Abstract
Pancreatic ductal adenocarcinoma can be a difficult imaging diagnosis early in its course given its subtle imaging findings such as focal pancreatic duct dilatation, abrupt duct cut-off, and encasement of vasculature. A variety of pancreatitidies have imaging findings that mimic pancreatic ductal adenocarcinoma and lead to mass formation making diagnosis even more difficult on imaging alone. These conditions include acute focal pancreatitis, chronic pancreatitis, autoimmune pancreatitis, and paraduodenal (“groove”) pancreatitis. This review will focus on imaging findings that can help differentiate these inflammatory processes from pancreatic ductal adenocarcinoma.
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Howlader N, Noone A, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis D, Chen H, Feuer E, Cronin Ke. SEER Cancer Statistics Review, 1975-2016, National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/csr/1975_2016/, based on November 2018 SEER data submission, posted to the SEER web site, April 2019.
Low G, Panu A, Millo N, Leen E. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics 2011;31(4):993-1015. https://doi.org/10.1148/rg.314105731
Gangi S, Fletcher JG, Nathan MA, Christensen JA, Harmsen WS, Crownhart BS, Chari ST. Time interval between abnormalities seen on CT and the clinical diagnosis of pancreatic cancer: retrospective review of CT scans obtained before diagnosis. AJR Am J Roentgenol 2004;182(4):897-903. https://doi.org/10.2214/ajr.182.4.1820897
Miller FH, Keppke AL, Dalal K, Ly JN, Kamler VA, Sica GT. MRI of pancreatitis and its complications: part 1, acute pancreatitis. AJR Am J Roentgenol 2004;183(6):1637-1644. https://doi.org/10.2214/ajr.183.6.01831637
Sherman S, Lehman G. Chronic pancreatitis. In: DiMarino A, Benjamin S, eds. Gastrointestinal Disease: An Endoscopic Approach. 2 ed. Thorofare, NJ: Slack, 2002; p. 1277-1296.
Sica GT, Braver J, Cooney MJ, Miller FH, Chai JL, Adams DF. Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis. Radiology 1999;210(3):605-610. https://doi.org/10.1148/radiology.210.3.r99fe55605
Siddiqi AJ, Miller F. Chronic pancreatitis: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR 2007;28(5):384-394. https://www.ncbi.nlm.nih.gov/pubmed/17970554.
Ito K, Koike S, Matsunaga N. MR imaging of pancreatic diseases. Eur J Radiol 2001;38(2):78-93. https://www.ncbi.nlm.nih.gov/pubmed/11335090.
Kroft SH, Stryker SJ, Winter JN, Ergun G, Rao MS. Inflammatory pseudotumor of the pancreas. Int J Pancreatol 1995;18(3):277-283. https://www.ncbi.nlm.nih.gov/pubmed/8708401.
Malka D, Hammel P, Maire F, Rufat P, Madeira I, Pessione F, Levy P, Ruszniewski P. Risk of pancreatic adenocarcinoma in chronic pancreatitis. Gut 2002;51(6):849-852. https://www.ncbi.nlm.nih.gov/pubmed/12427788.
Balthazar EJ. Pancreatitis associated with pancreatic carcinoma. Preoperative diagnosis: role of CT imaging in detection and evaluation. Pancreatology 2005;5(4-5):330-344. https://doi.org/10.1159/000086868
Baker ME. Pancreatic adenocarcinoma: are there pathognomonic changes in the fat surrounding the superior mesenteric artery? Radiology 1991;180(3):613-614. https://doi.org/10.1148/radiology.180.3.1871269
Johnson PT, Outwater EK. Pancreatic carcinoma versus chronic pancreatitis: dynamic MR imaging. Radiology 1999;212(1):213-218. https://doi.org/10.1148/radiology.212.1.r99jl16213
Ichikawa T, Sou H, Araki T, Arbab AS, Yoshikawa T, Ishigame K, Haradome H, Hachiya J. Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 2001;221(1):107-116. https://doi.org/10.1148/radiol.2211001157
Hart PA, Zen Y, Chari ST. Recent Advances in Autoimmune Pancreatitis. Gastroenterology 2015;149(1):39-51. https://doi.org/10.1053/j.gastro.2015.03.010
Hota P, Patel T, Zhao X, Jhala N, Agosto O. A Rare Multifocal Pattern of Type 2 Autoimmune Pancreatitis with Negative IgG4: A Potential Diagnostic Pitfall That May Mimic Multifocal Pancreatic Adenocarcinoma. Case Rep Gastroenterol 2018;12(1):46-55. https://doi.org/10.1159/000486443
Kamisawa T, Chari ST, Lerch MM, Kim MH, Gress TM, Shimosegawa T. Recent advances in autoimmune pancreatitis: type 1 and type 2. Gut 2013;62(9):1373-1380. https://doi.org/10.1136/gutjnl-2012-304224
Kloppel G, Luttges J, Sipos B, Capelli P, Zamboni G. Autoimmune pancreatitis: pathological findings. JOP 2005;6(1 Suppl):97-101. https://www.ncbi.nlm.nih.gov/pubmed/15650292.
