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Arora M, Lakhera D, Rawat K, Thakker V, Randhawa LS, Patel A, Agarwal R, Azad RK. Diffusion-weighted Imaging: New Paradigm in Diagnosis of Early Acute Pancreatitis. Ann Afr Med 2024; 23:635-640. [PMID: 39138974 PMCID: PMC11556478 DOI: 10.4103/aam.aam_79_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) has come up as a newer diagnostic modality for the diagnosis of early functional changes in various organs including the pancreas. DWI has shown the ability of early and accurate diagnosis of inflammatory pathologies, before the appearance of morphological changes on imaging. OBJECTIVES The objectives of this study were to study the diagnostic accuracy of DWI in the diagnosis of early acute interstitial pancreatitis. MATERIALS AND METHODS The present retrospective observational study was conducted at the department of radiodiagnosis of a tertiary teaching hospital for 1 year. Fifty patients who underwent magnetic resonance imaging of the pancreas with clinical or laboratory diagnosis of early pancreatitis were included in the study. The diagnostic accuracy of DWI was analyzed on the basis of quantitative (apparent diffusion coefficient [ADC] values) evaluation in the diagnosis of early acute pancreatitis. Threshold values for ADC were derived for differentiation of inflamed versus normal pancreas. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were obtained by drawing the receiver operating characteristic (ROC) curve. RESULTS The mean ADC values in the patient group (0.882 × 10 -3 mm 2 /s ± 0.102) were significantly lower than the control group (1.178 × 10 -3 mm 2 /s ± 0.232) with P < 0.001. The ROC curve deciphered a cutoff value of 0.937 × 10 -3 mm 2 /s with a sensitivity of 84%, specificity of 86%, PPV of 85.71%, and NPV of 84.31% for diagnosis of acute pancreatitis using quantitative ADC values. CONCLUSION DWI can thus be a succinct modality for early diagnosis of pancreatitis with excellent diagnostic accuracy and superlative advantage of lack of contrast and radiation in comparison to computed tomography scan.
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Affiliation(s)
- Manali Arora
- Department of Radiology, SGRRIM and HS, Dehradun, Uttarakhand, India
| | - Devkant Lakhera
- Department of Radiology, SGRRIM and HS, Dehradun, Uttarakhand, India
| | - Kanica Rawat
- Department of Radiology, SGRRIM and HS, Dehradun, Uttarakhand, India
| | - Vishal Thakker
- Department of Radiology, SGRRIM and HS, Dehradun, Uttarakhand, India
| | | | - Amisha Patel
- Department of Radiology, SGRRIM and HS, Dehradun, Uttarakhand, India
| | - Rachit Agarwal
- Department of Radiology, SGRRIM and HS, Dehradun, Uttarakhand, India
| | - Rajiv Kumar Azad
- Department of Radiology, SGRRIM and HS, Dehradun, Uttarakhand, India
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Wang S, Zhang Y, Xu Y, Yang P, Liu C, Gong H, Lei J. Progress in the application of dual-energy CT in pancreatic diseases. Eur J Radiol 2023; 168:111090. [PMID: 37742372 DOI: 10.1016/j.ejrad.2023.111090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/19/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
Pancreatic diseases are difficult to diagnose due to their insidious onset and complex pathophysiological developmental characteristics. In recent years, dual-energy computed tomography (DECT) imaging technology has rapidly advanced. DECT can quantitatively extract and analyze medical imaging features and establish a correlation between these features and clinical results. This feature enables the adoption of more modern and accurate clinical diagnosis and treatment strategies for patients with pancreatic diseases so as to achieve the goal of non-invasive, low-cost, and personalized treatment. The purpose of this review is to elaborate on the application of DECT for the diagnosis, biological characterization, and prediction of the survival of patients with pancreatic diseases (including pancreatitis, pancreatic cancer, pancreatic cystic tumor, pancreatic neuroendocrine tumor, and pancreatic injury) and to summarize its current limitations and future research prospects.
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Affiliation(s)
- Sha Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China
| | - Yanli Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China; Department of Radiology, The First Hospital of Lanzhou University, Lanzhou 730000, China; Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou 730000, China
| | - Yongsheng Xu
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China; Department of Radiology, The First Hospital of Lanzhou University, Lanzhou 730000, China; Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou 730000, China
| | - Pengcheng Yang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Chuncui Liu
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China
| | - Hengxin Gong
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China
| | - Junqiang Lei
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China; Department of Radiology, The First Hospital of Lanzhou University, Lanzhou 730000, China; Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou 730000, China.
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Ha J, Choi SH, Kim KW, Kim JH, Kim HJ. MRI features for differentiation of autoimmune pancreatitis from pancreatic ductal adenocarcinoma: A systematic review and meta-analysis. Dig Liver Dis 2022; 54:849-856. [PMID: 34903501 DOI: 10.1016/j.dld.2021.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The accurate differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic ductal adenocarcinoma (PDAC) is clinically important. We aimed to determine significant MRI features for differentiating AIP from PDAC, including assessment of diffusion-weighted imaging (DWI). METHODS We performed a systematic search using three databases. The pooled diagnostic odds ratio was calculated using a bivariate random effects model to determine significant MRI features for differentiating AIP from PDAC. The pooled sensitivity and specificity were calculated. The qualitative systematic review for DWI assessment was performed. RESULTS Of nine studies (775 patients), multiple main pancreatic duct (MPD) strictures, absence of upstream marked MPD dilatation, peripancreatic rim, and duct penetration sign were significant MRI features for differentiating AIP from PDAC. Absence of MPD dilatation had the highest pooled sensitivity (87%, 95% CI=68-96%), whereas peripancreatic rim had the highest pooled specificity (100%, 95% CI=88-100%). Of 12 studies evaluating DWI, seven reported statistically significant differences in apparent diffusion coefficient (ADC) values between AIP and PDAC; however, four reported lower ADC values in AIP than in PDAC, but three reported the opposite result. CONCLUSION The four significant MRI features can be useful to differentiate AIP from PDAC, but DWI assessment might be limited.
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Affiliation(s)
- Jiyeon Ha
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sang Hyun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Korea.
| | - Kyung Won Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Jin Hee Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Hyoung Jung Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Korea
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Smith HJ. The history of magnetic resonance imaging and its reflections in Acta Radiologica. Acta Radiol 2021; 62:1481-1498. [PMID: 34657480 DOI: 10.1177/02841851211050857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The first reports in Acta Radiologica on magnetic resonance imaging (MRI) were published in 1984, four years after the first commercial MR scanners became available. For the first two years, all MR papers originated from the USA. Nordic contributions started in 1986, and until 2020, authors from 44 different countries have published MR papers in Acta Radiologica. Papers on MRI have constituted, on average, 30%-40% of all published original articles in Acta Radiologica, with a high of 49% in 2019. The MR papers published since 1984 document tremendous progress in several areas such as magnet and coil design, motion compensation techniques, faster image acquisitions, new image contrast, contrast-enhanced MRI, functional MRI, and image analysis. In this historical review, all of these aspects of MRI are discussed and related to Acta Radiologica papers.
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Affiliation(s)
- Hans-Jørgen Smith
- Department of Radiology and Nuclear Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Deng Y, Ming B, Zhou T, Wu JL, Chen Y, Liu P, Zhang J, Zhang SY, Chen TW, Zhang XM. Radiomics Model Based on MR Images to Discriminate Pancreatic Ductal Adenocarcinoma and Mass-Forming Chronic Pancreatitis Lesions. Front Oncol 2021; 11:620981. [PMID: 33842325 PMCID: PMC8025779 DOI: 10.3389/fonc.2021.620981] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/01/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND It is difficult to identify pancreatic ductal adenocarcinoma (PDAC) and mass-forming chronic pancreatitis (MFCP) lesions through conventional CT or MR examination. As an innovative image analysis method, radiomics may possess potential clinical value in identifying PDAC and MFCP. To develop and validate radiomics models derived from multiparametric MRI to distinguish pancreatic ductal adenocarcinoma (PDAC) and mass-forming chronic pancreatitis (MFCP) lesions. METHODS This retrospective study included 119 patients from two independent institutions. Patients from one institution were used as the training cohort (51 patients with PDAC and 13 patients with MFCP), and patients from the other institution were used as the testing cohort (45 patients with PDAC and 10 patients with MFCP). All the patients had pathologically confirmed results, and preoperative MRI was performed. Four feature sets were extracted from T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and the artery (A) and portal (P) phases of dynamic contrast-enhanced MRI, and the corresponding radiomics models were established. Several clinical characteristics were used to discriminate PDAC and MFCP lesions, and clinical model was established. The results of radiologists' evaluation were compared with pathology and radiomics models. Univariate analysis and the least absolute shrinkage and selection operator algorithm were performed for feature selection, and a support vector machine was used for classification. The receiver operating characteristic (ROC) curve was applied to assess the model discrimination. RESULTS The areas under the ROC curves (AUCs) for the T1WI, T2WI, A and, P and clinical models were 0.893, 0.911, 0.958, 0.997 and 0.516 in the primary cohort, and 0.882, 0.902, 0.920, 0.962 and 0.649 in the validation cohort, respectively. All radiomics models performed better than clinical model and radiologists' evaluation both in the training and testing cohorts by comparing the AUC of various models, all P<0.050. Good calibration was achieved. CONCLUSIONS The radiomics models based on multiparametric MRI have the potential ability to classify PDAC and MFCP lesions.
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Affiliation(s)
- Yan Deng
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Bing Ming
- Department of Radiology, Deyang People’s Hospital, Deyang, China
| | - Ting Zhou
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jia-long Wu
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yong Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pei Liu
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ju Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shi-yong Zhang
- Department of Radiology, Deyang People’s Hospital, Deyang, China
| | - Tian-wu Chen
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Abuzeid HM, Yassin A, Kamel OF, Sabry KA. Role of diffusion-weighted MR imaging in diagnosis of acute pancreatitis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the diagnosis of acute pancreatitis is assessed in this study by measuring the apparent diffusion coefficient (ADC) values in acute pancreatitis and comparing them with a control group. The aim of this study is to compare those two groups thus supporting the diagnosis of this disease.
Sixteen patients with acute pancreatitis and 16 control participants underwent diffusion-weighted imaging with b values of 0, 200, and 800. ADC maps were generated from the DW-MRI and ADC values, which were calculated for the pancreas, and the results of the two groups of patients were compared.
