Skip to main content
Top
Published in: Abdominal Radiology 1/2012

01-02-2012

Diffusion-weighted MRI of focal cystic pancreatic lesions at 3.0-Tesla: preliminary results

Authors: Jeffrey C. Mottola, V. Anik Sahni, Sukru M. Erturk, Richard Swanson, Peter A. Banks, Koenraad J. Mortele

Published in: Abdominal Radiology | Issue 1/2012

Login to get access

Abstract

Purpose

To determine the utility of 3.0-Tesla diffusion-weighted (DW) magnetic resonance imaging (MRI) for focal cystic pancreatic lesion (FCPL) characterization.

Materials and methods

55 FCPL (34 IPMN, 5 serous cystadenoma, and 16 inflammatory) were evaluated. Two radiologists reviewed in consensus DW-MRI images. Reference standard was obtained from patient history, cytological and histopathology data, FCPL fluid analysis, and follow-up imaging results. Signal intensity (SI) and apparent diffusion coefficient values (ADC) of FCPL and normal pancreas were measured. FCPL-to-pancreas SI and ADC ratios were also calculated.

Results

Qualitatively, 11 of 21 non-mucinous vs. 4 of 34 mucinous lesions appeared hyperintense at b value of 1,000 s/mm2 (P = 0.02). Three FCPL demonstrated restricted diffusion: all inflammatory. Significant differences in mean ADC between neoplastic vs. non-neoplastic (P = 0.009), and mucinous vs. non-mucinous (P = 0.013) lesions were demonstrated. FCPL-to-pancreas ADC and SI ratios demonstrated significant differences between neoplastic vs. non-neoplastic lesions [ADC, (P = 0.019); SI for b values 750 (P = 0.010) and 1,000 s/mm2 (P = 0.017)] and mucinous vs. non-mucinous lesions [ADC (P = 0.018); SI for b values 750 (P = 0.013) and 1,000 s/mm2 (P = 0.015)].

