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Diffusion-weighted magnetic resonance imaging indicates the severity of acute pancreatitis

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Abstract

Purpose

To test the use of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate between different degrees of severity of acute pancreatitis (AP).

Method

Thirty-six patients who underwent DW-MRI and magnetic resonance cholangiopancreatography were divided into patients with mild AP (mAP, n = 15), patients with necrotizing AP (nAP, n = 8), and patients with a normal pancreas (nP, n = 15; controls). The pancreas was divided into head, body, and tail, and each segment was classified according to image features: pattern 1, normal; pattern 2, mild inflammation; and pattern 3, necrosis. Apparent diffusion coefficients (ADCs) were measured in each segment and correlated with clinical diagnoses.

Results

A total of 108 segments was assessed (three segments per patient). Segments classified as pattern 1 in the nP and mAP groups showed similar ADC values (P = 0.29). ADC values calculated for the pancreatic segments grouped according to the different image patterns (1–3) were significantly different (P < 0.001). Comparisons revealed significant differences in signal intensity between all three patterns (P < 0.05).

Conclusions

DW-MRI was a compatible and safe image option to differentiate tissue image patterns in patients with mAP, nAP, and nP, mainly in those with contraindications to contrast-enhanced MRI (which is classically required for determining the presence of necrosis) or computed tomography. ADC measures allowed precise differentiation between patterns 1, 2, and 3.

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Ethical aspects

The present research protocol was approved by the Research Ethics Committee at Hospital São Paulo, Universidade Federal de São Paulo and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The experiment complies with the current laws of the country in which it was performed. All patients signed an informed consent form agreeing to undergo DW-MRI/MRCP at the Radiology Unit of the same university.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil

    Franklin de Freitas Tertulino, José Celso Ardengh, Danilo Cerqueira do Espírito-Santo, Sergio Aron Ajzen, Jacob Szejnfeld & Suzan Menasce Goldman

  2. Department of Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil

    Vladimir Schraibman, Franz Robert Apodaca Torrez & Edson Jose Lobo

  3. Division of Surgery and Anatomy, Medicine School of Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Prêto, Brazil

    José Celso Ardengh

Authors
  1. Franklin de Freitas Tertulino
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  2. Vladimir Schraibman
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  9. Suzan Menasce Goldman
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Corresponding author

Correspondence to Suzan Menasce Goldman.

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de Freitas Tertulino, F., Schraibman, V., Ardengh, J.C. et al. Diffusion-weighted magnetic resonance imaging indicates the severity of acute pancreatitis. Abdom Imaging 40, 265–271 (2015). https://doi.org/10.1007/s00261-014-0205-y

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