Results
The mean pancreatic ADC value in the acute pancreatitis group (1.15 10(−3) mm(2)/s ± 0.28) was significantly lower than in the normal group (1.6 10−3 mm(2)/s ± 0.2). A threshold ADC value of 1.38 10−3 mm(2)/s yielded 81.25%, specificity of 93.75%, positive predictive value of 92.9%, negative predictive value of 83.3%, and accuracy of 91.8%. Pancreatic ADC values were significantly lower in patients with acute pancreatitis than in the control group.
Conclusion
Diffusion-weighted magnetic resonance imaging could be an important supportive tool in the diagnosis of acute pancreatitis.
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Greenhalf W, Lévy P, Gress T, Rebours V, Brand RE, Pandol S, Chari S, Jørgensen MT, Mayerle J, Lerch MM, Hegyi P, Kleeff J, Castillo CFD, Isaji S, Shimosegawa T, Sheel A, Halloran CM, Garg P, Takaori K, Besselink MG, Forsmark CE, Wilcox CM, Maisonneuve P, Yadav D, Whitcomb D, Neoptolemos J. International consensus guidelines on surveillance for pancreatic cancer in chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology 2020; 20:910-918. [PMID: 32624419 DOI: 10.1016/j.pan.2020.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with chronic pancreatitis (CP) have an increased risk of pancreatic cancer. We present the international consensus guidelines for surveillance of pancreatic cancer in CP. METHODS The international group evaluated 10 statements generated from evidence on 5 questions relating to pancreatic cancer in CP. The GRADE approach was used to evaluate the level of evidence available per statement. The working group voted on each statement for strength of agreement, using a nine-point Likert scale in order to calculate Cronbach's alpha reliability coefficient. RESULTS In the following domains there was strong consensus: (1) the risk of pancreatic cancer in affected individuals with hereditary pancreatitis due to inherited PRSS1 mutations is high enough to justify surveillance; (2) the risk of pancreatic cancer in patients with CP associated with SPINK1 p. N34S is not high enough to justify surveillance; (3) surveillance should be undertaken in pancreatic specialist centers; (4) surveillance should only be introduced after the age of 40 years and stopped when the patient would no longer be suitable for surgical intervention. All patients with CP should be advised to lead a healthy lifestyle aimed at avoiding risk factors for progression of CP and pancreatic cancer. There was only moderate or weak agreement on the best methods of screening and surveillance in other types of environmental, familial and genetic forms of CP. CONCLUSIONS Patients with inherited PRSS1 mutations should undergo surveillance for pancreatic cancer, but the best methods for cancer detection need further investigation.
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Affiliation(s)
- William Greenhalf
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Philippe Lévy
- Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, DHU UNITY, Hôpital Beaujon, APHP, 92118 Clichy Cedex, and Université Paris 7, France
| | - Thomas Gress
- Department of Gastroenterology, Endocrinology and Metabolism, University Hospital, Philipps-Universität Marburg, Marburg, Germany
| | - Vinciane Rebours
- Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, DHU UNITY, Hôpital Beaujon, APHP, 92118 Clichy Cedex, and Université Paris 7, France
| | - Randall E Brand
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, 5200 Centre Avenue, Suite 409, Pittsburgh, PA, 15232, USA
| | - Steve Pandol
- Cedars-Sinai Medical Center, Los Angeles, CA, United States Veterans Affairs Greater Los Angeles Healthcare System, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Suresh Chari
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, D-17475, Greifswald, Germany
| | - Péter Hegyi
- Institute for Translational Medicine &Department of Translational Medicine/1st Department of Medicine, Medical School, Pécs, H-7624, Hungary
| | - Jörg Kleeff
- Department of Surgery, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Shuiji Isaji
- Department of Surgery, Mie University Graduate School of Medicine, Japan.
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Andrea Sheel
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Christopher M Halloran
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Kyoichi Takaori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Marc G Besselink
- Department of Surgery, Amsterdam Gastroenterology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Chris E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| | | | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Dhiraj Yadav
- Department of Medicine University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - David Whitcomb
- Department of Medicine University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - John Neoptolemos
- Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Zhang T, Lu Y, Yang B, Zhang C, Li J, Liu H, Wang H, Wang D. Diffusion Metrics for Staging Pancreatic Fibrosis and Correlating With Epithelial‐Mesenchymal Transition Markers in a Chronic Pancreatitis Rat Model at 11.7T MRI. J Magn Reson Imaging 2020; 52:197-206. [DOI: 10.1002/jmri.26995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/20/2022] Open
Abstract
BackgroundChronic pancreatitis (CP) is characterized by pancreatic fibrosis, in which a epithelial‐mesenchymal transition (EMT)‐like process is observed. However, few noninvasive approaches have been reported to evaluate pancreatic fibrosis and EMT in an animal model based on diffusion imaging.PurposeTo evaluate pancreatic fibrosis in CP by conventional diffusion‐weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) and then explore the correlation between diffusion parameters and the EMT markers in an animal model.Study TypeProspective controlled imaging histological correlation.PopulationForty‐five rats with CP induced by injecting dibutyltin dichloride solution and 10 normal rats comprised the control group.Field Strength/Sequence11.7T MR, diffusion imaging with 10 b‐values.AssessmentApparent diffusion coefficient (ADC), IVIM‐associated perfusion fraction (f), pseudodiffusion coefficient (D*), diffusion coefficient (D), DKI‐associated mean kurtosis (MK), and mean corrected diffusion coefficient (MD) were quantitatively measured and correlated with pancreatic fibrosis stages as well as the EMT markers E‐cadherin and α‐smooth muscle actin (α‐SMA) expression. The discriminative performance of diffusion parameters for staging fibrosis was compared.Statistical TestsSpearman's correlation, Student's t‐test, and a receiver operating characteristic curve was conducted for statistical analysis.ResultsADC, D, and MD (r = –0.637, –0.688, and –0.535; P < 0.001) were negatively correlated with pancreatic fibrosis staging, but MK (r = 0.740, P < 0.001) had a positive correlation. ADC, D, MD, and MK were significantly correlated with α‐SMA (r = –0.684, –0.728, –0.627, and 0.721, all P < 0.001), while MK was significantly correlated with E‐cadherin (r = –0.606, P < 0.001). The area under the curve (AUC) was not significantly different (P > 0.05) among ADC (0.797, 0.816, 0.873), D (0.862, 0.810, 0.895), MD (0.767, 0.772, 0.801), and MK (0.836, 0.893, 0.951) for F1 or greater, F2 or greater, and F3 pancreatic fibrosis separately.Data ConclusionADC, D, MD, and MK were helpful for assessing pancreatic fibrosis staging, and these diffusion parameters were also significantly correlated with the expression of EMT markers in pancreatic fibrosis.Level of Evidence: 2Technical Efficacy Stage: 2J. Magn. Reson. Imaging 2020;52:197–206.
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Affiliation(s)
- Tingting Zhang
- Department of Radiology, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yimei Lu
- Department of Radiology, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Baofeng Yang
- Institute of Science and Technology for Brain‐Inspired Intelligence Fudan University Shanghai China
| | - Caiyuan Zhang
- Department of Radiology, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Jinning Li
- Department of Radiology, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Huanhuan Liu
- Department of Radiology, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - He Wang
- Institute of Science and Technology for Brain‐Inspired Intelligence Fudan University Shanghai China
- Human Phenome Institute Fudan University Shanghai China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
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Elsherif SB, Virarkar M, Javadi S, Ibarra-Rovira JJ, Tamm EP, Bhosale PR. Pancreatitis and PDAC: association and differentiation. Abdom Radiol (NY) 2020; 45:1324-1337. [PMID: 31705251 DOI: 10.1007/s00261-019-02292-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The discrimination of mass-forming chronic pancreatitis (MFCP) from pancreatic ductal adenocarcinoma (PDAC) is a central diagnostic dilemma. It is important to differentiate these entities since they have markedly different prognoses and management. Importantly, the appearance of these two entities significantly overlaps on a variety of imaging modalities. However, there are imaging features that may be suggestive of one entity more than the other. MFCP and PDAC may show different enhancement patterns on perfusion computed tomography (CT) and/or dynamic contrast-enhanced MRI (DCE-MRI). The duct-penetrating sign on magnetic resonance cholangiopancreatography (MRCP) is more often associated with MFCP, whereas abrupt cutoff with upstream dilatation of the main pancreatic duct and the double-duct sign (obstruction/cutoff of both the common bile duct and pancreatic duct) are more often associated with PDAC. Nevertheless, tissue sampling is the most reliable method to differentiate between these entities and is currently generally necessary for management.
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Affiliation(s)
- Sherif B Elsherif
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA.
- The Department of Internal Medicine, Weiss Memorial Hospital, Affiliate of the University of Illinois at Chicago, Chicago, USA.
| | - Mayur Virarkar
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
| | - Sanaz Javadi
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
| | - Juan J Ibarra-Rovira
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
| | - Eric P Tamm
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
| | - Priya R Bhosale
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
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10
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Harrington KA, Shukla-Dave A, Paudyal R, Do RKG. MRI of the Pancreas. J Magn Reson Imaging 2020; 53:347-359. [PMID: 32302044 DOI: 10.1002/jmri.27148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023] Open
Abstract
MRI has played a critical role in the evaluation of patients with pancreatic pathologies, from screening of patients at high risk for pancreatic cancer to the evaluation of pancreatic cysts and indeterminate pancreatic lesions. The high mortality associated with pancreatic adenocarcinomas has spurred much interest in developing effective screening tools, with MRI using magnetic resonance cholangiopancreatography (MRCP) playing a central role in the hopes of identifying cancers at earlier stages amenable to curative resection. Ongoing efforts to improve the resolution and robustness of imaging of the pancreas using MRI may thus one day reduce the mortality of this deadly disease. However, the increasing use of cross-sectional imaging has also generated a concomitant clinical conundrum: How to manage incidental pancreatic cystic lesions that are found in over a quarter of patients who undergo MRCP. Efforts to improve the specificity of MRCP for patients with pancreatic cysts and with indeterminate pancreatic masses may be achieved with continued technical advances in MRI, including diffusion-weighted and T1 -weighted dynamic contrast-enhanced MRI. However, developments in quantitative MRI of the pancreas remain challenging, due to the small size of the pancreas and its upper abdominal location, adjacent to bowel and below the diaphragm. Further research is needed to improve MRI of the pancreas as a clinical tool, to positively affect the lives of patients with pancreatic abnormalities. This review focuses on various MR techniques such as MRCP, quantitative imaging, and dynamic contrast-enhanced imaging and their clinical applicability in the imaging of the pancreas, with an emphasis on pancreatic malignant and premalignant lesions. Level of Evidence 5 Technical Efficacy Stage 3 J. MAGN. RESON. IMAGING 2021;53:347-359.
