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European Radiology
Published in: European Radiology 4/2017

01-04-2017 | Hepatobiliary-Pancreas

Differentiation of mass-forming focal pancreatitis from pancreatic ductal adenocarcinoma: value of characterizing dynamic enhancement patterns on contrast-enhanced MR images by adding signal intensity color mapping

Authors: Mimi Kim, Kyung Mi Jang, Jae-Hun Kim, Woo Kyoung Jeong, Seong Hyun Kim, Tae Wook Kang, Young Kon Kim, Dong Ik Cha, Kyunga Kim

Published in: European Radiology | Issue 4/2017

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Abstract

Objectives

To evaluate the value of dynamic enhancement patterns on contrast-enhanced MR images by adding signal intensity colour mapping (SICM) to differentiate mass-forming focal pancreatitis (MFFP) from pancreatic ductal adenocarcinoma (PDAC).

Methods

Forty-one clinicopathologically proven MFFPs and 144 surgically confirmed PDACs were enrolled. Laboratory and MR imaging parameters were used to differentiate MFFP from PDAC. In particular, enhancement patterns on MR images adding SICM were evaluated. By using classification tree analysis (CTA), we determined the predictors for the differentiation of MFFP from PDAC.

Results

In the CTA, with all parameters except enhancement pattern on SICM images, ductal obstruction grade and T1 hypointensity grade of the pancreatic lesion were the first and second splitting predictor for differentiation of MFFP from PDAC, in order. By adding an enhancement pattern on the SICM images to CTA, the enhancement pattern was the only splitting predictor to differentiate MFFP from PDAC. The CTA model including enhancement pattern on SICM images has sensitivity of 78.0 %, specificity of 99.3 %, and accuracy of 94.6 % for differentiating MFFP from PDAC.

Conclusion

The characterization of enhancement pattern for pancreatic lesions on contrast-enhanced MR images adding SICM would be helpful to differentiate MFFP from PDAC.

