Magnetic Resonance Imaging as a Valid Noninvasive Tool for the Assessment of Pancreatic Fibrosis

Abstract

Objectives The aim of this study was to evaluate the utility of magnetic resonance imaging (MRI) for the noninvasive assessment of pancreatic fibrosis (PF). Methods Fifty-two patients who underwent surgical resection of the pancreas, histological examination of resection margins, preoperative abdominal MRI, and fecal elastase-1 test were enrolled in the study. Pancreatic tissue was identified on the MRI T1-, T2-, and diffusion-weighted imaging sequences. Apparent diffusion coefficient (ADC) was measured at the expected resection margin of the pancreas. Results There was a significant negative correlation between the ADC mean and histologically determined PF (r = −0.752, P = 0.001). For equal to or greater than 25% of PF, the ADC cutoff value was 1.331 or less, with a sensitivity of 77% and specificity of 88%. The unenhanced T1-weighted signal intensity ratio (T1SI) cutoff value was 172.1 or less. For equal to or greater than 50% of PF, the ADC cutoff value was 1.316 or less with a sensitivity of 85% and specificity of 88%. The highest sensitivity was obtained by combining ADC and T1SI values. Conclusions Combining both the ADC and T1SI measurement allows the detection of early PF with good sensitivity and specificity. Magnetic resonance imaging has the advantage of being noninvasive and widely used in the clinical setting, thus making our results easily transferable to routine clinical practice.

CT- and MRI-Based Assessment of Body Composition and Pancreatic Fibrosis Reveals High Incidence of Clinically Significant Metabolic Changes That Affect the Quality of Life and Treatment Outcomes of Patients with Chronic Pancreatitis and Pancreatic Cancer

“…Based on ADC and T1 measurements of the pancreas and using cut-off values of ADC < 1.316 × 10 −3 mm 2 /s and T1 < 170 units for predicting ≥50% PF as defined in our previous study [6], we divided our patients into two groups: low-grade ( n = 39) and high-grade ( n = 61) PF.…”

“…All ADC values were measured directly from the ADC map data on an independent workstation. Since fibrotic pancreatic tissue is known to have a more hypo-intense signal intensity (SI) in fat-suppressed T1-weighted imaging, quantitative T1 SI values were measured on the T1 Dixon water-only images in the same location as the ADC [6].…”

“…Fibrosis is very fundamental in the development of CP, and it usually develops at an early point when other imaging findings are not very pronounced. MRI could potentially be a sufficient biomarker for the assessment of pancreatic fibrosis and has been validated against histology [6].…”

Recent Advances in Pancreatic MR Imaging: A Guide on How, When, and Why to Perform

“…ADC values decrease with increasing pancreatic fibrosis. 38 DWI is shown to diagnose chronic pancreatitis with high specificity. 39 Autoimmune pancreatitis (AP) can show markedly low-ADC value (very high signal on DWI).…”

Evaluating the Histopathology of Pancreatic Ductal Adenocarcinoma by Intravoxel Incoherent Motion-Diffusion Weighted Imaging Comparing With Diffusion-Weighted Imaging

“…DWI detects the physiological characteristics of tissue non-invasively by measuring the diffusion properties of water molecules ( 9 ). Several studies have applied the mean ADC value, which was significantly higher in the loose fibrosis group PDAC than in the dense fibrosis group and negatively correlated with PDAC fibrosis ( 10 – 12 ). Also, Klauss et al.…”