Advertisement

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
Hepatobiliary-Pancreas
  • 81 Downloads

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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

Abbreviations

AIP

Autoimmune pancreatitis

AP

Arterial phase

AUROC

Area under receiver operating characteristic curve

CE-MRI

Contrast-enhanced magnetic resonance imaging

DP

Delayed phase

MPD

Main pancreatic duct

PDA

Pancreatic ductal adenocarcinoma

PP

Portal phase

ROC

Receiver operating characteristic

ROI

Region of interest

SI

Signal intensity

UP

Unenhanced phase

Notes

Funding

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

Compliance with ethical standards

Guarantor

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.

Methodology

• retrospective

• observational

• performed at one institution

References

  1. 1.
    Finkelberg DL, Sahani D, Deshpande V, Brugge WR (2006) Autoimmune pancreatitis. N Engl J Med 355:2670–2676CrossRefGoogle Scholar
  2. 2.
    Chari ST, Takahashi N, Levy MJ et al (2009) A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer. Clin Gastroenterol Hepatol 7:1097–1103CrossRefGoogle Scholar
  3. 3.
    Kamisawa T, Imai M, Yui Chen P et al (2008) Strategy for differentiating autoimmune pancreatitis from pancreatic cancer. Pancreas 37:e62–e67CrossRefGoogle Scholar
  4. 4.
    Kim JH, Kim MH, Byun JH et al (2012) Diagnostic strategy for differentiating autoimmune pancreatitis from pancreatic cancer: is an endoscopic retrograde pancreatography essential. Pancreas 41:639–647CrossRefGoogle Scholar
  5. 5.
    Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A, Kamata N (2003) Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma. Am J Gastroenterol 98:2694–2699CrossRefGoogle Scholar
  6. 6.
    Lee S, Kim JH, Kim SY et al (2018) Comparison of diagnostic performance between CT and MRI in differentiating non-diffuse-type autoimmune pancreatitis from pancreatic ductal adenocarcinoma. Eur Radiol 28:5267–5274CrossRefGoogle Scholar
  7. 7.
    Manfredi R, Frulloni L, Mantovani W, Bonatti M, Graziani R, Mucelli RP (2011) Autoimmune pancreatitis: pancreatic and extrapancreatic MR imaging-MR cholangiopancreatography findings at diagnosis, after steroid therapy, and at recurrence. Radiology 260:428–436CrossRefGoogle Scholar
  8. 8.
    Rehnitz C, Klauss M, Singer R et al (2011) Morphologic patterns of autoimmune pancreatitis in CT and MRI. Pancreatology 11:240–251CrossRefGoogle Scholar
  9. 9.
    Takahashi N, Fletcher JG, Hough DM et al (2009) Autoimmune pancreatitis: differentiation from pancreatic carcinoma and normal pancreas on the basis of enhancement characteristics at dual-phase CT. AJR Am J Roentgenol 193:479–484CrossRefGoogle Scholar
  10. 10.
    Wakabayashi T, Kawaura Y, Satomura Y et al (2003) Clinical and imaging features of autoimmune pancreatitis with focal pancreatic swelling or mass formation: comparison with so-called tumor-forming pancreatitis and pancreatic carcinoma. Am J Gastroenterol 98:2679–2687CrossRefGoogle Scholar
  11. 11.
    Choi SY, Kim SH, Kang TW, Song KD, Park HJ, Choi YH (2016) Differentiating mass-forming autoimmune pancreatitis from pancreatic ductal adenocarcinoma on the basis of contrast-enhanced MRI and DWI findings. AJR Am J Roentgenol 206:291–300CrossRefGoogle Scholar
  12. 12.
    Hur BY, Lee JM, Lee JE et al (2012) Magnetic resonance imaging findings of the mass-forming type of autoimmune pancreatitis: comparison with pancreatic adenocarcinoma. J Magn Reson Imaging 36:188–197CrossRefGoogle Scholar
  13. 13.
    Kim M, Jang KM, Kim JH et al (2017) Differentiation of mass-forming focal pancreatitis from pancreatic ductal adenocarcinoma: value of characterizing dynamic enhancement patterns on contrast-enhanced MR images by adding signal intensity color mapping. Eur Radiol 27:1722–1732CrossRefGoogle Scholar
  14. 14.
    Negrelli R, Manfredi R, Pedrinolla B et al (2015) Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings. Eur Radiol 25:359–367CrossRefGoogle Scholar
  15. 15.
    Furuhashi N, Suzuki K, Sakurai Y, Ikeda M, Kawai Y, Naganawa S (2015) Differentiation of focal-type autoimmune pancreatitis from pancreatic carcinoma: assessment by multiphase contrast-enhanced CT. Eur Radiol 25:1366–1374CrossRefGoogle Scholar
  16. 16.
    Muhi A, Ichikawa T, Motosugi U et al (2012) 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 35:827–836CrossRefGoogle Scholar
  17. 17.
    Sugiyama Y, Fujinaga Y, Kadoya M et al (2012) Characteristic magnetic resonance features of focal autoimmune pancreatitis useful for differentiation from pancreatic cancer. Jpn J Radiol 30:296–309CrossRefGoogle Scholar
  18. 18.
    Sun GF, Zuo CJ, Shao CW, Wang JH, Zhang J (2013) Focal autoimmune pancreatitis: radiological characteristics help to distinguish from pancreatic cancer. World J Gastroenterol 19:3634–3641CrossRefGoogle Scholar
  19. 19.
    Otsuki M, Chung JB, Okazaki K et al (2008) Asian diagnostic criteria for autoimmune pancreatitis: consensus of the Japan-Korea Symposium on Autoimmune Pancreatitis. J Gastroenterol 43:403–408CrossRefGoogle Scholar
  20. 20.
    Chari ST, Smyrk TC, Levy MJ et al (2006) Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol 4:1010–1016 quiz 1934CrossRefGoogle Scholar
  21. 21.
    Shimosegawa T, Chari ST, Frulloni L et al (2011) International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 40:352–358CrossRefGoogle Scholar
  22. 22.
    Carbognin G, Girardi V, Biasiutti C et al (2009) Autoimmune pancreatitis: imaging findings on contrast-enhanced MR, MRCP and dynamic secretin-enhanced MRCP. Radiol Med 114:1214–1231CrossRefGoogle Scholar
  23. 23.
    Chang WI, Kim BJ, Lee JK et al (2009) The clinical and radiological characteristics of focal mass-forming autoimmune pancreatitis comparison with chronic pancreatitis and pancreatic cancer. Pancreas 38:401–408CrossRefGoogle Scholar
  24. 24.
    Kim HJ, Kim YK, Jeong WK, Lee WJ, Choi D (2015) Pancreatic duct "icicle sign" on MRI for distinguishing autoimmune pancreatitis from pancreatic ductal adenocarcinoma in the proximal pancreas. Eur Radiol 25:1551–1560CrossRefGoogle Scholar
  25. 25.
    Chandan VS, Iacobuzio-Donahue C, Abraham SC (2008) Patchy distribution of pathologic abnormalities in autoimmune pancreatitis: implications for preoperative diagnosis. Am J Surg Pathol 32:1762–1769CrossRefGoogle Scholar

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

Personalised recommendations