Basic Research
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Feb 14, 2007; 13(6): 858-865
Published online Feb 14, 2007. doi: 10.3748/wjg.v13.i6.858
Pancreatic carcinoma coexisting with chronic pancreatitis versus tumor-forming pancreatitis: Diagnostic utility of the time-signal intensity curve from dynamic contrast-enhanced MR imaging
Yoshitsugu Tajima, Tamotsu Kuroki, Ryuji Tsutsumi, Ichiro Isomoto, Masataka Uetani, Takashi Kanematsu
Yoshitsugu Tajima, Tamotsu Kuroki, Ryuji Tsutsumi, Takashi Kanematsu, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
Ichiro Isomoto, Masataka Uetani, Department of Radiology and Radiation Biology, Nagasaki University Graduate School of Biomedical Sciences, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Yoshitsugu Tajima, MD, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. ytajima@net.nagasaki-u.ac.jp
Telephone: +81-9-58497316 Fax: +81-9-58497319
Received: October 25, 2006
Revised: December 1, 2006
Accepted: December 23, 2006
Published online: February 14, 2007
Abstract

AIM: To evaluate the ability of the time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging (MRI) for differentiation of focal pancreatic masses, especially pancreatic carcinoma coexisting with chronic pancreatitis and tumor-forming pancreatitis.

METHODS: Forty-eight consecutive patients who underwent surgery for a focal pancreatic mass, including pancreatic ductal carcinoma (n = 33), tumor-forming pancreatitis (n = 8), and islet cell tumor (n = 7), were reviewed. Five pancreatic carcinomas coexisted with longstanding chronic pancreatitis. The pancreatic TICs were obtained from the pancreatic mass and the pancreatic parenchyma both proximal and distal to the mass lesion in each patient, prior to surgery, and were classified into 4 types according to the time to a peak: 25 s and 1, 2, and 3 min after the bolus injection of contrast material, namely, type-I, II, III, and IV, respectively, and were then compared to the corresponding histological pancreatic conditions.

RESULTS: Pancreatic carcinomas demonstrated type-III (n = 13) or IV (n = 20) TIC. Tumor-forming pancreatitis showed type-II (n = 5) or III (n = 3) TIC. All islet cell tumors revealed type-I. The type-IV TIC was only recognized in pancreatic carcinoma, and the TIC of carcinoma always depicted the slowest rise to a peak among the 3 pancreatic TICs measured in each patient, even in patients with chronic pancreatitis.

CONCLUSION: Pancreatic TIC from dynamic MRI provides reliable information for distinguishing pancreatic carcinoma from other pancreatic masses, and may enable us to avoid unnecessary pancreatic surgery and delays in making a correct diagnosis of pancreatic carcinoma, especially, in patients with longstanding chronic pancreatitis.

Keywords: Pancreatic carcinoma; Chronic pancreatitis; Focal pancreatic mass; Tumor-forming pancreatitis; Differential diagnosis; Dynamic magnetic resonance imaging; Time-signal intensity curve