MR-Elastography of the Pancreas: Research Technique, Normal Values, First Results of Application in Patients With Pancreatic Adenocarcinoma at the Planning of Pancreatoduodenodal Resection

Abstract

Objective: optimization of the technique and study of the possibilities of MR-elastography in assessing the rigidity of the pancreatic parenchyma under normal conditions, with fibrotic changes and adenocarcinoma. Materials and methods. MR elastography was performed for 15 patients with no history and clinical laboratory data indicating the presence of pancreatic diseases, 20 patients with pancreatic adenocarcinoma at the stage of preoperative planning to assess the rigidity of the tumor and parenchyma, in order to predict the probability of pancreatic fistulas. With the application of special software, the quantitative values of stiffness in kPa were calculated, a qualitative analysis of the state of the parenchyma was carried out using color parametric maps. Results. The stiffness of the pancreatic parenchyma normally ranged from 1,54 to 2,87 kPa, averaging 2,5 kPa. The unchanged parenchyma was characterized by blue staining on color parametric maps in the hardness range from 0 to 8 kPa, violet in the range from 0 to 20 kPa. In patients with a tumor process in all cases there was a low-grade adenocarcinoma of the pancreatic head, verified by histological data. The rigidity of adenocarcinoma varied from 6 to 9 kPa, on the color parametric maps there was a red staining of the tumor in the range of hardness of 0– 8 kPa, yellow in the range of 0–20 kPa. In the postoperative period, the pancreatic fistula on the background of preoperative preparation was formed only in 3 patients with normal pancreatic parenchyma, according to elastography rigidity indicators. Conclusion. MR-elastography is an informative method for quantitative and qualitative analysis of the stiffness of pancreatic parenchyma, and effective instrument for predicting the development of pancreatic fistulas.