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Affiliation(s)
- Kate A Harrington
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amita Shukla-Dave
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ramesh Paudyal
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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The Microarchitecture of Pancreatic Cancer as Measured by Diffusion-Weighted Magnetic Resonance Imaging Is Altered by T Cells with a Tumor Promoting Th17 Phenotype. Int J Mol Sci 2020; 21:ijms21010346. [PMID: 31948053 PMCID: PMC6982276 DOI: 10.3390/ijms21010346] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 12/17/2022] Open
Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is a diagnostic tool that is increasingly used for the detection and characterization of focal masses in the abdomen, among these, pancreatic ductal adenocarcinoma (PDAC). DW-MRI reflects the microarchitecture of the tissue, and changes in diffusion, which are reflected by changes in the apparent diffusion coefficient (ADC), are mainly attributed to variations in cellular density, glandular formation, and fibrosis. When analyzing the T cell infiltrates, we found an association of a tumor-promoting subpopulation, characterized by the expression of interleukin (IL) 21 and IL26, with high ADC values. Moreover, the presence of IL21+ and IL26+ positive T cells was associated with poor prognosis. Pancreatic cancers—but not healthy pancreatic tissue—expressed receptors for IL21 and IL26, a finding that could be confirmed in pancreatic cell lines. The functionality of these receptors was demonstrated in pancreatic tumor cell lines, which showed phosphorylation of ERK1/2 and STAT3 pathways in response to the respective recombinant interleukins. Moreover, in vitro data showed an increased colony formation of tumor cells. In summary, our data showed an association of IL21+ and IL26+ immune cell infiltration, increased ADC, and aggressive tumor disease, most likely due to the activation of the key cancer signaling pathways ERK1/2 and STAT3 and formation of tumor colonies.
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12
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Chouhan MD, Firmin L, Read S, Amin Z, Taylor SA. Quantitative pancreatic MRI: a pathology-based review. Br J Radiol 2019; 92:20180941. [PMID: 30982337 DOI: 10.1259/bjr.20180941] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
MRI plays an important role in the clinical management of pancreatic disorders and interpretation is reliant on qualitative assessment of anatomy. Conventional sequences capturing pancreatic structure can however be adapted to yield quantitative measures which provide more diagnostic information, with a view to increasing diagnostic accuracy, improving patient stratification, providing robust non-invasive outcome measures for therapeutic trials and ultimately personalizing patient care. In this review, we evaluate the use of established techniques such as secretin-enhanced MR cholangiopancreatography, diffusion-weighted imaging, T 1, T 2* and fat fraction mapping, but also more experimental methods such as MR elastography and arterial spin labelling, and their application to the assessment of diffuse pancreatic disease (including chronic, acute and autoimmune pancreatitis/IgG4 disease, metabolic disease and iron deposition disorders) and cystic/solid focal pancreatic masses. Finally, we explore some of the broader challenges to their implementation and future directions in this promising area.
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Affiliation(s)
- Manil D Chouhan
- 1 University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL , London , UK.,2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Louisa Firmin
- 2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Samantha Read
- 2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Zahir Amin
- 2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Stuart A Taylor
- 1 University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL , London , UK.,2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
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13
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Tonolini M, Di Pietro S. Diffusion-weighted MRI: new paradigm for the diagnosis of interstitial oedematous pancreatitis. Gland Surg 2019; 8:197-206. [PMID: 31183329 PMCID: PMC6534761 DOI: 10.21037/gs.2018.12.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/24/2018] [Indexed: 04/17/2024]
Affiliation(s)
- Massimo Tonolini
- Department of Radiology, “Luigi Sacco” University Hospital, Milan, Italy
| | - Salvatore Di Pietro
- Department of Radiology, “Luigi Sacco” University Hospital, Milan, Italy
- Post-graduation School in Radiodiagnostics, University of Milan, Milan, Italy
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14
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Shi Z, Li X, Li Y, You R, Cao D, Chen Q, Ramen K, Loosa VS. Assessment of acute obstructive pancreatitis by magnetic resonance imaging: Predicting the occurrence of pancreatic fistula following pancreatoduodenectomy. Mol Clin Oncol 2019; 10:371-376. [PMID: 30847176 DOI: 10.3892/mco.2019.1799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/20/2018] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to assess the effect of preoperative acute obstructive pancreatitis on the risk of the occurrence of pancreatic fistula (PF) following pancreaticoduodenectomy. A total of 22 patients who developed postoperative PF were carefully matched with 22 control patients without PF according to demographic data, pancreatic pathology, presenting symptoms and other surgery-associated parameters. These parameters were compared between these two groups. The mean pancreatic apparent diffusion coefficient (ADC) values in the fistula group were 1.14±0.31×10-3 mm2/s, which was significantly decreased compared with the non-fistula group (1.48±0.44×10-3 mm2/s) (P=0.005). The pancreas-muscle signal intensity (SI) ratio on fat-suppressed T1 weighted image (rT1) in the fistula group was 1.71±0.25, which was significantly increased compared with the non-fistula group (1.25±0.29) (P<0.001). The pancreas-muscle SI ratios on fat-suppressed T2 weighted image (T2WI) in the fistula group and the non-fistula group were 0.72±0.08 and 0.62±0.07, respectively (P=0.79). There was no significant difference in pancreas-muscle SI ratio on fat-suppressed T2-weighted image (rT2) value between these two groups. Based on the receiver operating characteristic curve, the optimal cut-off value of ADC as a criterion for prediction of pancreatic fistula was 1.29×10-3 mm2/s, which yielded a sensitivity of 77.3% and a specificity of 63.6%. In conclusion, the severity of acute obstructive pancreatitis was negatively associated with ADC values and pancreas-muscle SI ratio on rT1 images, which may be useful for predicting the occurrence of PF preoperatively.
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Affiliation(s)
- Zhenshan Shi
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Xiumei Li
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Yueming Li
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Ruixiong You
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Qunlin Chen
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Kamisha Ramen
- Department of Radiology, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Vikash Sahadeo Loosa
- Department of Radiology, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
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15
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Kareem HA, Abdel Rady A. The utility of DW-MRI in the diagnosis of pancreatic focal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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16
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Baleato-González S, García-Figueiras R, Luna A, Domínguez-Robla M, Vilanova J. Functional imaging in pancreatic disease. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Frøkjær JB, Akisik F, Farooq A, Akpinar B, Dasyam A, Drewes AM, Haldorsen IS, Morana G, Neoptolemos JP, Olesen SS, Petrone MC, Sheel A, Shimosoegawa T, Whitcomb DC. Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis. Pancreatology 2018; 18:764-773. [PMID: 30177434 DOI: 10.1016/j.pan.2018.08.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/16/2018] [Accepted: 08/25/2018] [Indexed: 02/01/2023]
Abstract
The paper presents the international guidelines for imaging evaluation of chronic pancreatitis. The following consensus was obtained: Computed tomography (CT) is often the most appropriate initial imaging modality for evaluation of patients with suspected chronic pancreatitis (CP) depicting most changes in pancreatic morphology. CT is also indicated to exclude other potential intraabdominal pathologies presenting with symptoms similar to CP. However, CT cannot exclude a diagnosis of CP nor can it be used to exclusively diagnose early or mild disease. Here magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) is superior and is indicated especially in patients where no specific pathological changes are seen on CT. Secretin-stimulated MRCP is more accurate than standard MRCP in the depiction of subtle ductal changes. It should be performed after a negative MRCP, when there is still clinical suspicion of CP. Endoscopic ultrasound (EUS) can also be used to diagnose parenchymal and ductal changes mainly during the early stage of the disease. No validated radiological severity scoring systems for CP are available, although a modified Cambridge Classification has been used for MRCP. There is an unmet need for development of a new and validated radiological CP severity scoring system based on imaging criteria including glandular volume loss, ductal changes, parenchymal calcifications and parenchymal fibrosis based on CT and/or MRI. Secretin-stimulated MRCP in addition, can provide assessment of exocrine function and ductal compliance. An algorithm is presented, where these imaging parameters can be incorporated together with clinical findings in the classification and severity grading of CP.
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Affiliation(s)
- Jens Brøndum Frøkjær
- Department of Radiology, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
| | - Fatih Akisik
- Department of Radiology, Indiana University, Indianapolis, USA
| | - Ammad Farooq
- Department of Radiology, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Burcu Akpinar
- Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Anil Dasyam
- Department of Radiology, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Denmark; Centre for Pancreatic Diseases, Department of Gastroenterology and Mech-Sense, Aalborg University Hospital, Denmark
| | | | - Giovanni Morana
- Radiological Department, Treviso General Hospital, Treviso, Italy
| | | | - Søren Schou Olesen
- Department of Clinical Medicine, Aalborg University, Denmark; Centre for Pancreatic Diseases, Department of Gastroenterology and Mech-Sense, Aalborg University Hospital, Denmark
| | - Maria Chiara Petrone
- Pancreas Translational and Clinical Research Center Vita Salute San Raffaele University, Milan, Italy
| | - Andrea Sheel
- Department of Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Tooru Shimosoegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
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Liu Y, Wang M, Ji R, Cang L, Gao F, Shi Y. Differentiation of pancreatic ductal adenocarcinoma from inflammatory mass: added value of magnetic resonance elastography. Clin Radiol 2018; 73:865-872. [DOI: 10.1016/j.crad.2018.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023]
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19
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Baleato-González S, García-Figueiras R, Luna A, Domínguez-Robla M, Vilanova JC. Functional imaging in pancreatic disease. RADIOLOGIA 2018; 60:451-464. [PMID: 30236460 DOI: 10.1016/j.rx.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/12/2022]
Abstract
In addition to the classical morphological evaluation of pancreatic disease, the constant technological advances in imaging techniques based fundamentally on computed tomography and magnetic resonance imaging have enabled the quantitative functional and molecular evaluation of this organ. In many cases, this imaging-based information results in substantial changes to patient management and can be a fundamental tool for the development of biomarkers. The aim of this article is to review the role of emerging functional and molecular techniques based on computed tomography and magnetic resonance imaging in the evaluation of pancreatic disease.