Furuhashi N, Suzuki K, Sakurai Y, Ikeda M, Kawai Y, Naganawa S. Differentiation of focal-type autoimmune pancreatitis from pancreatic carcinoma: assessment by multiphase contrast-enhanced CT. Eur Radiol 2015;25(5):1366-1374. https://doi.org/10.1007/s00330-014-3512-3
Kamisawa T, Takuma K, Tabata T, Inaba Y, Egawa N, Tsuruta K, Hishima T, Sasaki T, Itoi T. Serum IgG4-negative autoimmune pancreatitis. J Gastroenterol 2011;46(1):108-116. https://doi.org/10.1007/s00535-010-0317-2
Pak LM, Schattner MA, Balachandran V, D’Angelica MI, DeMatteo RP, Kingham TP, Jarnagin WR, Allen PJ. The clinical utility of immunoglobulin G4 in the evaluation of autoimmune pancreatitis and pancreatic adenocarcinoma. HPB (Oxford) 2018;20(2):182-187. https://doi.org/10.1016/j.hpb.2017.09.001
Muhi A, Ichikawa T, Motosugi U, Sou H, Sano K, Tsukamoto T, Fatima Z, Araki T. Mass-forming autoimmune pancreatitis and pancreatic carcinoma: differential diagnosis on the basis of computed tomography and magnetic resonance cholangiopancreatography, and diffusion-weighted imaging findings. J Magn Reson Imaging 2012;35(4):827-836. https://doi.org/10.1002/jmri.22881
Kamisawa T, Imai M, Yui Chen P, Tu Y, Egawa N, Tsuruta K, Okamoto A, Suzuki M, Kamata N. Strategy for differentiating autoimmune pancreatitis from pancreatic cancer. Pancreas 2008;37(3):e62-67. https://doi.org/10.1097/mpa.0b013e318175e3a0
Takahashi N, Kawashima A, Fletcher JG, Chari ST. Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings. Radiology 2007;242(3):791-801. https://doi.org/10.1148/radiol.2423060003
Bowman AW, Bolan CW. MRI evaluation of pancreatic ductal adenocarcinoma: diagnosis, mimics, and staging. Abdom Radiol (NY) 2018. https://doi.org/10.1007/s00261-018-1686-x
Kamisawa T, Takuma K, Anjiki H, Egawa N, Hata T, Kurata M, Honda G, Tsuruta K, Suzuki M, Kamata N, Sasaki T. Differentiation of autoimmune pancreatitis from pancreatic cancer by diffusion-weighted MRI. Am J Gastroenterol 2010;105(8):1870-1875. https://doi.org/10.1038/ajg.2010.87
Choi SY, Kim SH, Kang TW, Song KD, Park HJ, Choi YH. Differentiating Mass-Forming Autoimmune Pancreatitis From Pancreatic Ductal Adenocarcinoma on the Basis of Contrast-Enhanced MRI and DWI Findings. AJR Am J Roentgenol 2016;206(2):291-300. https://doi.org/10.2214/ajr.15.14974
Kim HJ, Kim YK, Jeong WK, Lee WJ, Choi D. Pancreatic duct “Icicle sign” on MRI for distinguishing autoimmune pancreatitis from pancreatic ductal adenocarcinoma in the proximal pancreas. Eur Radiol 2015;25(6):1551-1560. https://doi.org/10.1007/s00330-014-3548-4
Takahashi N, Fletcher JG, Fidler JL, Hough DM, Kawashima A, Chari ST. Dual-phase CT of autoimmune pancreatitis: a multireader study. AJR Am J Roentgenol 2008;190(2):280-286. https://doi.org/10.2214/ajr.07.2309
Chang WI, Kim BJ, Lee JK, Kang P, Lee KH, Lee KT, Rhee JC, Jang KT, Choi SH, Choi DW, Choi DI, Lim JH. The clinical and radiological characteristics of focal mass-forming autoimmune pancreatitis: comparison with chronic pancreatitis and pancreatic cancer. Pancreas 2009;38(4):401-408. https://doi.org/10.1097/mpa.0b013e31818d92c0
