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Higashi M, Tanabe M, Tanabe K, Okuya S, Takeda K, Nagao Y, Ito K. Multiparametric Magnetic Resonance Imaging Findings of the Pancreas: A Comparison in Patients with Type 1 and 2 Diabetes. Tomography 2025; 11:16. [PMID: 39997999 PMCID: PMC11861380 DOI: 10.3390/tomography11020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 01/28/2025] [Accepted: 02/05/2025] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND/OBJECTIVES Diabetes-related pancreatic changes on MRI remain unclear. Thus, we evaluated the pancreatic changes on MRI in patients with both type 1 diabetes (T1D) and type 2 diabetes (T2D) using multiparametric MRI. METHODS This prospective study involved patients with T1D or T2D who underwent upper abdominal 3-T MRI. Additionally, patients without impaired glucose metabolism were retrospectively included as a control. The imaging data included pancreatic anteroposterior (AP) diameter, pancreas-to-muscle signal intensity ratio (SIR) on fat-suppressed T1-weighted image (FS-T1WI), apparent diffusion coefficient (ADC) value, T1 value on T1 map, proton density fat fraction (PDFF), and mean secretion grade of pancreatic juice flow on cine-dynamic magnetic resonance cholangiopancreatography (MRCP). The MR measurements were compared using one-way analysis of variance and the Kruskal-Wallis test. RESULTS Sixty-one patients with T1D (n = 7) or T2D (n = 54) and 21 control patients were evaluated. The pancreatic AP diameters were significantly smaller in patients with T1D than in patients with T2D (p < 0.05). The average SIR on FS-T1WI was significantly lower in patients with T1D than in controls (p < 0.001). The average ADC and T1 values of the pancreas were significantly higher in patients with T1D than in patients with T2D (p < 0.01) and controls (p < 0.05). The mean secretion grade of pancreatic juice flow was significantly lower in patients with T1D than in controls (p = 0.019). The average PDFF of the pancreas was significantly higher in patients with T2D than in controls (p = 0.029). CONCLUSIONS Patients with T1D had reduced pancreas size, increased pancreatic T1 and ADC values, and decreased pancreatic juice flow on cine-dynamic MRCP, whereas patients with T2D had increased pancreatic fat content.
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Affiliation(s)
- Mayumi Higashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (M.T.); (K.I.)
| | - Masahiro Tanabe
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (M.T.); (K.I.)
| | - Katsuya Tanabe
- Division of Endocrinology, Metabolism, Hematological Sciences and Therapeutics, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (K.T.)
| | - Shigeru Okuya
- Health Administration Center, Organization for Education and Student Affairs, Yamaguchi 753-8511, Japan;
| | - Koumei Takeda
- Division of Endocrinology, Metabolism, Hematological Sciences and Therapeutics, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (K.T.)
| | - Yuko Nagao
- Division of Endocrinology, Metabolism, Hematological Sciences and Therapeutics, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (K.T.)
| | - Katsuyoshi Ito
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan; (M.T.); (K.I.)
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Chang Wu B, Wlodarczyk J, Nourmohammadi Abadchi S, Shababi N, Cameron JL, Harmon JW. Revolutionary transformation lowering the mortality of pancreaticoduodenectomy: a historical review. EGASTROENTEROLOGY 2023; 1:e100014. [PMID: 38292831 PMCID: PMC10827342 DOI: 10.1136/egastro-2023-100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
The History Maker paper focuses on the extraordinary revolution that dramatically improved the surgical results for the Whipple procedure (pancreaticoduodenectomy) in the 1980s and identifies Dr. Cameron as the leader of this revolution, who reported a mortality rate of approximately 1%. The revolutionary reduction of postoperative mortality for the Whipple procedure was achieved by adherence to gentle and precise Halstedian surgical techniques with adequate drainage of pancreatico-jejunal anastomosis with closed-suction silastic drains, along with the development of high-volume surgeons and hospitals. Excellent teamwork in patient care, including but not limited to preoperative evaluation by multidisciplinary teams, intraoperative communication between surgeons and anaesthesiologists, and postoperative management, contributed to a successful Whipple procedure.
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Affiliation(s)
- Bo Chang Wu
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Jakub Wlodarczyk
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of General and Oncological Surgery, Medical University of Lodz, Lodz, Poland
| | | | - Niloufar Shababi
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - John L Cameron
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - John W Harmon
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Nalbant MO, Inci E, Akinci O, Aygan S, Gulturk U, Boluk Gulsever A. Evaluation of Imaging Findings of Pancreatobiliary and Intestinal Type Periampullary Carcinomas with 3.0T MRI. Acad Radiol 2023; 30:1846-1855. [PMID: 36585328 DOI: 10.1016/j.acra.2022.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to differentiate pancreatobiliary and intestinal type periampullary carcinomas using dynamic contrast MRI and MRCP (Magnetic Resonance Cholangiopancreatography) with diffusion-weighted imaging (DWI) MATERIALS AND METHODS: MRI and MRCP images of 70 patients with pathologically proven periampullary adenocarcinoma were included. MRCP image features, extra-ampullary features, enhancement patterns, and apparent diffusion coefficient (ADC) values derived from b-values of 1000 s/mm² were evaluated by two radiologists independently. The interclass correlation coefficient (ICC) or Cohen's kappa statistic was used to evaluate the interobserver agreement. RESULTS 51 patients were diagnosed with pancreatobiliary type carcinomas, and 19 with intestinal type. In the pancreatobiliary subtype, the distal wall of the common bile duct was usually irregular (p = 0.047). Although the progressive enhancement pattern was evident in the pancreatobiliary type, an oval filling defect in the distal common bile duct was found to be more common in the intestinal type (p<0.001). The pancreatic duct cut-off sign (p<0.001), gastroduodenal artery involvement (p <0,001), and lymphadenopathy (p<0.05) were mostly observed in pancreatobiliary carcinomas. The ADCmin, ADCmean, and ADCmax values of the pancreatobiliary type carcinomas were all lower compared to the intestinal type carcinomas (p <0.05). CONCLUSION The oval filling defect seen in MRI and MRCP examinations suggests intestinal type, whereas the progressive contrasting pattern of the masses with irregular narrowing in the distal margin of the common bile duct, the pancreatic duct cut-off sign, gastroduodenal artery involvement, lymphadenopathy, and low ADC values indicate pancreatobiliary type carcinomas.