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Affiliation(s)
- S Baleato-González
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - R García-Figueiras
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - A Luna
- Grupo Health Time. Director - Advanced Medical Imaging, Sercosa (Servicio de Radiología Computerizada), Clínica Las Nieves, Jaén, España
| | - M Domínguez-Robla
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J C Vilanova
- Departamento de Radiología, Clínica Girona-Hospital Santa Caterina, Girona, España
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20
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Torres US, Matsumoto C, de Macedo Neto AC, Caldana RP, Motoyama Caiado ÂH, Tiferes DA, Warmbrand G, de Godoy LL, D’Ippolito G. Common and Uncommon Benign Pancreatic Lesions Mimicking Malignancy: Imaging Update and Review. Semin Ultrasound CT MR 2018; 39:206-219. [DOI: 10.1053/j.sult.2017.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Ma W, Zhang G, Ren J, Pan Q, Wen D, Zhong J, Zhang Z, Huan Y. Quantitative parameters of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI): potential application in predicting pathological grades of pancreatic ductal adenocarcinoma. Quant Imaging Med Surg 2018; 8:301-310. [PMID: 29774183 DOI: 10.21037/qims.2018.04.08] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The aim of this study was to compare intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) parameters such as standard apparent diffusion coefficient (ADCstandard), pure diffusion coefficient (Dslow), pseudodiffusion coefficient (Dfast) and perfusion fraction (ƒ) for differentiating pancreatic ductal adenocarcinoma (PDAC) with different pathological grades. Methods Institutional Review Board of our hospital approved this study protocol. Subjects comprised 38 PDACs confirmed by pathology. Pancreatic multiple b values DWI with 15 b values of 0, 10, 20, 40, 60, 80, 100, 150, 200, 400, 800, 1,000, 1200, 1,500, and 2,000 s/mm2 was performed using GE Discovery MR750 3.0T scanner. ADCstandard, Dslow, Dfast and ƒ values of all PDACs were calculated using mono- and bi-exponential models. Parameters of well/moderately differentiated and poorly differentiated PDAC were compared using Independent Sample t-test. P values <0.05 were considered significant. Results Mean Dslow value of well/moderately differentiated PDAC was significantly lower than that of poorly differentiated PDAC (0.540×10-3vs. 0.676×10-3 mm2/s, P<0.001). Mean ƒ value of well/moderately differentiated PDAC was significantly higher than that of poorly differentiated PDAC (60.3% vs. 38.4%, P<0.001). The area under curve value of ƒ in differentiating well/moderately differentiated PDAC from poorly differentiated PDAC was slightly higher than that of Dslow (0.894>0.865). When the Dslow value was less than or equal to 0.599×10-3 mm2/s, the sensitivity and specificity were 100% and 84.6% respectively. When ƒ value was greater than 49.6%, the sensitivity and specificity were 92.0% and 84.6% respectively. Conclusions Dslow and ƒ derived from IVIM-DWI model can be used to distinguish well/moderately differentiated PDAC from poorly differentiated PDAC. And to serve this purpose, Dslow and ƒ have high diagnostic performance. IVIM-DWI is a promising and non-invasive tool for predicting pathological grade of PDAC.
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Affiliation(s)
- Wanling Ma
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Guangwen Zhang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Jing Ren
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Qi Pan
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Didi Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Jinman Zhong
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yi Huan
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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Taron J, Martirosian P, Kuestner T, Schwenzer NF, Othman A, Weiß J, Notohamiprodjo M, Nikolaou K, Schraml C. Scan time reduction in diffusion-weighted imaging of the pancreas using a simultaneous multislice technique with different acceleration factors: How fast can we go? Eur Radiol 2017; 28:1504-1511. [DOI: 10.1007/s00330-017-5132-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/12/2017] [Accepted: 10/11/2017] [Indexed: 12/13/2022]
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Ma C, Li J, Boukar MB, Yang P, Wang L, Chen L, Su L, Qu J, Chen SY, Hao Q, Lu JP. Optimized ROI size on ADC measurements of normal pancreas, pancreatic cancer and mass-forming chronic pancreatitis. Oncotarget 2017; 8:99085-99092. [PMID: 29228754 PMCID: PMC5716794 DOI: 10.18632/oncotarget.18457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/23/2017] [Indexed: 12/20/2022] Open
Abstract
Objectives To investigate the effects of region of interest (ROI) sizes on apparent diffusion coefficient (ADC) measurements for the differentiation of normal pancreas (NP), pancreatic ductal adenocarcinoma (PDAC) and mass-forming chronic pancreatitis (MFCP). Results There were no significant differences for the mean ADCs measured by 12 different-size ROIs for MFCP, or PDAC and NP (P = 0.858–1.0). With the increase of ROI size (≥ 55 mm2), ADCs of PDAC were significantly lower than those of NP (all P < 0.05), but there was no difference of the accuracy in ADC for differentiating the two groups only at a ROI size of 214 mm2. When ROI size was above 99 mm2, ADCs of MFCP were significantly lower than those of NP (all P < 0.05). There were no significant differences for any of the mean ADCs measured by 12 different-size ROIs between PDAC and MFCP (P > 0.05). Materials and Methods Diffusion-weighted imaging (DWI) was performed on 89 participants: 64 with PDAC, 7 with MFCP, as well as 18 healthy volunteers. ADC maps were created using mono-exponential model. A homemade software was used to measure the mean ADC values of 12 concentric round ROIs (areas: 15, 46, 55, 82, 99, 121, 134, 152, 161, 189, 214, 223, and 245 mm2) for the mass of lesions and the NP tissue. Conclusions In ADC measurements, the optimized ROI size is 214 mm2 for the differentiation of PDAC and NP; ROI size of ≥ 99 mm2 is recommended to differentiate between MFCP and NP. ADC was not useful for the differentiation of PDAC and MFCP.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Mbaiaoure Barak Boukar
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Panpan Yang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Luguang Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Li Su
- School of Pharmacy, Second Military Medical University, Shanghai, China
| | - Jianxun Qu
- GE Healthcare, MR Group, Shanghai, China
| | - Shi-Yue Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Qiang Hao
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
| | - Jian-Ping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, Shanghai, China
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Ma C, Guo X, Liu L, Zhan Q, Li J, Zhu C, Wang L, Zhang J, Fang X, Qu J, Chen S, Shao C, Lu JP. Effect of region of interest size on ADC measurements in pancreatic adenocarcinoma. Cancer Imaging 2017; 17:13. [PMID: 28464866 PMCID: PMC5414294 DOI: 10.1186/s40644-017-0116-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To investigate the influence of region of interest (ROI) size on tumor apparent diffusion coefficient (ADC) measurements in pancreatic cancer. METHODS The study population consisted of 64 patients with pathologically proved pancreatic ductal adenocarcinomas (PDACs), who underwent preoperative magnetic resonance imaging (MRI) examinations including diffusion-weighted imaging (DWI). The tumor ADCs were measured by two independent readers using six round ROIs with sizes ranging from 20 to 214 mm2 (9 to 97 pixels) in both the six separate measurements. The intra- and inter-observer variabilities were analyzed by using the coefficient of variance (CV), the interclass correlation coefficient (ICC) and Bland-Altman analysis. The mean ADCs measured with the 6 different-sized ROIs were compared using one-way repeated analysis of variance. The sample sizes were calculated by using 80% power and a 5% significance level to detect 10 to 25% changes in ADC measurements. RESULTS The largest ROI (ROI214) yielded the best intra-observer repeatability (CV, 6.3%; ICC, 0.93) and inter-observer reproducibility (CV, 10.1%; ICC, 0.84). The mean differences in ADC measurements ± limits of agreement between the two readers were (0.06 ± 0.47) × 10-3 mm2 for ROI20, (0.08 ± 0.46) × 10-3 mm2 for ROI46, (0.05 ± 0.37) × 10-3 mm2 for ROI82, (0.07 ± 0.42) × 10-3 mm2 for ROI115, (0.05 ± 0.43) × 10-3 mm2 for ROI152 and (-0.02 ± 0.29) × 10-3 mm2 for ROI214. CONCLUSIONS ROI size had a considerable influence on the ADC measurements of PDACs.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Xiaoyu Guo
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Li Liu
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Qian Zhan
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China.
| | - Jing Zhang
- Department of Pathology, Changhai Hospital of Shanghai, the Second Military Medical University, Shanghai, China
| | - Xu Fang
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Jianxun Qu
- GE Healthcare, MR Group, Shanghai, China
| | - Shiyue Chen
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
| | - Jian-Ping Lu
- Department of Radiology, Changhai Hospital of Shanghai, the Second Military Medical University, No.168 Changhai Road, 200433, Shanghai, China
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Ma C, Li Y, Wang L, Wang Y, Zhang Y, Wang H, Chen S, Lu J. Intravoxel incoherent motion DWI of the pancreatic adenocarcinomas: monoexponential and biexponential apparent diffusion parameters and histopathological correlations. Cancer Imaging 2017; 17:12. [PMID: 28454564 PMCID: PMC5410078 DOI: 10.1186/s40644-017-0114-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
Background To investigate the associations between the diffusion parameters obtained from multiple-b-values diffusion weighted imaging (DWI) of pancreatic ductal adenocarcinoma (PDAC) and the aggressiveness and local stage prediction, and assess the values of the quantitative parameters for the discrimination of tumors from healthy pancreas. Methods Fifty-one patients with surgical pathology-proven PDAC (size, 35 ± 12 mm) and fifty-seven healthy volunteers were enrolled. Diffusion parameters including monoexponential apparent diffusion coefficient (ADCb and ADCtotal) and biexponential intravoxel incoherent motion (IVIM) parameters (ADCslow, ADCfast and f) based on 9 b-values (0 to 1000s/mm2) DWI were calculated for the lesions and the healthy pancreas. These parameters were compared by grades of differentiation, lymph node status, tumor stage and location. The diagnostic performances were calculated and compared by using the receiver operating characteristic curves (ROC) analyses. Results There was no statistically significant difference in ADCb, ADCtotal, ADCslow, ADCfast or f between PDAC stage T1/T2 and stage T3/T4 or moderately differentiated versus poorly differentiated PDAC (p = 0.060-0.941). In addition, no significant differences were observed for the quantitative parameters between tumors located in the pancreatic head versus other pancreatic regions (p = 0.203-0.954) or between tumors with and without metastatic peri-pancreatic lymph nodes (p = 0.313-0.917). ADC25-600, ADC1000, ADCtotal and ADCfast were significantly lower for PDAC compared the healthy pancreas (all p < 0.05). ROC analyses showed the area under curve for ADC20 was the largest (0.911) to distinguish PDAC from normal pancreas (cut-off value, 5.58 × 10−3mm2/s) and had the highest combined sensitivity (89.5%) and specificity (82.4%). Conclusions Multiple-b-values DWI derived monoexponential and biexponential parameters of PDAC do not exhibit significance dependence on tumor grade or tumor characteristics. ADC20 provided the best accuracy for differentiating PDAC from healthy pancreas in the study.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Yanjun Li
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Yang Wang
- Department of Pathology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, China
| | - Yong Zhang
- MR Group, GE Healthcare, No. 1 Huatuo Road, Shanghai, China
| | - He Wang
- MR Group, GE Healthcare, No. 1 Huatuo Road, Shanghai, China
| | - Shiyue Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China.
