Pancreatic disease: prospective comparison of CT, ERCP, and 1.5-T MR imaging with dynamic gadolinium enhancement and fat suppression.

Abstract

New magnetic resonance (MR) imaging techniques possess features desirable for imaging the pancreas. Computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) were prospectively compared with breath-hold fast low-angle shot (FLASH) and fat-suppressed spin-echo techniques before and after enhancement with gadopentetate dimeglumine. Thirty-five patients underwent ERCP, CT, and/or MR imaging studies within a 1-month period. Correlation with surgical findings, histologic findings, or clinical and/or imaging follow-up was obtained in all cases. Quantitative measurements of pancreas, pancreas minus pancreatic lesion, and pancreas minus fat signal-to-noise ratios (SNRs) were performed on MR images. The highest measurements of pancreas minus pancreatic tumor SNR were on gadolinium-enhanced, fat-suppressed images (8.9 +/- 3.4). The 1-second postcontrast FLASH images most reliably showed enhancement of normal pancreatic tissue. Nonenhanced FLASH images depicted peripancreatic fluid and inflammatory changes most successfully. The findings from this study suggest MR imaging is effective for imaging inflammatory and neoplastic pancreatic disease and may be superior to CT.

Juxtapapillary diverticulum: Findings on MRI

“…MRI demonstrated parenchymal signal decreases consistent with the presence of pancreatitis. Diminished signal of the pancreatic gland on T1-weighted fat saturated images associated with chronic pancreatitis has been described previously (18,19). Pancreatic cystic neoplasms and pseudocysts can be considered in the differential diagnosis with the juxtapapillary diverticulum if the former are located in close proximity to the papilla (20).…”

Pancreatic Carcinoma: Imaging Update 2001

“…The MRI criteria of a pancreatic carcinoma are similar to those of CT and include a tumor mass or an alteration in the anatomic contour of the gland with or without asso-10 ciated pancreatic or bile duct dilatation [8,[32][33][34]. A pancreatic carcinoma can be detected on fat-suppressed T1-weighted spin echo images as a focal mass of relatively diminished signal intensity as compared with the normal pancreas ( fig.…”

“…MRI has an accuracy rate similar to CT in detection and staging of pancreatic carcinomas [8,[32][33][34]. MRI is particularly useful, when a contrast-enhanced CT examination cannot be performed.…”

Chronic pancreatitis

“…In addition to EUS, recent studies have suggested that magnetic resonance imaging (MRI) might be helpful in the diagnosis of chronic pancreatitis based not only on the imaging of duct abnormalities, but also parenchymal abnormalities, particularly abnormalities on enhanced T1-weighted fat-suppressed (T1-FS) sequence [95]. MRI may reveal pancreatic parenchymal changes at an earlier stage than CT, particularly prior to the development of morphologic changes in chronic pancreatitis [95,96]. Since natural history may be the most definitive gold standard for early chronic pancreatitis, long-term follow-up of the patients with mild EUS or MRI changes will determine the validity of these imaging studies in diagnosing the early stages of chronic pancreatitis.…”