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Magnetic resonance imaging as a non-invasive method for the assessment of pancreatic fibrosis (MINIMAP): a comprehensive study design from the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer

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Abstract

Characteristic features of chronic pancreatitis (CP) may be absent on standard imaging studies. Quantitative Magnetic Resonance Imaging (MRI) techniques such as T1 mapping, extracellular volume (ECV) fraction, diffusion-weighted imaging (DWI) with apparent diffusion coefficient map (ADC), MR elastography (MRE), and T1-weighted signal intensity ratio (SIR) have shown promise for the diagnosis and grading severity of CP. However, radiologists still use the Cambridge classification which is based on traditional ductal imaging alone. There is an urgent need to develop new diagnostic criteria that incorporate both parenchymal and ductal features of CP seen by MRI/MRCP. Designed to fulfill this clinical need, we present the MINIMAP study, which was funded in September 2018 by the National Institutes of Health. This is a comprehensive quantitative MR imaging study which will be performed at multiple institutions in well-phenotyped CP patient cohorts. We hypothesize that quantitative MRI/MRCP features can serve as valuable non-invasive imaging biomarkers to detect and grade CP. We will evaluate the role of T1 relaxometry, ECV, T1-weighted gradient echo SIR, MRE, arteriovenous enhancement ratio, ADC, pancreas volume/atrophy, pancreatic fat fraction, ductal features, and pancreatic exocrine output following secretin stimulation in the assessment of CP. We will attempt to generate a multi-parametric pancreatic tissue fibrosis (PTF) scoring system. We anticipate that a quantitative scoring system may serve as a biomarker of pancreatic fibrosis; hence this imaging technique can be used in clinical practice as well as clinical trials to evaluate the efficacy of agents which may slow the progression or reverse measures of CP.

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Abbreviations

ADC:

Apparent diffusion coefficient

CP:

Chronic pancreatitis

CPDPC:

Chronic pancreatitis, diabetes, and pancreatic cancer consortium

DWI:

Diffusion-weighted imaging

ECV:

Extracellular Volume

ERCP:

Endoscopic retrograde cholangiopancreatography

MINIMAP:

Magnetic resonance imaging as a non-invasive method for the assessment of pancreatic fibrosis

MRCP:

Magnetic resonance cholangiopancreatography

MRI:

Magnetic resonance imaging

MRE:

Magnetic resonance elastography

PROCEED:

Prospective evaluation of chronic pancreatitis for epidemiologic and translational studies

SIR:

Signal intensity ratio

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Acknowledgements

We acknowledge Anil Dasyam, MD; Ely Felker, MD; Zarine Shah, MD; Naoki Takahashi, MD; Shreyas Vasanawala, MD; and Ashley Wachsman, MD (in alphabetical order) for their participation in this study. We acknowledge the support of ChiRhoClin Inc. (Burtonsville, MD, USA) for supplying the Secretin (ChiRhoStim).

Funding

Research reported in this publication was supported by National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award numbers R01DK116963 (MINIMAP), U01DK108323 (IU), U01DK108306 (UPMC), U01DK108327 (OSU), U01DK108314 (CSMC), DKP3041301 (UCLA), U01DK108300 (Stanford), and U01DK108288 (Mayo). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550N. University Blvd. Suite 0663, Indianapolis, IN, 46202, USA

    Temel Tirkes

  2. Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Dhiraj Yadav

  3. Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, Ohio State University Wexner Medical Center, Columbus, OH, USA

    Darwin L. Conwell

  4. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 W. Walnut Street, R2 E124G, Indianapolis, IN, 46202, USA

    Paul R. Territo & Xuandong Zhao

  5. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Sudhakar K. Venkatesh

  6. The Ohio State University Wexner Medical Center, 395 West 12th AVE, 4th Floor, Columbus, OH, 43210, USA

    Arunark Kolipaka

  7. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Liang Li

  8. Division of Gastroenterology and Hepatology, Departments of Medicine and Human Genetics, VA Greater Los Angeles HCS, Los Angeles, CA, USA

    Joseph R. Pisegna

  9. Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Stephen J. Pandol

  10. Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA

    Walter G. Park

  11. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic Campus, Rochester, MN, USA

    Mark Topazian

  12. CAPT, Medical Corps US Public Health Service, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, 2 Democracy Plaza, Room 6007, MSC 5450, Bethesda, MD, 20892, USA

    Jose Serrano

  13. Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN, USA

    Evan L. Fogel

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  1. Temel Tirkes
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the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer

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Correspondence to Temel Tirkes.

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Tirkes, T., Yadav, D., Conwell, D.L. et al. Magnetic resonance imaging as a non-invasive method for the assessment of pancreatic fibrosis (MINIMAP): a comprehensive study design from the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Abdom Radiol 44, 2809–2821 (2019). https://doi.org/10.1007/s00261-019-02049-5

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