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Zhang TT, Wang L, Liu HH, Zhang CY, Li XM, Lu JP, Wang DB. Differentiation of pancreatic carcinoma and mass-forming focal pancreatitis: qualitative and quantitative assessment by dynamic contrast-enhanced MRI combined with diffusion-weighted imaging. Oncotarget 2017; 8:1744-1759. [PMID: 27661003 PMCID: PMC5352094 DOI: 10.18632/oncotarget.12120] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/13/2016] [Indexed: 12/18/2022] Open
Abstract
Differentiation between pancreatic carcinoma (PC) and mass-forming focal pancreatitis (FP) is invariably difficult. For the differential diagnosis, we qualitatively and quantitatively assessed the value of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in PC and FP in the present study. This study included 32 PC and 18 FP patients with histological confirmation who underwent DCE-MRI and DWI. The time-signal intensity curve (TIC) of PC and FP were classified into 5 types according to the time of reaching the peak, namely, type I, II, III, IV, and V, respectively, and two subtypes, namely, subtype-a (washout type) and subtype-b (plateau type) according to the part of the TIC profile after the peak. Moreover, the mean and relative apparent diffusion coefficient (ADC) value between PC and FP on DWI were compared. The type V TIC was only recognized in PC group (P < 0.01). Type IV b were more frequently observed in PC (P = 0.036), while type- IIa (P < 0.01), type- Ia (P = 0.037) in FP. We also found a significant difference in the mean and relative ADC value between PC and FP. The combined image set of DCE-MRI and DWI yielded an excellent sensitivity, specificity, and diagnostic accuracy (96.9%, 94.4%, and 96.0%). The TIC of DCE-MRI and ADC value of DWI for pancreatic mass were found to provide reliable information in differentiating PC from FP, and the combination of DCE-MRI and DWI can achieve a higher sensitivity, specificity, and diagnostic accuracy.
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Affiliation(s)
- Ting-Ting Zhang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Wang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Huan-huan Liu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cai-yuan Zhang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-ming Li
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-ping Lu
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Deng-bin Wang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Fifty Years of Technological Innovation: Potential and Limitations of Current Technologies in Abdominal Magnetic Resonance Imaging and Computed Tomography. Invest Radiol 2016; 50:584-93. [PMID: 26039773 DOI: 10.1097/rli.0000000000000173] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Magnetic resonance imaging (MRI) has become an important modality for the diagnosis of intra-abdominal pathology. Hardware and pulse sequence developments have made it possible to derive not only morphologic but also functional information related to organ perfusion (dynamic contrast-enhanced MRI), oxygen saturation (blood oxygen level dependent), tissue cellularity (diffusion-weighted imaging), and tissue composition (spectroscopy). These techniques enable a more specific assessment of pathologic lesions and organ functionality. Magnetic resonance imaging has thus transitioned from a purely morphologic examination to a modality from which image-based disease biomarkers can be derived. This fits well with several emerging trends in radiology, such as the need to accurately assess response to costly treatment strategies and the need to improve lesion characterization to potentially avoid biopsy. Meanwhile, the cost-effectiveness, availability, and robustness of computed tomography (CT) ensure its place as the current workhorse for clinical imaging. Although the lower soft tissue contrast of CT relative to MRI is a long-standing limitation, other disadvantages such as ionizing radiation exposure have become a matter of public concern. Nevertheless, recent technical developments such as dual-energy CT or dynamic volume perfusion CT also provide more functional imaging beyond morphology.The aim of this article was to review and discuss the most important recent technical developments in abdominal MRI and state-of-the-art CT, with an eye toward the future, providing examples of their clinical utility for the evaluation of hepatic and renal pathologies.
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Triantopoulou C, Papaparaskeva K, Agalianos C, Dervenis C. Innovations in macroscopic evaluation of pancreatic specimens and radiologic correlation. Eur J Radiol Open 2016; 3:49-59. [PMID: 27069980 PMCID: PMC4811858 DOI: 10.1016/j.ejro.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/23/2016] [Indexed: 02/07/2023] Open
Abstract
The axial slicing technique offers many advantages in accurate estimation of tumors extend and staging. Cross-sectional axial imaging is the best technique for accurate radiologic-pathologic correlation. Correlation may explain any discrepancies between radiological and histopathological findings. Pathology correlation may offer a better understanding of the missed findings by imaging or pitfalls The purpose of this study was to evaluate the feasibility of a novel dissection technique of surgical specimens in different cases of pancreatic tumors and provide a radiologic pathologic correlation. In our hospital, that is a referral center for pancreatic diseases, the macroscopic evaluation of the pancreatectomy specimens is performed by the pathologists using the axial slicing technique (instead of the traditional procedure with longitudinal opening of the main pancreatic and/or common bile duct and slicing along the plane defined by both ducts). The specimen is sliced in an axial plane that is perpendicular to the longitudinal axis of the descending duodenum. The procedure results in a large number of thin slices (3–4 mm). This plane is identical to that of CT or MRI and correlation between pathology and imaging is straightforward. We studied 70 cases of suspected different solid and cystic pancreatic tumors and we correlated the tumor size and location, the structure—consistency (areas of necrosis—hemorrhage—fibrosis—inflammation), the degree of vessels’ infiltration, the size of pancreatic and common bile duct and the distance from resection margins. Missed findings by imaging or pitfalls were recorded and we tried to explain all discrepancies between radiology evaluation and the histopathological findings. Radiologic-pathologic correlation is extremely important, adding crucial information on imaging limitations and enabling quality assessment of surgical specimens. The deep knowledge of different pancreatic tumors’ consistency and way of extension helps to improve radiologists’ diagnostic accuracy and minimize the radiological-surgical mismatching, preventing patients from unnecessary surgery.
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Affiliation(s)
| | - Kleo Papaparaskeva
- Histopathology Department, Konstantopouleio General Hospital, Athens, Greece
| | | | - Christos Dervenis
- Surgery Department, Konstantopouleio General Hospital, Athens, Greece
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Hayano K, Miura F, Wada K, Suzuki K, Takeshita K, Amano H, Toyota N, Sano K, Asano T. Diffusion-weighted MR imaging of pancreatic cancer and inflammation: Prognostic significance of pancreatic inflammation in pancreatic cancer patients. Pancreatology 2016; 16:121-126. [PMID: 26596539 DOI: 10.1016/j.pan.2015.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pancreatic cancer often accompanies chronic obstructive pancreatitis (COP) due to obstruction of the main pancreatic duct, and the inflammatory environment may enhance cancer progression. The purpose of this study is to evaluate COP using the apparent diffusion coefficient (ADC) value measured by diffusion-weighted MR imaging (DWI), and to assess its prognostic significance in pancreatic cancer. METHODS Twenty-eight patients (16 men, 12 women; mean age 67.1 years) with pancreatic cancers who underwent DWI followed by curative surgery were evaluated. The ADC value of pancreatic parenchyma upstream to the tumor (upstream pancreas) was measured and compared with the upstream pancreatic duct dilatation to assess whether DWI could reflect COP. The ADC values of tumor and upstream portion were compared with overall survival (OS) using Cox regression and Kaplan-Meier analysis. RESULTS The ADC value of upstream pancreas was significantly lower in patients with greater dilated pancreatic duct than those with less (P = 0.03). In univariate Cox regression analysis, the ADC value of upstream pancreas showed a significant association with OS (P = 0.01), but that of tumor did not (P = 0.06). In Kaplan-Meier analysis, patients with lower ADC value of upstream pancreas (<1.36 × 10(-3) mm(2)/s) were significantly associated with poor OS (P = 0.0006). In multivariate analysis, the ADC value of upstream pancreas was identified as an independent prognostic factor (P = 0.01; hazards ratio, 0.05; 95% CI, 0.004-0.59). CONCLUSIONS The ADC value of upstream pancreas was an independent prognostic factor for OS in pancreatic cancer patients. Inflammatory environment may play an important role in pancreatic cancer progression.
