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

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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.

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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


  1. Finkelberg DL, Sahani D, Deshpande V, Brugge WR (2006) Autoimmune pancreatitis. N Engl J Med 355:2670–2676

    Article  CAS  Google Scholar 

  2. Chari ST, Takahashi N, Levy MJ et al (2009) A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer. Clin Gastroenterol Hepatol 7:1097–1103

    Article  CAS  Google Scholar 

  3. Kamisawa T, Imai M, Yui Chen P et al (2008) Strategy for differentiating autoimmune pancreatitis from pancreatic cancer. Pancreas 37:e62–e67

    Article  Google Scholar 

  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 41:639–647

    Article  CAS  Google Scholar 

  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 98:2694–2699

    Article  Google Scholar 

  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 28:5267–5274

    Article  Google Scholar 

  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 260:428–436

    Article  Google Scholar 

  8. Rehnitz C, Klauss M, Singer R et al (2011) Morphologic patterns of autoimmune pancreatitis in CT and MRI. Pancreatology 11:240–251

    Article  Google Scholar 

  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 193:479–484

    Article  Google Scholar 

  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 98:2679–2687

    Article  Google Scholar 

  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 206:291–300

    Article  Google Scholar 

  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 36:188–197

    Article  Google Scholar 

  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 27:1722–1732

    Article  Google Scholar 

  14. Negrelli R, Manfredi R, Pedrinolla B et al (2015) Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings. Eur Radiol 25:359–367

    Article  Google Scholar 

  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 25:1366–1374

    Article  Google Scholar 

  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 35:827–836

    Article  Google Scholar 

  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 30:296–309

    Article  CAS  Google Scholar 

  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 19:3634–3641

    Article  Google Scholar 

  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 43:403–408

    Article  CAS  Google Scholar 

  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 1934

    Article  Google Scholar 

  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 40:352–358

    Article  Google Scholar 

  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 114:1214–1231

    Article  CAS  Google Scholar 

  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 38:401–408

    Article  Google Scholar 

  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 25:1551–1560

    Article  Google Scholar 

  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 32:1762–1769

    Article  Google Scholar 

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Correspondence to Jin Hee Kim.

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Kwon, J.H., Kim, J.H., Kim, S.Y. et al. Differentiating focal autoimmune pancreatitis and pancreatic ductal adenocarcinoma: contrast-enhanced MRI with special emphasis on the arterial phase. Eur Radiol 29, 5763–5771 (2019).

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