Skip to main content
SpringerLink
Log in

Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography

  • Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used for the diagnosis of pancreatic cancer. Because autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer and can be tested for by FDG-PET analysis based on the presence of suspected pancreatic cancer, we attempted to clarify the differences in FDG-PET findings between the two conditions.

Methods

We compared FDG-PET findings between 15 patients with autoimmune pancreatitis and 26 patients with pancreatic cancer. The findings were evaluated visually or semiquantitatively using the maximum standardized uptake value and the accumulation pattern of FDG.

Results

FDG uptake was found in all 15 patients with autoimmune pancreatitis, whereas it was found in 19 of 26 patients (73.1%) with pancreatic cancer. An accumulation pattern characterized by nodular shapes was significantly more frequent in pancreatic cancer, whereas a longitudinal shape indicated autoimmune pancreatitis. Heterogeneous accumulation was found in almost all cases of autoimmune pancreatitis, whereas homogeneous accumulation was found in pancreatic cancer. Significantly more cases of pancreatic cancer showed solitary localization, whereas multiple localization in the pancreas favored the presence of autoimmune pancreatitis. FDG uptake by the hilar lymph node was significantly more frequent in autoimmune pancreatitis than in pancreatic cancer, and uptake by the lachrymal gland, salivary gland, biliary duct, retroperitoneal space, and prostate were seen only in autoimmune pancreatitis.

Conclusions

FDG-PET is a useful tool for differentiating autoimmune pancreatitis from suspected pancreatic cancer, if the accumulation pattern and extrapancreatic involvement are considered. IgG4 measurement and other current image tests can further confirm the diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Delbeke D, Rose DM, Chapman WC, Pinson CW, Wright JK, Beauchamp RD, et al. Optimal interpretation of FDG PET in the diagnosis, staging and management of pancreatic carcinoma. J Nucl Med 1999;40:1784–1791.

    PubMed  CAS  Google Scholar 

  2. Imdahl A, Nitzsche E, Krautmann F, Hogerle S, Boos S, Einert A, et al. Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose for the differentiation of chronic pancreatitis and pancreatic cancer. Br J Surg 1999;86:194–199.

    Article  PubMed  CAS  Google Scholar 

  3. Inokuma T, Tamaki N, Torizuka T, Magata Y, Fujii M, Yonekura Y, et al. Evaluation of pancreatic tumors with positron emission tomography and F-18 fluorodeoxyglucose: comparison with CT and US. Radiology 1995;195:345–352.

    PubMed  CAS  Google Scholar 

  4. Zimny M, Bares R, Fass J, Adam G, Cremerius U, Dohmen B, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in the differential diagnosis of pancreatic carcinoma: a report of 106 cases. Eur J Nucl Med 1997;24:678–682.

    PubMed  CAS  Google Scholar 

  5. Nakamoto Y, Higashi T, Sakahara H, Tamaki N, Kogire M, Doi R, et al. Delayed (18)F-fluoro-2-deoxy-d-glucose positron emission tomography scan for differentiation between malignant and benign lesions in the pancreas. Cancer 2000;89:2547–2554.

    Article  PubMed  CAS  Google Scholar 

  6. van Kouwen MC, Jansen JB, van Goor H, de Castro S, Oyen WJ, Drenth JP. FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis. Eur J Nucl Med Mol Imaging 2005;32:399–404.

    Article  PubMed  Google Scholar 

  7. Heinrich S, Goerres GW, Schafer M, Sagmeister M, Bauerfeind P, Pestalozzi BC, et al. Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg 2005;242:235–243.

    Article  PubMed  Google Scholar 

  8. Toki F, Kozu T, Oi I, Nakasato T, Suzuki M, Hanyu F. An unusual type of chronic pancreatitis showing diffuse irregular narrowing of the entire main pancreatic duct on ERCP-a report of four cases. Endoscopy 1992;24:640.

    Google Scholar 

  9. Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 1995;40:1561–1568.

    Article  PubMed  CAS  Google Scholar 

  10. Ito T, Nakano I, Koyanagi S, Miyahara T, Migita Y, Ogoshi K, et al. Autoimmune pancreatitis as a new clinical entity. Three cases of autoimmune pancreatitis with effective steroid therapy. Dig Dis Sci 1997;42:1458–1468.

    Article  PubMed  CAS  Google Scholar 

  11. Horiuchi A, Kawa S, Akamatsu T, Aoki Y, Mukawa K, Furuya N, et al. Characteristic pancreatic duct appearance in autoimmune chronic pancreatitis: a case report and review of the Japanese literature. Am J Gastroenterol 1998;93:260–263.

    Article  PubMed  CAS  Google Scholar 

  12. Horiuchi A, Kawa S, Hamano H, Hayama M, Ota H, Kiyosawa K. ERCP features in 27 patients with autoimmune pancreatitis. Gastrointest Endosc 2002;55:494–499.

    PubMed  Google Scholar 

  13. Abraham SC, Wilentz RE, Yeo CJ, Yeo CJ, Sohn TA, Cameron JL, Boitnott, et al. Pancreaticoduodenectomy (Whipple resection) in patients without malignancy. Am J Surg Pathol 2003;27:110–120.

    Article  PubMed  Google Scholar 

  14. Kawa S, Hamano H, Kiyosawa K. Pancreatitis. In: Rose NR, MacKay IR, editors. The autoimmune diseases. 4th ed. St Louis: Academic; 2006. p. 779–786.

    Google Scholar 

  15. Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med 2001;344:732–738.

    Article  PubMed  CAS  Google Scholar 

  16. Hamano H, Kawa S, Ochi Y, Unno H, Shiba N, Wajiki M, et al. Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis. Lancet 2002;359:1403–1404.