Key Points

• SICM was useful to characterize enhancement pattern.
• Enhancement pattern on SICM was the only splitting predictor on CTA.
• This model may be useful for differentiating MFFP from PDAC.
Literature
1.
Sugiyama Y, Fujinaga Y, Kadoya M et al (2012) Characteristic magnetic resonance features of focal autoimmune pancreatitis useful for differentiation from pancreatic cancer. Jpn J Radiol 30:296–309CrossRefPubMed
2.
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 36:188–197CrossRefPubMed
3.
Servais A-M, Pestieau SR, Detry O et al (2001) Autoimmune pancreatitis mimicking cancer of the head of pancreas: report of two cases. Acta Ggastroenterol Belg 64:227–230
4.
Hardacre JM, Iacobuzio-Donahue CA, Sohn TA et al (2003) Results of pancreaticoduodenectomy for lymphoplasmacytic sclerosing pancreatitis. Ann Surg 237:853–859PubMedPubMedCentral
5.
Abraham SC, Wilentz RE, Yeo CJ et al (2003) Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: Are they AllChronic Pancreatitis'? Am J Surg Pathol 27:110–120CrossRefPubMed
6.
Kennedy T, Preczewski L, Stocker SJ et al (2006) Incidence of benign inflammatory disease in patients undergoing Whipple procedure for clinically suspected carcinoma: a single-institution experience. Am J Surg 191:437–441CrossRefPubMed
7.
Rasheed ZA (2012) Pathology of pancreatic stroma in PDAC. In : Grippo PJ, Munshi HG (eds) Pancreatic Cancer and Tumor Microenvironment Trivandrum (India), Transworld Research Network, Available via http://​www.​ncbi.​nlm.​nih.​gov/​books/​NBK98933/​
8.
Apte M, Park S, Phillips P et al (2004) Desmoplastic reaction in pancreatic cancer: role of pancreatic stellate cells. Pancreas 29:179–187CrossRefPubMed
9.
10.
Kim SA, Lee JM, Lee KB et al (2011) Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern—correlation with clinicopathologic findings. Radiology 260:148–157CrossRefPubMed
11.
Chari ST, Kloeppel G, Zhang L et al (2010) Histopathologic and clinical subtypes of autoimmune pancreatitis: the Honolulu consensus document. Pancreatology 10:664–672CrossRefPubMed
12.
Shimosegawa T, Chari ST, Frulloni L et al (2011) International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 40:352–358CrossRefPubMed
13.
Haradome H, Grazioli L, Tsunoo M et al (2010) Can MR fluoroscopic triggering technique and slow rate injection provide appropriate arterial phase images with reducing artifacts on gadoxetic acid-DTPA (Gd-EOB-DTPA)-enhanced hepatic MR imaging? J Magn Reson Imaging 32:334–340CrossRefPubMed
14.
Nitta T, Mitsuhashi T, Hatanaka Y, Hirano S, Matsuno Y (2013) Pancreatic ductal adenocarcinomas with multiple large cystic structures: A clinicopathologic and immunohistochemical study of seven cases. Pancreatology 13:401–408CrossRefPubMed
15.
Kosmahl M, Pauser U, Anlauf M, Klöppel G (2005) Pancreatic ductal adenocarcinomas with cystic features: neither rare nor uniform. Mod Pathol 18:1157–1164CrossRefPubMed
16.
Kim HJ, Kim YK, Jeong WK, Lee WJ, Choi D (2015) Pancreatic duct “Icicle sign” on MRI for distinguishing autoimmune pancreatitis from pancreatic ductal adenocarcinoma in the proximal pancreas. Eur Radiol 25:1551–1560CrossRefPubMed
17.
Fattahi R, Balci NC, Perman WH et al (2009) Pancreatic diffusion‐weighted imaging (DWI): comparison between mass‐forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging 29:350–356CrossRefPubMed
18.
Sun G-F, Zuo C-J, Shao C-W, Wang J-H, Zhang J (2013) Focal autoimmune pancreatitis: radiological characteristics help to distinguish from pancreatic cancer. World J Gastroenterol 19:3634–3641CrossRefPubMedPubMedCentral
19.
Negrelli R, Manfredi R, Pedrinolla B et al (2015) Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings. Eur Radiol 25:359–367CrossRefPubMed
20.
Park MJ, Kim YK, Choi S-y, Rhim H, Lee WJ, Choi D (2014) Preoperative detection of small pancreatic carcinoma: value of adding diffusion-weighted imaging to conventional MR imaging for improving confidence level. Radiology 273:433–443CrossRefPubMed
21.
22.
Ichikawa T, Sou H, Araki T et al (2001) Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas 1. Radiology 221:107–116CrossRefPubMed
23.
Carbognin G, Girardi V, Biasiutti C et al (2009) Autoimmune pancreatitis: imaging findings on contrast-enhanced MR, MRCP and dynamic secretin-enhanced MRCP. Radiol Med 114:1214–1231CrossRefPubMed
24.
Furuhashi N, Suzuki K, Sakurai Y, Ikeda M, Kawai Y, Naganawa S (2015) Differentiation of focal-type autoimmune pancreatitis from pancreatic carcinoma: assessment by multiphase contrast-enhanced CT. Eur Radiol 25:1366–1374CrossRefPubMed
25.
Gangi S, Fletcher J, Nathan MA et al (2004) Time interval between abnormalities seen on CT and the clinical diagnosis of pancreatic cancer: retrospective review of CT scans obtained before diagnosis. AJR Am J Roentgenol 182:897–903CrossRefPubMed
26.
Kamisawa T, Notohara K, Shimosegawa T (2010) Two clinicopathologic subtypes of autoimmune pancreatitis: LPSP and IDCP. Gastroenterology 139:22–25CrossRefPubMed
27.
Lee SS, Byun JH, Park BJ et al (2008) Quantitative analysis of diffusion‐weighted magnetic resonance imaging of the pancreas: Usefulness in characterizing solid pancreatic masses. J Magn Reson Imaging 28:928–936CrossRefPubMed
28.
Huang WC, Sheng J, Chen SY, Lu JP (2011) Differentiation between pancreatic carcinoma and mass‐forming chronic pancreatitis: Usefulness of high b value diffusion‐weighted imaging. J Dig Dis 12:401–408CrossRefPubMed
29.
Barral M, Taouli B, Guiu B et al (2014) Diffusion-weighted MR imaging of the pancreas: current status and recommendations. Radiology 274:45–63CrossRef
30.
Klau M, Lemke A, Grünberg K et al (2011) Intravoxel incoherent motion MRI for the differentiation between mass forming chronic pancreatitis and pancreatic carcinoma. Invest Radiol 46:57–63CrossRef
31.
Kang KM, Lee JM, Yoon JH, Kiefer B, Han JK, Choi BI (2014) Intravoxel incoherent motion diffusion-weighted MR imaging for characterization of focal pancreatic lesions. Radiology 270:444–453CrossRefPubMed
32.
Swords DS, Mone MC, Zhang C, Presson AP, Mulvihill SJ, Scaife CL (2015) Initial misdiagnosis of proximal pancreatic adenocarcinoma is associated with delay in diagnosis and advanced stage at presentation. J Gastrointest Surg 19:1813–1821CrossRefPubMed
33.
34.
Thomassin-Naggara I, Toussaint I, Perrot N et al (2011) Characterization of complex adnexal masses: value of adding perfusion-and diffusion-weighted MR imaging to conventional MR imaging. Radiology 258:793–803CrossRefPubMed
35.
Nunes LW, Schnall MD, Orel SG (2001) Updat;e of breast MR imaging architectural interpretation model 1. Radiology 219:484–494CrossRefPubMed
Metadata
Title
Differentiation of mass-forming focal pancreatitis from pancreatic ductal adenocarcinoma: value of characterizing dynamic enhancement patterns on contrast-enhanced MR images by adding signal intensity color mapping
Authors
Mimi Kim
Kyung Mi Jang
Jae-Hun Kim
Woo Kyoung Jeong
Seong Hyun Kim
Tae Wook Kang
Young Kon Kim
Dong Ik Cha
Kyunga Kim
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4522-0

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