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Affiliation(s)
- Koichi Hayano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan; Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazufumi Suzuki
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koji Takeshita
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hodaka Amano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoyuki Toyota
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takehide Asano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Lee NK, Kim S, Kim DU, Seo HI, Kim HS, Jo HJ, Kim TU. Diffusion-weighted magnetic resonance imaging for non-neoplastic conditions in the hepatobiliary and pancreatic regions: pearls and potential pitfalls in imaging interpretation. ACTA ACUST UNITED AC 2015; 40:643-62. [PMID: 25216848 DOI: 10.1007/s00261-014-0235-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Potentially, diffusion-weighted magnetic resonance imaging (DWI) can assess the functional information on concerning the status of tissue cellularity, because increased cellularity is associated with impeded diffusion. DWI in the hepatobiliary and pancreatic regions has demonstrated the usefulness to detect malignant lesions and differentiate them from benign lesions. However, it has been shown more recently that there is some overlap in ADC values for benign and malignant neoplasms. Moreover, some non-neoplastic lesions in the hepatobiliary and pancreatic regions exhibit restricted diffusion on DWI, because of pus, inflammation, or high cellularity. Focal eosinophilic liver disease, hepatic inflammatory myofibroblastic tumor, granulomatous liver disease, acute cholecystitis, xanthogranulomatous cholecystitis, focal pancreatitis, or autoimmune pancreatitis frequently exhibit restricted diffusion on DWI, which may be confused with malignancy in the hepatobiliary and pancreatic regions. Thus, DWI should not be interpreted in isolation, but in conjunction with other conventional images, to avoid the diagnostic pitfalls of DWI. Nevertheless, the presence of diffusion restriction in the non-neoplastic lesions sometimes provides additional information regarding the diagnosis, in problematic patients where conventional images have yielded equivocal findings. DWI may help differentiate hepatic abscess from malignant necrotic tumors, gallbladder empyema from dense bile or sludge in the gallbladder, and pylephlebitis from bland thrombosis in the portal vein. Therefore, knowledge of DWI findings to conventional imaging findings of diffusion-restricted non-neoplastic conditions in the hepatobiliary and pancreatic regions helps establishing a correct diagnosis.
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Affiliation(s)
- Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, #179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea
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Liu L, Ma C, Li J, Wang L, Chen LG, Zhang Y, Chen SY, Lu JP. Comparison of the Diagnostic Performances of Three Techniques of ROI Placement for ADC Measurements in Pancreatic Adenocarcinoma. Acad Radiol 2015; 22:1385-92. [PMID: 26292914 DOI: 10.1016/j.acra.2015.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/16/2015] [Accepted: 06/16/2015] [Indexed: 01/27/2023]
Abstract
RATIONALE AND OBJECTIVES To prospectively investigate and compare three techniques of region of interest (ROI) placement for apparent diffusion coefficient (ADC) measurements in patients with pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS Twenty-one patients with surgical pathology-proven PDAC and 18 healthy volunteers were included. Respiratory-triggered single-shot echo-planar diffusion-weighted imaging (b values = 0, 600 s/mm(2)) was used to calculate the ADC maps across all participants. Three readers independently measured the ADCs according to three ROI methods: whole-volume, single-slice, and small solid samples of tumor. Mean ADCs for the healthy pancreas were calculated using three measurements from pancreatic head to tail, and ADCs of distal pancreas to the tumor were also measured. The interobserver variability for the three techniques was measured using the interclass correlation coefficient. The diagnostic performances were calculated and compared using the receiver operating characteristic curves (ROC). RESULTS All the ADCs measured from the three ROI placements on PDAC were significantly lower than that from the normal pancreas. ADCs of solid tumor samples were significantly lower than that measured from whole volume or single slice (both P < .001). Only the ADCs measured from the solid sample ROI placements on tumor were observed significantly lower than the ADC of distal pancreatic parenchyma (P = .005). Areas under the ROC for the identification of PDAC, based on small solid samples, single-slice and whole-volume ROIs, respectively, were 0.939, 0.791, and 0.735. CONCLUSIONS ADC based on the small solid samples of tumor provided the highest diagnostic performance in assessing PDAC and was more accurate than ADCs measured from single-slice or whole-volume ROI.
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Affiliation(s)
- Li Liu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Lu-guang Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Yong Zhang
- GE Healthcare, MR Group, Shanghai, China
| | - Shi-yue Chen
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China
| | - Jian-ping Lu
- Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No. 168 Changhai Rd, Shanghai 20043, China.
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De Robertis R, Tinazzi Martini P, Demozzi E, Dal Corso F, Bassi C, Pederzoli P, D’Onofrio M. Diffusion-weighted imaging of pancreatic cancer. World J Radiol 2015; 7:319-328. [PMID: 26516428 PMCID: PMC4620112 DOI: 10.4329/wjr.v7.i10.319] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/27/2015] [Accepted: 08/28/2015] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a reliable and accurate imaging method for the evaluation of patients with pancreatic ductal adenocarcinoma (PDAC). Diffusion-weighted imaging (DWI) is a relatively recent technological improvement that expanded MRI capabilities, having brought functional aspects into conventional morphologic MRI evaluation. DWI can depict the random diffusion of water molecules within tissues (the so-called Brownian motions). Modifications of water diffusion induced by different factors acting on the extracellular and intracellular spaces, as increased cell density, edema, fibrosis, or altered functionality of cell membranes, can be detected using this MR sequence. The intravoxel incoherent motion (IVIM) model is an advanced DWI technique that consent a separate quantitative evaluation of all the microscopic random motions that contribute to DWI, which are essentially represented by molecular diffusion and blood microcirculation (perfusion). Technological improvements have made possible the routine use of DWI during abdominal MRI study. Several authors have reported that the addition of DWI sequence can be of value for the evaluation of patients with PDAC, especially improving the staging; nevertheless, it is still unclear whether and how DWI could be helpful for identification, characterization, prognostic stratification and follow-up during treatment. The aim of this paper is to review up-to-date literature data regarding the applications of DWI and IVIM to PDACs.
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Kim H, Lee JM, Yoon JH, Jang JY, Kim SW, Ryu JK, Kannengiesser S, Han JK, Choi BI. Reduced Field-of-View Diffusion-Weighted Magnetic Resonance Imaging of the Pancreas: Comparison with Conventional Single-Shot Echo-Planar Imaging. Korean J Radiol 2015; 16:1216-25. [PMID: 26576110 PMCID: PMC4644742 DOI: 10.3348/kjr.2015.16.6.1216] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 07/21/2015] [Indexed: 02/01/2023] Open
Abstract
Objective To investigate the image quality (IQ) and apparent diffusion coefficient (ADC) of reduced field-of-view (FOV) di-ffusion-weighted imaging (DWI) of pancreas in comparison with full FOV DWI. Materials and Methods In this retrospective study, 2 readers independently performed qualitative analysis of full FOV DWI (FOV, 38 × 38 cm; b-value, 0 and 500 s/mm2) and reduced FOV DWI (FOV, 28 × 8.5 cm; b-value, 0 and 400 s/mm2). Both procedures were conducted with a two-dimensional spatially selective radiofrequency excitation pulse, in 102 patients with benign or malignant pancreatic diseases (mean size, 27.5 ± 14.4 mm). The study parameters included 1) anatomic structure visualization, 2) lesion conspicuity, 3) artifacts, 4) IQ score, and 5) subjective clinical utility for confirming or excluding initially considered differential diagnosis on conventional imaging. Another reader performed quantitative ADC measurements of focal pancreatic lesions and parenchyma. Wilcoxon signed-rank test was used to compare qualitative scores and ADCs between DWI sequences. Mann Whitney U-test was used to compare ADCs between the lesions and parenchyma. Results On qualitative analysis, reduced FOV DWI showed better anatomic structure visualization (2.76 ± 0.79 at b = 0 s/mm2 and 2.81 ± 0.64 at b = 400 s/mm2), lesion conspicuity (3.11 ± 0.99 at b = 0 s/mm2 and 3.15 ± 0.79 at b = 400 s/mm2), IQ score (8.51 ± 2.05 at b = 0 s/mm2 and 8.79 ± 1.60 at b = 400 s/mm2), and higher clinical utility (3.41 ± 0.64), as compared to full FOV DWI (anatomic structure, 2.18 ± 0.59 at b = 0 s/mm2 and 2.56 ± 0.47 at b = 500 s/mm2; lesion conspicuity, 2.55 ± 1.07 at b = 0 s/mm2 and 2.89 ± 0.86 at b = 500 s/mm2; IQ score, 7.13 ± 1.83 at b = 0 s/mm2 and 8.17 ± 1.31 at b = 500 s/mm2; clinical utility, 3.14 ± 0.70) (p < 0.05). Artifacts were significantly improved on reduced FOV DWI (2.65 ± 0.68) at b = 0 s/mm2 (full FOV DWI, 2.41 ± 0.63) (p < 0.001). On quantitative analysis, there were no significant differences between the 2 DWI sequences in ADCs of various pancreatic lesions and parenchyma (p > 0.05). ADCs of adenocarcinomas (1.061 × 10-3 mm2/s ± 0.133 at reduced FOV and 1.079 × 10-3 mm2/s ± 0.135 at full FOV) and neuroendocrine tumors (0.983 × 10-3 mm2/s ± 0.152 at reduced FOV and 1.004 × 10-3 mm2/s ± 0.153 at full FOV) were significantly lower than those of parenchyma (1.191 × 10-3 mm2/s ± 0.125 at reduced FOV and 1.218 × 10-3 mm2/s ± 0.103 at full FOV) (p < 0.05). Conclusion Reduced FOV DWI of the pancreas provides better overall IQ including better anatomic detail, lesion conspicuity and subjective clinical utility.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea. ; Aerospace Medical Group, Air Force Education and Training Command, Jinju 52634, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea. ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Ji Kon Ryu
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | | | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea. ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea. ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
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Pancreatic ductal adenocarcinoma and chronic mass-forming pancreatitis: Differentiation with dual-energy MDCT in spectral imaging mode. Eur J Radiol 2015; 84:2470-6. [PMID: 26481480 DOI: 10.1016/j.ejrad.2015.09.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/01/2015] [Accepted: 09/27/2015] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate the value of dual-energy MDCT in spectral imaging in the differential diagnosis of chronic mass-forming chronic pancreatitis (CMFP) and pancreatic ductal adenocarcinoma (PDAC) during the arterial phase (AP) and the pancreatic parenchymal phase (PP). MATERIALS AND METHODS Thirty five consecutive patients with CMFP (n=15) or PDAC (n=20) underwent dual-energy MDCT in spectral imaging during AP and PP. Iodine concentrations were derived from iodine-based material-decomposition CT images and normalized to the iodine concentration in the aorta. The difference in iodine concentration between the AP and PP, contrast-to-noise ratio (CNR) and the slope K of the spectrum curve were calculated. RESULTS Normalized iodine concentrations (NICs) in patients with CMFP differed significantly from those in patients with PDAC during two double phases (mean NIC, 0.26±0.04 mg/mL vs. 0.53±0.02 mg/mL, p=0.0001; 0.07±0.02 mg/mL vs. 0.28±0.04 mg/mL, p=0.0002, respectively). There were significant differences in the value of the slope K of the spectrum curve in two groups during AP and PP (K(CMFP)=3.27±0.70 vs. K(PDAC)=1.35±0.41, P=0.001, and K(CMFP)=3.70±0.17 vs. K(PDAC)=2.16±0.70, p=0.003, respectively). CNRs at low energy levels (40-70 keV) were higher than those at high energy levels (80-40 keV). CONCLUSION Individual patient CNR-optimized energy level images and the NIC can be used to improve the sensitivity and the specificity for differentiating CMFP from PDAC by use of dual-energy MDCT in spectral imaging with fast tube voltage switching.
