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European Radiology
Published in: European Radiology 6/2015

01-06-2015 | Gastrointestinal

Pancreatic duct “Icicle sign” on MRI for distinguishing autoimmune pancreatitis from pancreatic ductal adenocarcinoma in the proximal pancreas

Authors: Hae Jin Kim, Young Kon Kim, Woo Kyoung Jeong, Won Jae Lee, Dongil Choi

Published in: European Radiology | Issue 6/2015

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Abstract

Objective

To determine reliable MRI features of autoimmune pancreatitis (AIP) in the proximal pancreas that could allow its differentiation from pancreatic ductal adenocarcinoma (PDAC).

Methods

Twenty-three patients with AIP and 61 patients with PDAC in the proximal pancreas underwent MRI. Two observers analyzed MRI for lesion morphology, hypointensity degree on T1-weighted images, enhancement pattern during dynamic phases, capsule-like rim, presence of cysts and duct penetrating sign, morphology of bile duct, and icicle appearance and tortuosity of the upstream pancreatic duct. Sensitivity and specificity for the diagnosis of AIP were calculated for each category or combined.

Results

When isointensity on the portal and late phase of MRI and/or the icicle sign of pancreatic duct are applied, 100 % sensitivity for the diagnosis of AIP in the proximal pancreas was achieved. Applying both mild T1 hypointensity similar to the spleen and the icicle sign enabled 100 % specificity for the diagnosis of AIP by differentiating it from PDAC.

Conclusion

The combination of the icicle sign in the upstream pancreatic duct and mild T1 hypointensity or isointensity on portal and late phase of dynamic MRI could be reliable MR features for the diagnosis of AIP in the proximal pancreas by allowing its differentiation from PDAC.

Key Points

• The icicle sign of the pancreatic duct is useful for diagnosing AIP.
• Mild T1 hypointensity similar to the spleen is useful for diagnosing AIP.
• Isointensity on portal and late phases MRI is useful for diagnosing AIP.
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Metadata
Title
Pancreatic duct “Icicle sign” on MRI for distinguishing autoimmune pancreatitis from pancreatic ductal adenocarcinoma in the proximal pancreas
Authors
Hae Jin Kim
Young Kon Kim
Woo Kyoung Jeong
Won Jae Lee
Dongil Choi
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3548-4

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