Focal pancreatic mass: Distinction of pancreatic cancer from chronic pancreatitis using gadolinium‐enhanced 3D‐gradient‐echo MRI

Abstract

Purpose:To determine the accuracy of MRI including T1-weighted gadolinium (Gd)-enhanced three-dimensionalgradient-echo (3D-GE) sequences to distinguish pancreatic cancer from chronic pancreatitis in patients with pancreatic mass or focal enlargement. Materials and Methods:The study included 22 patients (15 males and seven females; mean age Ϯ SD, 56.2 Ϯ 11.5 years) with pancreatic mass or focal enlargement. Fourteen had pancreatic carcinoma and eight had chronic pancreatitis based on the histopathological and clinical findings. MRI examinations of all patients were retrospectively evaluated by two independent reviewers for the predetermined imaging findings of carcinoma and chronic pancreatitis. The accuracy of MRI for differentiating pancreatic carcinoma from chronic pancreatitis was determined. MRI findings of both entities were compared using t-tests, chi-squared tests, and logistic regression analyses for the differentiation of these two entities. The extent of agreement between two reviewers was determined with Kappa statistics. Results:The sensitivity and specificity of MRI including T1-weighted 3D-GE sequences for differentiating pancreatic carcinoma from chronic pancreatitis were 93% (13/14) and 75% (6/8), respectively. The most discriminative finding for pancreatic carcinoma was relative demarcation of the mass compared to background pancreas in contrast to chronic pancreatitis on post-Gd 3D-GRE sequences (P Ͻ 0.05). Conclusion:MRI including Gd-enhanced T1-weighted 3D-GE sequences can differentiate pancreatic carcinoma from chronic pancreatitis successfully in most cases.

Preoperative evaluation of pancreatic cancer: Comparison of gadolinium‐enhanced dynamic MRI with MR cholangiopancreatography versus MDCT

“…4). Moreover, according to several, recently published articles on 3D MRI, dynamic gadolinium-enhanced MR using a 3D-GRE sequence was helpful in detecting pancreatic cancer with a high degree of confidence regarding the accuracy, as well as in differentiating pancreatic carcinoma from chronic pancreatitis, or in the diagnosis of various focal pancreatic tumors (38,39).…”

Diffusion-weighted magnetic resonance imaging in cancer: Reported apparent diffusion coefficients,in-vitroandin-vivoreproducibility

“…Unfortunately differentiating between benign mass-forming focal pancreatitis and pancreatic ductal adenocarcinoma is extremely difficult as they both show similar histologic and radiologic patterns [66][67][68] . Multimodality approaches such as ultrasound, computed tomography and different MR techniques have been suggested to differentiate between benign mass-forming focal pancreatitis and pancreatic carcinoma [66] .…”

Malignant Appearance of Pancreatic Benign Lesion: Focal Chronic Pancreatitis

“…Bununla birlikte MR teknolojisinde son zamanlarda yaşanan gelişmeler ile pankreasın malign ve benign lezyonlarının ayırımında etkin teknikler ortaya çıkmıştır. Yapılan çalışmalarda difüzyon ağırlıklı MR, kontrastlı MR, MR spektroskopi gibi tekniklerle inflamatuar lezyonların kanserden ayırımında sensitivite ve spesifite % 90'ların üzerine çıkabilmiştir 10,11 . FDG-pozitron emisyon tomografisi (PET)' nin pankreatik kanser ile kronik pankreatit ayırımında sensitivitesi BT veya MR' dan daha yüksek saptanmıştır.…”