Conclusion

Although mean ADC values and FCPL-to-pancreas SI and ADC ratios may be helpful in differentiating FCPL, characterization of individual FCPL by means of 3.0-Tesla DW-MRI appears limited.
Literature
1.
go back to reference Spinelli KS, Fromwiller TE, Daniel RA, et al. (2004) Cystic pancreatic neoplasm: observe or operate. Ann Surg 239:651–657PubMedCrossRef Spinelli KS, Fromwiller TE, Daniel RA, et al. (2004) Cystic pancreatic neoplasm: observe or operate. Ann Surg 239:651–657PubMedCrossRef
2.
go back to reference Allen PJ, Brennan MF (2007) The management of cystic lesions of the pancreas. Adv Surg 41:211–228PubMedCrossRef Allen PJ, Brennan MF (2007) The management of cystic lesions of the pancreas. Adv Surg 41:211–228PubMedCrossRef
3.
go back to reference Lee KS, Sekhar A, Rofsky NM, Pedrosa I (2010) Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 105:2079–2084PubMedCrossRef Lee KS, Sekhar A, Rofsky NM, Pedrosa I (2010) Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 105:2079–2084PubMedCrossRef
4.
go back to reference Xhang XM, Mitchell DG, Dohke M, Holland GA, Parker L (2002) Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 223:547–553CrossRef Xhang XM, Mitchell DG, Dohke M, Holland GA, Parker L (2002) Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 223:547–553CrossRef
5.
go back to reference Khalid A, Brugge W (2007) ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol 102:2339–2349PubMedCrossRef Khalid A, Brugge W (2007) ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol 102:2339–2349PubMedCrossRef
6.
go back to reference Ferrone CR, Correa-Gallego C, Warshaw AL, et al. (2009) Current trends in pancreatic cystic neoplasms. Arch Surg 144:448–454PubMedCrossRef Ferrone CR, Correa-Gallego C, Warshaw AL, et al. (2009) Current trends in pancreatic cystic neoplasms. Arch Surg 144:448–454PubMedCrossRef
7.
go back to reference Garcea G, Ong SL, Rajesh A, et al. (2008) Cystic lesions of the pancreas. A diagnostic and management dilemma. Pancreatology 8:236–251PubMedCrossRef Garcea G, Ong SL, Rajesh A, et al. (2008) Cystic lesions of the pancreas. A diagnostic and management dilemma. Pancreatology 8:236–251PubMedCrossRef
8.
go back to reference Lopez Hanninen E, Pech M, Rickie J, et al. (2006) Magnetic resonance imaging in the assessment of cystic pancreatic lesions: differentiation of benign and malignant lesion status. Acta Radiol 47:121–129PubMedCrossRef Lopez Hanninen E, Pech M, Rickie J, et al. (2006) Magnetic resonance imaging in the assessment of cystic pancreatic lesions: differentiation of benign and malignant lesion status. Acta Radiol 47:121–129PubMedCrossRef
9.
go back to reference Kim SY, Lee JM, Kim SH, et al. (2006) Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. AJR Am J Roentgenol 187:1192–1198PubMedCrossRef Kim SY, Lee JM, Kim SH, et al. (2006) Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. AJR Am J Roentgenol 187:1192–1198PubMedCrossRef
10.
go back to reference Macari M, Finn ME, Bennett GL, et al. (2009) Differentiating pancreatic cystic neoplasms from pancreatic pseudocysts at MR imaging: value of perceived internal debris. Radiology 251:77–84PubMedCrossRef Macari M, Finn ME, Bennett GL, et al. (2009) Differentiating pancreatic cystic neoplasms from pancreatic pseudocysts at MR imaging: value of perceived internal debris. Radiology 251:77–84PubMedCrossRef
11.
go back to reference Curry CA, Eng J, Horton KM, et al. (2000) CT of primary cystic neoplasms: can CT be used for patient and triage? AJR Am J Roentgenol 175:99–103PubMed Curry CA, Eng J, Horton KM, et al. (2000) CT of primary cystic neoplasms: can CT be used for patient and triage? AJR Am J Roentgenol 175:99–103PubMed
12.
go back to reference Sidden CR, Mortele KJ (2007) Cystic tumors of the pancreas: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MRI 28:339–356CrossRef Sidden CR, Mortele KJ (2007) Cystic tumors of the pancreas: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MRI 28:339–356CrossRef
13.
go back to reference Parikh T, Drew SJ, Lee VS, et al. (2008) Focal liver lesions detection and characterization with diffusion weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 246:812–822PubMedCrossRef Parikh T, Drew SJ, Lee VS, et al. (2008) Focal liver lesions detection and characterization with diffusion weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 246:812–822PubMedCrossRef
14.
go back to reference Kandpal H, Sharma R, Madhusudhan KS, Kapoor KS (2009) Respiratory-triggered versus breath-hold diffusion-weighted MRI of liver lesions: Comparison of image quality and apparent diffusion coefficient values. AJR Am J Roentgenol 192:915–922PubMedCrossRef Kandpal H, Sharma R, Madhusudhan KS, Kapoor KS (2009) Respiratory-triggered versus breath-hold diffusion-weighted MRI of liver lesions: Comparison of image quality and apparent diffusion coefficient values. AJR Am J Roentgenol 192:915–922PubMedCrossRef
15.
go back to reference Soyer P, Corno L, Boudiaf M, et al. (2010) Differentiation between cavernous hemangiomas and untreated malignant neoplasms of the liver with free-breathing diffusion-weighted MR imaging: comparison with T2-weighted spin-echo MR imaging. Eur J Radiol Soyer P, Corno L, Boudiaf M, et al. (2010) Differentiation between cavernous hemangiomas and untreated malignant neoplasms of the liver with free-breathing diffusion-weighted MR imaging: comparison with T2-weighted spin-echo MR imaging. Eur J Radiol
16.
