Differentiating focal autoimmune pancreatitis and pancreatic ductal adenocarcinoma: contrast-enhanced MRI with special emphasis on the arterial phase

  • Ji Hye Kwon
  • Jin Hee KimEmail author
  • So Yeon Kim
  • Jae Ho Byun
  • Hyoung Jung Kim
  • Moon-Gyu Lee
  • Seung Soo Lee



To compare focal-type autoimmune pancreatitis (AIP) and pancreatic ductal adenocarcinoma (PDA) using contrast-enhanced MR imaging (CE-MRI), and to assess diagnostic performance of the lesion contrast at arterial phase (AP) (ContrastAP) for differentiating between the two diseases.


Thirty-six patients with focal-type AIP and 72 patients with PDA were included. All included patients underwent CE-MRI with triple phases. The signal intensity (SI) of the mass and normal pancreas was measured at each phase, and the lesion contrast (SIpancreas/SImass) was compared between AIP and PDA groups. The sensitivity and specificity of ContrastAP using an optimal cutoff point were compared with those of key imaging features specific to AIP and PDA.


The lesion contrast differed significantly between AIP and PDA groups at all phases of CE-MRI; the maximum difference was observed at AP. For AIP, the sensitivity (94.4%) and specificity (87.5%) of ContrastAP (cutoff ≤ 1.41) were comparable or significantly higher than those of all key imaging features (sensitivity, 38.9–88.9%; specificity, 48.6–95.8%), except for the halo sign. For PDA, the sensitivity (87.5%) and specificity (94.4%) of ContrastAP (cutoff > 1.41) were comparable or significantly higher than those of all key imaging features (sensitivity, 40.3–68.1%; specificity, 72.2–94.4%), except for the discrete mass.


Quantitative analysis of the lesion contrast using CE-MRI, particularly at AP, was helpful to differentiate focal-type AIP from PDA. The diagnostic performance of ContrastAP was mostly comparable or higher than those of the key imaging features.

Key Points

• Diagnosis of focal-type AIP vs. PDA using imaging techniques is extremely challenging.

• Lesion contrast in the arterial-phase MRI differs significantly between focal-type AIP and PDA.

• Quantitative analysis of lesion contrast using CE-MRI, particularly at the arterial phase, is helpful to differentiate focal-type AIP from PDA.


Pancreatic neoplasms Pancreatitis Autoimmune disease Carcinoma, pancreatic ductal Magnetic resonance imaging 



Autoimmune pancreatitis


Arterial phase


Area under receiver operating characteristic curve


Contrast-enhanced magnetic resonance imaging


Delayed phase


Main pancreatic duct


Pancreatic ductal adenocarcinoma


Portal phase


Receiver operating characteristic


Region of interest


Signal intensity


Unenhanced phase



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Jin Hee Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea

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