    Article  PubMed  Google Scholar 

  17. Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients. Eur J Nucl Med 1996;23:1409–1415.

    Article  PubMed  CAS  Google Scholar 

  18. Shreve PD. Focal fluorine-18 fluorodeoxyglucose accumulation in inflammatory pancreatic disease. Eur J Nucl Med 1998;25:259–264.

    Article  PubMed  CAS  Google Scholar 

  19. Higashi T, Saga T, Nakamoto Y, Ishimori T, Fujimoto K, Doi R, et al. Diagnosis of pancreatic cancer using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET)-usefulness and limitations in “clinical reality”. Ann Nucl Med 2003;17:261–279.

    Article  PubMed  Google Scholar 

  20. Yokoyama Y, Nagino M, Hiromatsu T, Yuasa N, Oda K, Arai T, et al. Intense PET signal in the degenerative necrosis superimposed on chronic pancreatitis. Pancreas 2005;31:192–194.

    Article  PubMed  Google Scholar 

  21. Huang B, Puri S. Pancreatic pseudocyst observed on F-18 FDG PET imaging. Clin Nucl Med 2005;30:259–261.

    Article  PubMed  Google Scholar 

  22. Sperti C, Pasquali C, Decet G, Chierichetti F, Liessi G, Pedrazzoli S. F-18-fluorodeoxyglucose positron emission tomography in differentiating malignant from benign pancreatic cysts: a prospective study. J Gastrointest Surg 2005;9:22–28; discussion 28–9.

    Article  PubMed  Google Scholar 

  23. Nakamoto Y, Sakahara H, Higashi T, Saga T, Sato N, Okazaki K, et al. Autoimmune pancreatitis with F-18 fluoro-2-deoxy-d-glucose PET findings Clin Nucl Med. 1999;24:778–780.

    Article  PubMed  Google Scholar 

  24. Nakamoto Y, Saga T, Ishimori T, Higashi T, Mamede M, Okazaki K, et al. FDG-PET of autoimmune-related pancreatitis: preliminary results. Eur J Nucl Med 2000;27:1835–1838.

    Article  PubMed  CAS  Google Scholar 

  25. Members of the Criteria Committee for Autoimmune Pancreatitis of the Japan Pancreas Society. Diagnostic criteria for autoimmune pancreatitis by the Japan Pancreas Society. J Jpn Pancreas (Suizou) 2002;17:587.

    Google Scholar 

  26. Okazaki K, Kawa S, Kamisawa T, Naruse S, Tanaka S, Nishimori I, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol 2006;41:626–631.

    Article  PubMed  Google Scholar 

  27. Bares R, Klever P, Hauptmann S, Hellwig D, Fass J, Cremerius U, et al. F-18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer. Radiology 1994;192:79–86.

    PubMed  CAS  Google Scholar 

  28. Diederichs CG, Staib L, Glasbrenner B, Guhlmann A, Glatting G, Pauls S, et al. F-18 fluorodeoxyglucose (FDG) and C-reactive protein (CRP). Clin Positron Imaging 1999;2:131–136.

    Article  PubMed  Google Scholar 

  29. Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 1992;33:1972–1980.

    PubMed  CAS  Google Scholar 

  30. Sperti C, Pasquali C, Decet G, Chierichetti F, Liessi G, Pedrazzoli S. F-18-fluorodeoxyglucose positron emission tomography in differentiating malignant from benign pancreatic cysts: a prospective study. J Gastrointest Surg 2005;9:22–28.

    Article  PubMed  Google Scholar 

  31. Heinrich S, Goerres GW, Schafer M, Sagmeister M, Bauerfeind P, Pestalozzi BC, et al. Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg 2005;242:235–243.

    Article  PubMed  Google Scholar 

  32. Hamano H, Arakura N, Muraki T, Ozaki Y, Kiyosawa K, Kawa S. Prevalence and distribution of extra-pancreatic lesions complicated with autoimmune pancreatitis. J Gastroenterol 2006;41:1197–1205.

    Article  PubMed  Google Scholar 

  33. Saegusa H, Momose M, Kawa S, Hamano H, Ochi Y, Takayama M, et al. Hilar and pancreatic gallium-67 accumulation is characteristic feature of autoimmune pancreatitis. Pancreas 2003;27:20–25.

    Article  PubMed  Google Scholar 

  34. Hustinx R, Lemaire C, Jerusalem G, Moreau P, Cataldo D, Duysinx B, et al. Whole-body tumor imaging using PET and 2–18F-fluoro-l-tyrosine: preliminary evaluation and comparison with 18F-FDG. J Nucl Med 2003;44:533–539.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan

    Yayoi Ozaki, Hideaki Hamano, Norikazu Arakura, Takashi Muraki & Kendo Kiyosawa

  2. Positron Imaging Center, Aizawa Hospital, Matsumoto, Japan

    Kazuhiro Oguchi

  3. Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan

    Mitsuhiro Momose & Masumi Kadoya

  4. Department of Internal Medicine, Aizawa Hospital, Matsumoto, Japan

    Kazunobu Miyata & Takao Aizawa

  5. Center for Health, Safety and Environmental Management, Shinshu University, 3-1-1 Asahi, Matsumoto, 390-8621, Japan

    Shigeyuki Kawa

Authors
  1. Yayoi Ozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuhiro Oguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideaki Hamano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Norikazu Arakura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takashi Muraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kendo Kiyosawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mitsuhiro Momose
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masumi Kadoya
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kazunobu Miyata
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takao Aizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shigeyuki Kawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ozaki, Y., Oguchi, K., Hamano, H. et al. Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography. J Gastroenterol 43, 144–151 (2008). https://doi.org/10.1007/s00535-007-2132-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-007-2132-y

Key words

Search

Navigation