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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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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.

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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

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea

    Ji Hye Kwon, Jin Hee Kim, So Yeon Kim, Jae Ho Byun, Hyoung Jung Kim, Moon-Gyu Lee & Seung Soo Lee

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  1. Ji Hye Kwon
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  2. Jin Hee Kim
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  3. So Yeon Kim
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  4. Jae Ho Byun
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  6. Moon-Gyu Lee
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  7. Seung Soo Lee
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Correspondence to Jin Hee Kim.

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The scientific guarantor of this publication is Jin Hee Kim.

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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.

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• observational

• performed at one institution

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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). https://doi.org/10.1007/s00330-019-06200-0

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  • DOI: https://doi.org/10.1007/s00330-019-06200-0

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