go back to reference Zhang J, Tehrani YM, Wang L, et al. (2008) Renal masses: characterization with diffusion-weighted MR imaging—a preliminary experience. Radiology 247:458–464PubMedCrossRef Zhang J, Tehrani YM, Wang L, et al. (2008) Renal masses: characterization with diffusion-weighted MR imaging—a preliminary experience. Radiology 247:458–464PubMedCrossRef
17.
go back to reference Kim S, Jain M, Harris AB, et al. (2009) T1 hyperintense renal lesions: characterization with diffusion weighted MR imaging versus contrast-enhanced MR imaging. Radiology 251:796–807PubMedCrossRef Kim S, Jain M, Harris AB, et al. (2009) T1 hyperintense renal lesions: characterization with diffusion weighted MR imaging versus contrast-enhanced MR imaging. Radiology 251:796–807PubMedCrossRef
18.
go back to reference Qayyum A (2009) Diffusion-weighted imaging in the pelvis: concepts and applications. RadioGraphics 29:1797–1810PubMedCrossRef Qayyum A (2009) Diffusion-weighted imaging in the pelvis: concepts and applications. RadioGraphics 29:1797–1810PubMedCrossRef
19.
go back to reference Yamashita Y, Namimoto T, Mitsuzaki K, et al. (1998) Mucin-producing tumor of the pancreas: diagnostic value of diffusion-weighted echo-planar MR imaging. Radiology 208:605–609PubMed Yamashita Y, Namimoto T, Mitsuzaki K, et al. (1998) Mucin-producing tumor of the pancreas: diagnostic value of diffusion-weighted echo-planar MR imaging. Radiology 208:605–609PubMed
20.
go back to reference Inan N, Arslan A, Akansel G, Anik Y, Demerci A (2008) Diffusion-weighted imaging in the differential diagnosis of cystic lesions of the pancreas. AJR Am J Roentgenol 191:1115–1121PubMedCrossRef Inan N, Arslan A, Akansel G, Anik Y, Demerci A (2008) Diffusion-weighted imaging in the differential diagnosis of cystic lesions of the pancreas. AJR Am J Roentgenol 191:1115–1121PubMedCrossRef
21.
go back to reference Boraschi P, Donati F, Gigoni R, Salemi Bartolozzi C, Falaschi F (2010) Diffusion-weighted MRI in the characterization of cystic pancreatic lesions: usefulness of ADC values. Magn Reson Imaging 28:1447–1455PubMedCrossRef Boraschi P, Donati F, Gigoni R, Salemi Bartolozzi C, Falaschi F (2010) Diffusion-weighted MRI in the characterization of cystic pancreatic lesions: usefulness of ADC values. Magn Reson Imaging 28:1447–1455PubMedCrossRef
22.
go back to reference Fatima Z, Ichikawa T, Motosugi U, et al. (2011) Magnetic resonance diffusion-weighted imaging in characterization of pancreatic mucinous cystic lesions. Clin Radiol 66:108–111PubMedCrossRef Fatima Z, Ichikawa T, Motosugi U, et al. (2011) Magnetic resonance diffusion-weighted imaging in characterization of pancreatic mucinous cystic lesions. Clin Radiol 66:108–111PubMedCrossRef
23.
go back to reference Irie H, Honda H, Kuroiwa T, et al. (2002) Measurement of the apparent diffusion coefficient in intraductal mucin-producing tumor of the pancreas by diffusion-weighted echo-planar MR imaging. Abdom Imaging 27:82–87PubMedCrossRef Irie H, Honda H, Kuroiwa T, et al. (2002) Measurement of the apparent diffusion coefficient in intraductal mucin-producing tumor of the pancreas by diffusion-weighted echo-planar MR imaging. Abdom Imaging 27:82–87PubMedCrossRef
24.
go back to reference Chang KJ, Kamel IR, Macura KJ, Bluemke DA (2008) 3.0-T MR imaging of the abdomen: comparison with 1.5-T. Radiographics 28:1983–1998PubMedCrossRef Chang KJ, Kamel IR, Macura KJ, Bluemke DA (2008) 3.0-T MR imaging of the abdomen: comparison with 1.5-T. Radiographics 28:1983–1998PubMedCrossRef
25.
go back to reference Notohamiprodjo M, Dietrich O, Horger W, et al. (2010) Diffusion tensor imaging (DTI) of the kidney at 3 Tesla–feasibility, protocol evaluation and comparison to 1.5 Tesla. Investig Radiol 45:245–254CrossRef Notohamiprodjo M, Dietrich O, Horger W, et al. (2010) Diffusion tensor imaging (DTI) of the kidney at 3 Tesla–feasibility, protocol evaluation and comparison to 1.5 Tesla. Investig Radiol 45:245–254CrossRef
26.
go back to reference Kuhl CK, Textor J, Gieseke J, et al. (1995) Acute and sub-acute ischemic stroke at high field strength (3.0-T) diffusion-weighted MR imaging: intraindividual comparative study. Radiology 234:509–516CrossRef Kuhl CK, Textor J, Gieseke J, et al. (1995) Acute and sub-acute ischemic stroke at high field strength (3.0-T) diffusion-weighted MR imaging: intraindividual comparative study. Radiology 234:509–516CrossRef
27.
go back to reference Rosenkrantz AB, Oei M, Babb JS, Niver BE, Taouli B (2011) Diffusion-weighted imaging of the abdomen at 3.0 Tesla: image quality and apparent diffusion coefficient reproducibility compared with 1.5 Tesla. J Magn Reson Imaging 33:128–135PubMedCrossRef Rosenkrantz AB, Oei M, Babb JS, Niver BE, Taouli B (2011) Diffusion-weighted imaging of the abdomen at 3.0 Tesla: image quality and apparent diffusion coefficient reproducibility compared with 1.5 Tesla. J Magn Reson Imaging 33:128–135PubMedCrossRef
28.
go back to reference Nam SJ, Hwang HK, Kim H, et al. (2010) Lymphoepithelial cysts in the pancreas: MRI of two cases with emphasis of diffusion-weighted imaging characteristics. J Magn Reson Imaging 32:692–696PubMedCrossRef Nam SJ, Hwang HK, Kim H, et al. (2010) Lymphoepithelial cysts in the pancreas: MRI of two cases with emphasis of diffusion-weighted imaging characteristics. J Magn Reson Imaging 32:692–696PubMedCrossRef
Metadata
Title
Diffusion-weighted MRI of focal cystic pancreatic lesions at 3.0-Tesla: preliminary results
Authors
Jeffrey C. Mottola
V. Anik Sahni
Sukru M. Erturk
Richard Swanson
Peter A. Banks
Koenraad J. Mortele
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
Abdominal Radiology / Issue 1/2012
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-011-9737-6

Other articles of this Issue 1/2012

Abdominal Radiology 1/2012 Go to the issue