Sun GF, Zuo CJ, Shao CW, Wang JH, Zhang J. Focal autoimmune pancreatitis: radiological characteristics help to distinguish from pancreatic cancer. World J Gastroenterol 2013;19(23):3634-3641. https://doi.org/10.3748/wjg.v19.i23.3634
Cheng MF, Guo YL, Yen RF, Chen YC, Ko CL, Tien YW, Liao WC, Liu CJ, Wu YW, Wang HP. Clinical Utility of FDG PET/CT in Patients with Autoimmune Pancreatitis: a Case-Control Study. Sci Rep 2018;8(1):3651. https://doi.org/10.1038/s41598-018-21996-5
Levenick JM, Gordon SR, Sutton JE, Suriawinata A, Gardner TB. A comprehensive, case-based review of groove pancreatitis. Pancreas 2009;38(6):e169-175. https://doi.org/10.1097/mpa.0b013e3181ac73f1
Raman SP, Salaria SN, Hruban RH, Fishman EK. Groove pancreatitis: spectrum of imaging findings and radiology-pathology correlation. AJR Am J Roentgenol 2013;201(1):W29-39. https://doi.org/10.2214/ajr.12.9956
Blasbalg R, Baroni RH, Costa DN, Machado MC. MRI features of groove pancreatitis. AJR Am J Roentgenol 2007;189(1):73-80. https://doi.org/10.2214/ajr.06.1244
Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying “cystic dystrophy of heterotopic pancreas”, “para-duodenal wall cyst”, and “groove pancreatitis”. Semin Diagn Pathol 2004;21(4):247-254. https://www.ncbi.nlm.nih.gov/pubmed/16273943.
Ishigami K, Tajima T, Nishie A, Kakihara D, Fujita N, Asayama Y, Ushijima Y, Irie H, Nakamura M, Takahata S, Ito T, Honda H. Differential diagnosis of groove pancreatic carcinomas vs. groove pancreatitis: usefulness of the portal venous phase. Eur J Radiol 2010;74(3):e95-e100. https://doi.org/10.1016/j.ejrad.2009.04.026
Castell-Monsalve FJ, Sousa-Martin JM, Carranza-Carranza A. Groove pancreatitis: MRI and pathologic findings. Abdom Imaging 2008;33(3):342-348. https://doi.org/10.1007/s00261-007-9245-x
Kalb B, Martin DR, Sarmiento JM, Erickson SH, Gober D, Tapper EB, Chen Z, Adsay NV. Paraduodenal pancreatitis: clinical performance of MR imaging in distinguishing from carcinoma. Radiology 2013;269(2):475-481. https://doi.org/10.1148/radiol.13112056
Itoh S, Yamakawa K, Shimamoto K, Endo T, Ishigaki T. CT findings in groove pancreatitis: correlation with histopathological findings. J Comput Assist Tomogr 1994;18(6):911-915. https://www.ncbi.nlm.nih.gov/pubmed/7962798.
Mittal PK, Harri P, Nandwana S, Moreno CC, Muraki T, Adsay V, Cox K, Pehlivanoglu B, Alexander LF, Chatterjee A, Miller FH. Paraduodenal pancreatitis: benign and malignant mimics at MRI. Abdom Radiol (NY) 2017;42(11):2652-2674. https://doi.org/10.1007/s00261-017-1238-9
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Kothari, K., Lopes Vendrami, C., Kelahan, L.C. et al. Inflammatory mimickers of pancreatic adenocarcinoma. Abdom Radiol 45, 1387–1396 (2020). https://doi.org/10.1007/s00261-019-02233-7
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DOI: https://doi.org/10.1007/s00261-019-02233-7