Comparison of Multidetector CT and Gadobutrol-Enhanced MR Imaging for Evaluation of Small, Solid Pancreatic Lesions

Abstract

ObjectiveTo compare multidetector computed tomography (MDCT) and MRI for lesion conspicuity, as well as the detection and characterization of small solid pancreatic lesions (SPLs).Materials and Methods193 patients with small SPLs (< 3 cm) and 52 patients with normal pancreas who underwent both multiphasic MDCT and gadobutrol-enhanced MRI were included in our study. Two radiologists blinded to the pathologic diagnoses independently reviewed those images, and determined the detection of "SPL per se" and "SPL in consideration of secondary features", the lesion conspicuity, the probability of pancreatic ductal adenocarcinoma (PDAC), and the most likely specific diagnosis.ResultsThe sensitivity of MRI for "detection of SPL per se" was significantly higher than that of CT in both reviewers: 92.7% (179/193) and 97.9% (189/193), respectively, for reviewer 1 (p = 0.031) and 90.7% (175/193) and 99.5% (192/193), respectively, for reviewer 2 (p < 0.001). In addition, MRI provided better lesion conspicuity than MDCT for both reviewers (p < 0.001). However, CT and MRI did not show significant difference in sensitivity for "detection of SPL in consideration of secondary features", specificity for SPL detection, and differentiation of PDAC vs. non-PDAC (p > 0.05). The accuracies of CT and MRI for making a specific diagnosis were as follows: 85.7% (210/245) vs. 86.9% (213/245), respectively, for reviewer 1 (p = 0.736), and 91.8% (225/245) vs. 93.5% (229/245), respectively, for reviewer 2 (p = 0.454).ConclusionMRI showed better lesion conspicuity than MDCT, but did not show significantly different diagnostic performance compared with MDCT for detecting and characterizing small SPLs.

Gadobutrol: A Review in Contrast-Enhanced MRI and MRA

“…The sensitivity of gadobutrol-enhanced MRI for detecting small, (i.e. < 3 cm) solid pancreatic lesions (SPLs) was significantly higher than that with CT imaging in 193 patients with SPLs (98–99.5 vs. 91–93% ; p < 0.05) [ 49 ]. There was no significant difference between the two imaging techniques for the specificity of detecting SPL (100% for both techniques for both readers).…”

“…There was no significant difference between the two imaging techniques for the specificity of detecting SPL (100% for both techniques for both readers). Overall, SPL were significantly ( p < 0.001) more conspicuous on gadobutrol-enhanced MRI than CT images [ 49 ].…”

The borderline resectable/locally advanced pancreatic ductal adenocarcinoma staging with computed tomography/magnetic resonance imaging

“…MRI is more accurate than CT in the detection of small pancreatic adenocarcinoma and in liver staging. [ 29 31 ]…”

Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up of Exocrine Pancreatic Ductal Adenocarcinoma: Evidence Evaluation and Recommendations by the Italian Association of Medical Oncology (AIOM)

“…The detection of pancreatic adenocarcinomas is reported to be superior for Magnetic Resonance (MR) imaging with respect to CT [ 15 ]. Choi et al reported that MR was able to identify small PDAC better than CT [ 18 ] ( Table 2 ).…”