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Warda MHA, Hasan DI, Elteeh OA. Differentiation of Pancreatic lesions using Diffusion-Weighted MRI. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Ma C, Liu L, Li J, Wang L, Chen LG, Zhang Y, Chen SY, Lu JP. Apparent diffusion coefficient (ADC) measurements in pancreatic adenocarcinoma: A preliminary study of the effect of region of interest on ADC values and interobserver variability. J Magn Reson Imaging 2015; 43:407-13. [PMID: 26182908 DOI: 10.1002/jmri.25007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess the influence of region of interest (ROI) on tumor apparent diffusion coefficient (ADC) measurements and interobserver variability in pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS Twenty-two patients recruited with pathology-proven PDAC underwent diffusion-weighted imaging (DWI, 3.0T) prior to the surgical resection. Two independent readers measured tumor ADCs according to three ROI methods: whole-volume, single-slice, and small solid sample of tumor. Minimum and mean ADCs were obtained. The interobserver variability for each of the three methods was analyzed using interclass correlation coefficient (ICC) and Bland-Altman analysis. The minimum and mean ADCs among the ROI methods were compared using nonparametric tests. RESULTS The single-slice ROI method showed the best reproducibility in the minimum ADC measurements (mean difference ± limits of agreement between two readers were 0.025 ± 0.25 × 10(-3) mm2 /s; ICC, 0.92) among the three ROI methods. For the solid tumor sample ROI, both minimum ADC and mean ADC measurements reproducibility were the worst, with limits of agreement up to ±0.50 × 10(-3) mm2 /s and ±0.32 × 10(-3) mm2 /s, respectively (ICCs, 0.41/0.58). Both the minimum and mean ADCs demonstrated significant differences among the three ROI methods (both P < 0.001). The post-hoc analyses results showed no significant difference with regard to the mean ADCs between whole-volume and single-slice ROI methods (P = 0.14). CONCLUSION The ROI method had a considerable influence on both the minimum and mean ADC values and the interobserver variability in PDAC. The worst interobserver variability was observed for both the minimum and mean ADCs derived from small solid-sample ROI.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Li Liu
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Li Wang
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Lu-Guang Chen
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Yong Zhang
- GE Healthcare, MR Group, Shanghai, China
| | - Shi-Yue Chen
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
| | - Jian-Ping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, Shanghai, China
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Abstract
Diffusion-weighted imaging (DWI) has become a routine component of clinical MR imaging. Its unique soft tissue contrast mechanism exploits differences in the motion of water molecules in vivo at a biologically meaningful scale. The clinical potential of DWI in lesion detection, characterization, and response assessment has been explored. This review briefly covers basic principles of DWI and introduces advances, specifically for abdominopelvic organs.
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Affiliation(s)
- Lorenzo Mannelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; St Eloi Hospital, CHU Montpellier, Montpellier, France
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Value of diffusion-weighted MRI for differentiating malignant from benign intraductal papillary mucinous neoplasms of the pancreas. AJR Am J Roentgenol 2015; 203:992-1000. [PMID: 25341136 DOI: 10.2214/ajr.13.11980] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether the use of diffusion-weighted MRI (DWI) increases diagnostic accuracy in the differentiation of malignant from benign intraductal papillary mucinous neoplasms (IPMNs) of the pancreas over the accuracy of contrast-enhanced MRI with MRCP. MATERIALS AND METHODS A total of 61 patients with surgically resected IPMNs (19 malignant, 42 benign) who underwent gadoxetic acid-enhanced MRI, DWI, and MRCP were included. Two blinded observers evaluated two image sets, that is, conventional MRI with MRCP images versus combined conventional MRI with MRCP and DW images, and scored their confidence for malignancy of IPMNs. Qualitative analyses of the IPMNs were also conducted. Diagnostic performance (ROC curve analysis), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. The Fisher exact test was used to compare groups. RESULTS The diagnostic performance (area under the ROC curve [Az]) with respect to predicting malignancy of IPMNs improved significantly for both observers after additional review of DW images (p < 0.05). The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of combined conventional and DW images were higher than those of conventional MR images alone. Diffusion restriction was more often present in malignant IPMNs (78.9%) than in benign IPMNs (16.7%) (p < 0.001) with excellent interobserver agreement (ĸ = 0.965). CONCLUSION Compared with conventional MRI alone, adding DWI to conventional MRI improves diagnostic accuracy with increased specificity for differentiating malignant from benign IPMNs of the pancreas.
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de Freitas Tertulino F, Schraibman V, Ardengh JC, do Espírito-Santo DC, Ajzen SA, Torrez FRA, Lobo EJ, Szejnfeld J, Goldman SM. Diffusion-weighted magnetic resonance imaging indicates the severity of acute pancreatitis. ABDOMINAL IMAGING 2015; 40:265-271. [PMID: 25070771 DOI: 10.1007/s00261-014-0205-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To test the use of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate between different degrees of severity of acute pancreatitis (AP). METHOD Thirty-six patients who underwent DW-MRI and magnetic resonance cholangiopancreatography were divided into patients with mild AP (mAP, n = 15), patients with necrotizing AP (nAP, n = 8), and patients with a normal pancreas (nP, n = 15; controls). The pancreas was divided into head, body, and tail, and each segment was classified according to image features: pattern 1, normal; pattern 2, mild inflammation; and pattern 3, necrosis. Apparent diffusion coefficients (ADCs) were measured in each segment and correlated with clinical diagnoses. RESULTS A total of 108 segments was assessed (three segments per patient). Segments classified as pattern 1 in the nP and mAP groups showed similar ADC values (P = 0.29). ADC values calculated for the pancreatic segments grouped according to the different image patterns (1-3) were significantly different (P < 0.001). Comparisons revealed significant differences in signal intensity between all three patterns (P < 0.05). CONCLUSIONS DW-MRI was a compatible and safe image option to differentiate tissue image patterns in patients with mAP, nAP, and nP, mainly in those with contraindications to contrast-enhanced MRI (which is classically required for determining the presence of necrosis) or computed tomography. ADC measures allowed precise differentiation between patterns 1, 2, and 3.
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40
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Barral M, Taouli B, Guiu B, Koh DM, Luciani A, Manfredi R, Vilgrain V, Hoeffel C, Kanematsu M, Soyer P. Diffusion-weighted MR Imaging of the Pancreas: Current Status and Recommendations. Radiology 2015; 274:45-63. [DOI: 10.1148/radiol.14130778] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ma X, Zhao X, Ouyang H, Sun F, Zhang H, Zhou C. Quantified ADC histogram analysis: a new method for differentiating mass-forming focal pancreatitis from pancreatic cancer. Acta Radiol 2014; 55:785-92. [PMID: 24167322 DOI: 10.1177/0284185113509264] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND As their prognosis and management are different, differentiation of mass-forming focal pancreatitis (FP) from pancreatic adenocarcinoma (PC) is important. However, the similar clinical presentations and imaging features of these conditions, along with inconclusive biopsy results can make such differentiation difficult. PURPOSE To determine whether apparent diffusion coefficient (ADC) histogram analysis can discriminate between a normal pancreas, FP, and PC. MATERIAL AND METHODS In a retrospective study, 25 PC patients, 14 FP patients, and 25 subjects with a normal pancreas underwent breath-hold diffusion-weighted imaging (DWI) on a 3.0 T magnetic resonance (MR) scanner. Regions of interest (ROIs) were drawn on the normal pancreases and on the entire focal lesions of both PC and FP. The ADC value was averaged from the lowest to 10th, 30th, 50th, and 100th percentile of the histogram (i.e. ADC10, ADC30, ADC50, and ADC100, respectively), and the results were analyzed statistically. RESULTS There were no significant differences among the head, body, and tail of normal pancreases for any of the mean ADC values (P > 0.05). ADC10, ADC30, and ADC50 values demonstrated significant differences between lesion and non-lesion areas of both PC (P < 0.05) and FP (P < 0.05). Differences in lesion areas between PC and FP were found with ADC50 and ADC100 values (P < 0.05), and helped differentiate a normal pancreas from FP and PC, and FP from PC. CONCLUSION Quantified ADC histogram can specifically reflect tissue heterogeneity and help differentiate a normal pancreas from FP and PC.
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Affiliation(s)
- Xiaohong Ma
- Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinming Zhao
- Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Han Ouyang
- Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Fei Sun
- GE Healthcare, Beijing, People’s Republic of China
| | - Hongmei Zhang
- Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
| | - Chunwu Zhou
- Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China
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42
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Diffusion-weighted magnetic resonance imaging of the pancreas: diagnostic benefit from an intravoxel incoherent motion model-based 3 b-value analysis. Invest Radiol 2014; 49:93-100. [PMID: 24089021 DOI: 10.1097/rli.0b013e3182a71cc3] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the diagnostic benefit of an intravoxel incoherent motion (IVIM) model-based characterization of pancreatic masses from diffusion-weighted imaging (DWI) with 3 b values. MATERIALS AND METHODS This retrospective study had an approval from the institutional review board, and informed patient consent was waived. The 1.5-T DWI data of 42 patients with or without pancreatic disease, acquired by a respiratory-gated spin-echo echo-planar imaging sequence with 3 b values (0, 50, 800 s/mm²), were retrospectively analyzed. The IVIM-related parameters D', which is the apparent diffusion coefficient [ADC(50,800)], and f', as well as ADC(0,50), and conventional ADC(0,800) were calculated voxelwise. Regions of interest were analyzed in pancreatic adenocarcinomas (CAs, n = 12), neuroendocrine pancreatic tumors (NETs, n = 9), and chronic pancreatitis (CPs, n = 11), not affected tissue of each pathologic group, and in the head, body, and tail of the healthy pancreas (n = 10). RESULTS By ADC(0,800) and D', CAs could hardly be distinguished from neuroendocrine pancreatic tumors and chronic pancreatitis. However, CAs revealed very low ADC(0,50) and f' values, which differed significantly from all other groups. In the healthy pancreas, ADC(0,800) and D' values were significantly higher for the head than for the body and tail, but no significant differences were found for ADC(0,50) and f'. CONCLUSIONS The determination of IVIM-based microcirculation-sensitive parameter maps from DWI with 3 b values significantly improved the discrimination of CAs from NETs, CPs, and the healthy tissue.
