World J Gastroenterol 19(23):3634–3641CrossRef

14.

Kim HJ, Kim YK, Jeong WK et al (2015) Pancreatic duct “icicle sign” on MRI for distinguishing autoimmune pancreatitis from pancreatic ductal adenocarcinoma in the proximal pancreas. Eur Radiol 25(6):1551–1560CrossRef

15.

Choi SY, Kim SH, Kang TW et al (2016) Differentiating mass-forming autoimmune pancreatitis from pancreatic ductal adenocarcinoma on the basis of contrast-enhanced MRI and DWI findings. AJR Am J Roentgenol 206(2):291–300CrossRef

16.

Hur BY, Lee JM, Lee JE et al (2012) Magnetic resonance imaging findings of the mass-forming type of autoimmune pancreatitis: comparison with pancreatic adenocarcinoma. J Magn Reson Imaging 36(1):188–197CrossRef

17.

Sugumar A, Levy MJ, Kamisawa T et al (2011) Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: an international multicentre study. Gut 60(5):666–670CrossRef

18.

Apte MV, Park S, Phillips PA et al (2004) Desmoplastic reaction in pancreatic cancer: role of pancreatic stellate cells. Pancreas 29(3):179–187CrossRef

19.

Zamboni G, Luttges J, Capelli P et al (2004) Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchows Arch 445(6):552–563CrossRef

20.

Shi Y, Cang L, Zhang X et al (2018) The use of magnetic resonance elastography in differentiating autoimmune pancreatitis from pancreatic ductal adenocarcinoma: a preliminary study. Eur J Radiol 108:13–20CrossRef

21.

Streitberger KJ, Lilaj L, Schrank F et al (2020) How tissue fluidity influences brain tumor progression. Proc Natl Acad Sci U S A 117(1):128–134CrossRef

22.

Shahryari M, Tzschatzsch H, Guo J et al (2019) Tomoelastography distinguishes noninvasively between benign and malignant liver lesions. Cancer Res 79(22):5704–5710CrossRef

23.

Tzschatzsch H, Guo J, Dittmann F et al (2016) Tomoelastography by multifrequency wave number recovery from time-harmonic propagating shear waves. Med Image Anal 30:1–10CrossRef

24.

Streitberger KJ, Diederichs G, Guo J et al (2015) In vivo multifrequency magnetic resonance elastography of the human intervertebral disk. Magn Reson Med 74(5):1380–1387CrossRef

25.

Marticorena Garcia SR, Grossmann M, Bruns A et al (2019) Tomoelastography paired with T2* magnetic resonance imaging detects lupus nephritis with normal renal function. Invest Radiol 54(2):89–97CrossRef

26.

Bertalan G, Guo J, Tzschatzsch H et al (2019) Fast tomoelastography of the mouse brain by multifrequency single-shot MR elastography. Magn Reson Med 81(4):2676–2687CrossRef

27.

Hallgren KA (2012) Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol 8(1):23–34CrossRef

28.

Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143(1):29–36CrossRef

29.

Hudert CA, Tzschatzsch H, Rudolph B et al (2019) Tomoelastography for the evaluation of pediatric nonalcoholic fatty liver disease. Invest Radiol 54(4):198–203CrossRef

30.

Lang ST, Guo J, Bruns A et al (2019) Multiparametric quantitative MRI for the detection of IgA nephropathy using Tomoelastography, DWI, and BOLD imaging. Invest Radiol 54(10):669–674CrossRef

31.

Marticorena Garcia SR, Fischer T, Durr M et al (2016) Multifrequency magnetic resonance elastography for the assessment of renal allograft function. Invest Radiol 51(9):591–595CrossRef

32.

Takahashi N, Fletcher JG, Fidler JL et al (2008) Dual-phase CT of autoimmune pancreatitis: a multireader study. AJR Am J Roentgenol 190(2):280–286CrossRef

33.

Fukukura Y, Takumi K, Kamimura K et al (2012) Pancreatic adenocarcinoma: variability of diffusion-weighted MR imaging findings. Radiology 263(3):732–740CrossRef

34.

Mujica VR, Barkin JS, Go VL (2000) Acute pancreatitis secondary to pancreatic carcinoma. Study Group Participants. Pancreas 21(4):329–332CrossRef

35.

Shi Y, Liu Y, Liu YQ et al (2017) Early diagnosis and severity assessment of acute pancreatitis (AP) using MR elastography (MRE) with spin-echo echo-planar imaging. J Magn Reson Imaging 46(5):1311–1319CrossRef

36.

Liu Y, Wang M, Ji R et al (2018) Differentiation of pancreatic ductal adenocarcinoma from inflammatory mass: added value of magnetic resonance elastography. Clin Radiol 73(10):865–872CrossRef

37.

Shi Y, Gao F, Li Y et al (2018) Differentiation of benign and malignant solid pancreatic masses using magnetic resonance elastography with spin-echo echo planar imaging and three-dimensional inversion reconstruction: a prospective study. Eur Radiol 28(3):936–945CrossRef

Title: Distinguishing pancreatic cancer and autoimmune pancreatitis with in vivo tomoelastography
Authors: Liang Zhu
Jing Guo
Zhengyu Jin
Huadan Xue
Menghua Dai
Wen Zhang
Zhaoyong Sun
Jia Xu
Stephan R. Marticorena Garcia
Patrick Asbach
Bernd Hamm
Ingolf Sack
Publication date: 01-05-2021
Publisher: Springer Berlin Heidelberg
Keywords: Autoimmune Pancreatitis
Pancreatic Cancer
Pancreatic Cancer
Published in: European Radiology / Issue 5/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07420-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Distinguishing pancreatic cancer and autoimmune pancreatitis with in vivo tomoelastography

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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