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Differentiation of benign and malignant solid pancreatic masses using magnetic resonance elastography with spin-echo echo planar imaging and three-dimensional inversion reconstruction: a prospective study

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To determine the diagnostic performance of MR elastography (MRE) and compare it with serum CA19-9 in differentiating malignant from benign pancreatic masses, with emphasis on differentiating between pancreatic ductal adenocarcinoma (PDAC) and mass-forming pancreatitis (MFP).

Methods

We performed a prospective, consecutive, 24-month study in 85 patients with solid pancreatic masses confirmed by histopathologic examinations. The mass stiffness and stiffness ratio (calculated as the ratio of mass stiffness to the parenchymal stiffness) were assessed. The diagnostic accuracy was analysed by calculating the area under the ROC curve (AUROC).

Results

The final diagnosis included 54 malignant tumours (43 patients with PDAC) and 31 benign masses (24 patients with MFP). The stiffness ratio showed better diagnostic performance than the mass stiffness and serum CA19-9 for the differentiation between malignant and benign masses (AUC: 0.912 vs. 0.845 vs. 0.702; P = 0.026, P < 0.001) and, specifically, between PDAC and MFP (AUC: 0.955 vs. 0.882 vs. 0.745; P = 0.026, P = 0.003). The sensitivity, specificity, and accuracy of stiffness ratio for the differentiation of PDAC and MFP were all higher than 0.9.

Conclusions

MRE presents an effective and quantitative strategy for non-invasive differentiation between PDAC and MFP based on their mechanical properties.

Key Points

• 3D MRE is useful for calculating stiffness of solid pancreatic tumours.

• Stiffness ratio outperformed stiffness and CA19-9 for differentiating PDAC from MFP.

• Incorporation of 3D MRE into a standard MRI protocol is recommended.

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Abbreviations

MRE:

MR elastography

CA19-9:

Carbohydrate antigen 19-9

PDAC:

Pancreatic ductal adenocarcinoma

MFP:

Mass-forming pancreatitis

ROC:

Receiver operating characteristic

AUC:

Area under the curve

SPN:

Solid pseudo-papillary neoplasm

NEPT:

Neuroendocrine pancreatic tumour

CT:

Computed tomography

EUS:

Endoscopic ultrasound

EPI:

Echo planar imaging

FNA:

Fine-needle aspiration

3D:

Three dimensional

ROI:

Region of interest

SD:

Standard deviation

SE:

Spin echo

IQR:

Interquartile range

ANOVA:

Analysis of variance

ICC:

Intra-class correlation coefficient

NPV:

Negative predictive value

PPV:

Positive predictive value

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Acknowledgements

We thank Jun Chen, PHD, from the Department of Radiology, Mayo Clinic, for his assistance with providing the tailored pancreatic MRE driver. We thank Bing Ma, from the Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, the First Affiliated Hospital of China Medical University, who kindly provided statistical advice for this manuscript.

Author information

Authors and Affiliations

  1. Department of Radiology, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang, 110004, People’s Republic of China

    Yu Shi, Bing Yu, Yanqing Liu & Qiyong Guo

  2. Department of Hepato-Pancreato-Biliary Tumour Surgery, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China

    Feng Gao

  3. Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China

    Yue Li

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

    Shengzhen Tao, Kevin J. Glaser & Richard L. Ehman

  5. Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong, People’s Republic of China

    Zaiyi Liu

Authors
  1. Yu Shi
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Corresponding author

Correspondence to Qiyong Guo.

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Guarantor

The scientific guarantor of this publication is Qiyong Guo.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Kevin J. Glaser has stock in Resoundant and intellectual property related to MRE. He has a patent and receives licensing royalties through Resoundant and GE Medical Systems. Richard L. Ehman is an equity holder in and chief executive officer of Resoundant. He has a patent and receives licensing royalties for MRE.

Funding

This study has received funding by the National Natural Science Foundation of China (no. 81401376, 81471718, 81771802), National Institutes of Health (grant EB001981), and Outstanding Youth Foundation of China Medical University (no. YQ20160005).

Statistics and biometry

Bing Ma kindly provided statistical advice for this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

This research was approved by the Institutional Review Board of Shengjing Hospital of China Medical University and conducted in accordance with the Declaration of Helsinki and its amendments, and Good Clinical Practice guidelines.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Shi, Y., Gao, F., Li, Y. et al. Differentiation of benign and malignant solid pancreatic masses using magnetic resonance elastography with spin-echo echo planar imaging and three-dimensional inversion reconstruction: a prospective study. Eur Radiol 28, 936–945 (2018). https://doi.org/10.1007/s00330-017-5062-y

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  • DOI: https://doi.org/10.1007/s00330-017-5062-y

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