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Abstract
In this article, functional magnetic resonance (MR) imaging techniques in the abdomen are discussed. Diffusion-weighted imaging (DWI) increases the confidence in detecting and characterizing focal hepatic lesions. The potential uses of DWI in kidneys, adrenal glands, bowel, and pancreas are outlined. Studies have shown potential use of quantitative dynamic contrast-enhanced MR imaging parameters, such as K(trans), in predicting outcomes in cancer therapy. MR elastography is considered to be a useful tool in staging liver fibrosis. A major issue with all functional MR imaging techniques is the lack of standardization of the protocol.
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Affiliation(s)
- Kumar Sandrasegaran
- Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN 46202, USA.
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44
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Ma C, Liu L, Li YJ, Chen LG, Pan CS, Zhang Y, Wang H, Chen SY, Lu JP. Intravoxel incoherent motion MRI of the healthy pancreas: Monoexponential and biexponential apparent diffusion parameters of the normal head, body and tail. J Magn Reson Imaging 2014; 41:1236-41. [PMID: 24979657 DOI: 10.1002/jmri.24684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/10/2014] [Indexed: 02/01/2023] Open
Affiliation(s)
- Chao Ma
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
| | - Li Liu
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
| | - Yan-jun Li
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
- Department of Medical Imaging; Jinling Hospital, Clinical School of Medical College, Nanjing University; Nanjing China
| | - Lu-guang Chen
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
| | - Chun-shu Pan
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
| | | | - He Wang
- GE Healthcare, MR Group; Shanghai China
| | - Shi-yue Chen
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
| | - Jian-ping Lu
- Department of Radiology; Changhai Hospital of Shanghai, The Second Military Medical University; Shanghai China
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45
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Added value of diffusion-weighted acquisitions in MRI of the abdomen and pelvis. AJR Am J Roentgenol 2014; 202:995-1006. [PMID: 24758652 DOI: 10.2214/ajr.12.9563] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this article is to review abdominopelvic applications of diffusion-weighted imaging (DWI), discuss advantages and limitations of DWI, and illustrate these with examples. CONCLUSION High-quality abdominopelvic DWI can be performed routinely on current MRI systems and may offer added value in image interpretation. Particularly in unenhanced MRI examinations, DWI may provide an alternative source of image contrast and improved conspicuity to identify and potentially characterize pathology. DWI is a powerful technique that warrants implementation in routine abdominal and pelvic imaging protocols.
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Ma C, Wang J, Li YJ, Pan CS, Zhang Y, Wang H, Chen SY, Lu JP. Comparisons of Image Quality and ADCs in Breath-Hold, Respiratory-Triggered and Free-Breathing DWI of Pancreas at 3-T. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojrad.2014.44037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Urata T, Naito Y, Izumi Y, Takekuma Y, Yokomizo H, Nagamine M, Fukuda S, Notohara K, Hifumi M. Localized type 1 autoimmune pancreatitis superimposed upon preexisting intraductal papillary mucinous neoplasms. World J Gastroenterol 2013; 19:9127-9132. [PMID: 24379640 PMCID: PMC3870568 DOI: 10.3748/wjg.v19.i47.9127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/20/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
A 70-year-old woman was found to have 2 cystic lesions in the head of the pancreas on abdominal ultrasonography during a routine medical examination. Endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography showed multilocular cysts in the head of the pancreas without dilation of the main pancreatic duct. The patient was followed-up semiannually with imaging studies for suspected branch duct-type intraductal papillary mucinous neoplasm (IPMN). At 3 years after initial presentation, hypoechoic lesions were observed around each pancreatic cyst by EUS. Diffusion-weighted imaging showed high-intensity regions corresponding to these lesions. Therefore, a diagnosis of invasive carcinoma derived from IPMN could not be excluded, and subtotal stomach-preserving pancreaticoduodenectomy was performed. The macroscopic examination of the surgical specimen showed whitish solid masses in the head of the pancreas, with multilocular cysts within each mass. Microscopically, each solid mass consisted of inflammatory cells such as lymphocytes and plasma cells. Furthermore, immunochemical staining revealed immunoglobulin G4-positive cells, and many obliterating phlebitides were observed. The cysts consisted of mucus-producing epithelial cells and showed a papillary growth pattern. Based on these findings, we diagnosed multiple localized type 1 autoimmune pancreatitis occurring only in the vicinity of the branch duct-type IPMN.
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MESH Headings
- Aged
- Autoimmune Diseases/complications
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/surgery
- Biopsy
- Carcinoma, Pancreatic Ductal/complications
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/surgery
- Cholangiopancreatography, Magnetic Resonance
- Diffusion Magnetic Resonance Imaging
- Endosonography
- Female
- Humans
- Immunohistochemistry
- Neoplasms, Cystic, Mucinous, and Serous/complications
- Neoplasms, Cystic, Mucinous, and Serous/diagnosis
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pancreatic Cyst/complications
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/surgery
- Pancreatic Neoplasms/complications
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/surgery
- Pancreaticoduodenectomy
- Pancreatitis/complications
- Pancreatitis/diagnosis
- Pancreatitis/surgery
- Treatment Outcome
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El-Shinnawy MA, Zidan DZ, Maarouf RA. Can high-b-value diffusion weighted imaging differentiate between pancreatic cancer, mass forming focal pancreatitis and normal pancreas? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Hao JG, Wang JP, Gu YL, Lu ML. Importance of b value in diffusion weighted imaging for the diagnosis of pancreatic cancer. World J Gastroenterol 2013; 19:6651-5. [PMID: 24151395 PMCID: PMC3801382 DOI: 10.3748/wjg.v19.i39.6651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/02/2013] [Accepted: 09/16/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the use of multi-b-value diffusion-weighted imaging in diagnosing pancreatic cancer. METHODS We retrospectively analyzed 33 cases of pancreatic cancer and 12 cases of benign pancreatic tumors at the Second Affiliated Hospital of Kunming Medical University from December 2008 to January 2011. The demographic characteristics, clinical presentation, routine magnetic resonance imaging and diffusion weighted imaging (DWI) features with different b values were reviewed. Continuous data were expressed as mean ± SD. Comparisons between pancreatic cancer and benign pancreatic tumors were performed using the Student's t test. A probability of P < 0.05 was considered statistically significant. RESULTS Thirty-three patients with pancreatic cancer were identified. The mean age at diagnosis was 60 ± 5.6 years. The male: female ratio was 21:12. Twenty cases were confirmed by surgical resection and 13 by biopsy of metastases. T1 weighted images demonstrated a pancreatic head mass in 16 patients, a pancreatic body mass in 10 cases, and a pancreatic tail mass with pancreatic atrophy in 7 cases. Eight patients had hepatic metastases, 13 had invasion or envelopment of mesenteric vessels, 4 had bone metastases, and 8 had lymph node metastases. DWI demonstrated an irregular intense mass with unclear margins. Necrotic tissue demonstrated an uneven low signal. A b of 1100 s/mm² was associated with a high intensity signal with poor anatomical delineation. A b of 700 s/mm² was associated with apparent diffusion coefficients (ADCs) that were useful in distinguishing benign and malignant pancreatic tumors (P < 0.05). b values of 50, 350, 400, 450 and 1100 s/mm² were associated with ADCs that did not differentiate the two tumors. CONCLUSION Low b value images demonstrated superior anatomical details when compared to high b value images. Tumor tissue definition was high and contrast with the surrounding tissues was good. DWI was useful in diagnosing pancreatic cancer.
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50
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Ma C, Li YJ, Pan CS, Wang H, Wang J, Chen SY, Lu JP. High resolution diffusion weighted magnetic resonance imaging of the pancreas using reduced field of view single-shot echo-planar imaging at 3 T. Magn Reson Imaging 2013; 32:125-31. [PMID: 24231348 DOI: 10.1016/j.mri.2013.10.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/01/2013] [Accepted: 10/11/2013] [Indexed: 12/20/2022]
Abstract
Diffusion weighted magnetic resonance imaging (DWI) has been mostly acquired using single-shot echo-planar imaging (ss EPI) to minimize motion induced artifacts. The spatial resolution, however, is inherently limited in ss EPI especially for abdominal imaging, even with the advances in parallel imaging. A novel method of reduced Field of View ss EPI (rFOV ss EPI) has achieved high resolution DWI in human carotid artery, spinal cord with reduced blurring and higher spatial resolution than conventional ss EPI, but it has not been used to pancreas imaging. In the work, comparisons between the full FOV ss-DW EPI and rFOV ss-DW EPI in image qualities and ADC values of pancreatic tumors and normal pancreatic tissues were performed to demonstrate the feasibility of pancreatic high resolution rFOV DWI. There were no significant differences in the mean ADC values between full FOV DWI and rFOV DWI for the 17 subjects using b=600s/mm(2) (P=0.962). However, subjective scores of image quality was significantly higher at rFOV ss DWI (P=0.008 and 0.000 for b-value=0s/mm(2) and 600s/mm(2) respectively). The spatial resolution of DWI for pancreas was increased by a factor of over 2.0 (from almost 3.0mm/pixel to 1.25mm/pixel) using rFOV ss EPI technique. Reduced FOV ss EPI can provide good DW images and is promising to benefit applications for pancreatic diseases.
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Affiliation(s)
- Chao Ma
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Yan-jun Li
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Chun-shu Pan
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - He Wang
- MR Group, GE Healthcare, Shanghai, China
| | - Jian Wang
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Shi-yue Chen
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Jian-ping Lu
- Department of Radiology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
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