Multitasking dynamic contrast enhanced magnetic resonance imaging can accurately differentiate chronic pancreatitis from pancreatic ductal adenocarcinoma

Abstract

Background and aimsAccurate differentiation of chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDAC) is an area of unmet clinical need. In this study, a novel Multitasking dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) technique was used to quantitatively evaluate the microcirculation properties of pancreas in CP and PDAC and differentiate between them.MethodsThe Multitasking DCE technique was able to acquire one 3D image per second during the passage of MRI contrast agent, allowing the quantitative estimation of microcirculation properties of tissue, including blood flow Fp, plasma volume fraction vp, transfer constant Ktrans, and extravascular extracellular volume fraction ve. Receiver operating characteristic (ROC) analysis was performed to differentiate the CP pancreas, PDAC pancreas, normal control pancreas, PDAC tumor, PDAC upstream, and PDAC downstream. ROCs from quantitative analysis and conventional analysis were compared.ResultsFourteen PDAC patients, 8 CP patients and 20 healthy subjects were prospectively recruited. The combination of Fp, vp, Ktrans, and ve can differentiate CP versus PDAC pancreas with good AUC (AUC [95% CI] = 0.821 [0.654 – 0.988]), CP versus normal pancreas with excellent AUC (1.000 [1.000 – 1.000]), PDAC pancreas versus normal pancreas with excellent AUC (1.000 [1.000 – 1.000]), CP versus PDAC tumor with excellent AUC (1.000 [1.000 – 1.000]), CP versus PDAC downstream with excellent AUC (0.917 [0.795 – 1.000]), and CP versus PDAC upstream with fair AUC (0.722 [0.465 – 0.980]). This quantitative analysis outperformed conventional analysis in differentiation of each pair.ConclusionMultitasking DCE MRI is a promising clinical tool that is capable of unbiased quantitative differentiation between CP from PDAC.

Quantitative Magnetic Resonance Imaging for the Pancreas

“…Kim et al 146 demonstrated that chronic pancreatitis is associated with a significantly lower K trans and k ep than the healthy pancreas; however, there were no significant differences found in v e . Wang et al 150 showed that v e was significantly higher in chronic pancreatitis versus the healthy pancreas; nevertheless, there were no significant differences noted in K trans .…”

“…4). 31,[137][138][139][140][141][142][143][144][145][146][147][148][149][150] Currently, the use of DCE-MRI-derived estimation in chronic pancreatitis remains poorly investigated. Kim et al 146 demonstrated that chronic pancreatitis is associated with a significantly lower K trans and k ep than the healthy pancreas; however, there were no significant differences found in v e .…”

“…[142][143][144] Several studies have shown that PDAC has a lower K trans and k ep than the normal pancreas or chronic pancreatitis, while having a larger v e . 31,[145][146][147][148][149][150] Two studies examined the use of DCE-MRI in differentiating PDAC from NEN, showing a lower K trans in the former versus the latter. 146,149 The utility of DCE-MRI-derived estimation in predicting tumor aggressiveness was addressed in 2 studies.…”

“…Previous researchers have reported that the degree of fibrosis within PDACs is negatively correlated with K trans and positively correlated with v e 142–144 . Several studies have shown that PDAC has a lower K trans and k ep than the normal pancreas or chronic pancreatitis, while having a larger v e 31,145–150 . Two studies examined the use of DCE-MRI in differentiating PDAC from NEN, showing a lower K trans in the former versus the latter 146,149 …”

Chronic pancreatitis: Pain and computed tomography/magnetic resonance imaging findings

“…In addition, magnetic resonance elastography (MRE)-derived stiffness, which can be used to measure tissue mechanical properties and provide information on soft tissue stiffness in vivo, is the highest diagnostic indicator for detecting CP without secretory insufficiency (reflecting early CP), and there is no difference in the diagnostic effect between T1 relaxation time and MRE-derived stiffness[ 28 ]. Furthermore, the research of Wang et al [ 33 ] showed that multitasking dynamic contrast enhanced MRI technology can not only achieve early detection and early diagnosis of CP because changes in microcirculation characteristics are usually preceded by morphological changes, but also it can identify and diagnose CP and pancreatic ductal adenocarcinoma by estimating microcirculation parameters (such as tissue plasma flow, fractional plasma volume, transfer constant, etc. ).…”