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Affiliation(s)
- Mustafa Orhan Nalbant
- Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
| | - Ercan Inci
- Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Akinci
- Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sinan Aygan
- Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ulas Gulturk
- Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Aycan Boluk Gulsever
- Radiology Department, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Kanbay M, Copur S, Demiray A, Sag AA, Covic A, Ortiz A, Tuttle KR. Fatty kidney: A possible future for chronic kidney disease research. Eur J Clin Invest 2022; 52:e13748. [PMID: 35040119 DOI: 10.1111/eci.13748] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/15/2022] [Accepted: 01/16/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Metabolic syndrome is a growing twenty-first century pandemic associated with multiple clinical comorbidities ranging from cardiovascular diseases, non-alcoholic fatty liver disease and polycystic ovary syndrome to kidney dysfunction. A novel area of research investigates the concept of fatty kidney in the pathogenesis of chronic kidney disease, especially in patients with diabetes mellitus or metabolic syndrome. AIM To review the most updated literature on fatty kidney and provide future research, diagnostic and therapeutic perspectives on a disease increasingly affecting the contemporary world. MATERIALS AND METHOD We performed an extensive literature search through three databases including Embase (Elsevier) and the Cochrane Central Register of Controlled Trials (Wiley) and PubMed/Medline Web of Science in November 2021 by using the following terms and their combinations: 'fatty kidney', 'ectopic fat', 'chronic kidney disease', 'cardiovascular event', 'cardio-metabolic risk', 'albuminuria' and 'metabolic syndrome'. Each study has been individually assessed by the authors. RESULTS Oxidative stress and inflammation, Klotho deficiency, endoplasmic reticulum stress, mitochondrial dysfunction and disruption of cellular energy balance appear to be the main pathophysiological mechanisms leading to tissue damage following fat accumulation. Despite the lack of large-scale comprehensive studies in this novel field of research, current clinical trials demonstrate fatty kidney as an independent risk factor for the development of chronic kidney disease and cardiovascular events. CONCLUSION The requirement for future studies investigating the pathophysiology, clinical outcomes and therapeutics of fatty kidney is clear.
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Affiliation(s)
- Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Atalay Demiray
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Alan A Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Adrian Covic
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Alberto Ortiz
- Department of Medicine, Universidad Autonoma de Madrid and IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Kathherine R Tuttle
- Division of Nephrology, University of Washington, Seattle, Washington, USA.,Providence Medical Research Center, Providence Health Care, Spokane, Washington, USA
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Wang L, Nie F, Dong T, Yin C, Li M, Li Y. Nonhypovascular pancreatic ductal adenocarcinomas: CEUS imaging findings and differentiation from other types of solid pancreatic lesions. Clin Hemorheol Microcirc 2022; 81:163-176. [PMID: 35253738 DOI: 10.3233/ch-221397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To observe and assess the diagnostic value of contrast-enhanced ultrasound (CEUS) in patients with iso-/hypervascular solid pancreatic lesions. METHODS 70 pancreatic lesions (all confirmed by surgery or biopsy pathology) that manifested iso-/hyperenhancement on CEUS were retrospectively studied from January 2018 to January 2022, including 24 pancreatic ductal adenocarcinomas (PDAC), 15 mass-forming pancreatitis (MFP), 24 pancreatic neuroendocrine tumors (PNET) (14 hyper-PNETs, 10 iso-PNETs), and 7 solid pseudopapillary tumors of pancreas (SPTP). 65 pancreatic ductal adenocarcinomas (PDAC) that manifested hypoenhancement on CEUS were retrospectively studied from January 2020 to January 2022. CEUS patterns and the clinical and pathologic features were analyzed, and the diagnostic ability of CEUS for iso/hyperenhanced solid pancreatic lesions was assessed. RESULTS Centripetal enhancement, heterogeneous enhancement, early washout, and hypoenhancement in the late phase mostly appeared in iso-/hyper-PDACs (p < 0.05). Heterogeneous enhancement in small lesions (< 3 cm) as the diagnostic criterion for iso-/hyper-PDACs had an accuracy of 74.3% and a specificity of 91.3%. Iso-PNETs more commonly had larger tumor sizes and more often showed heterogeneous enhancement than hyper-PNETs (p = 0.007, p = 0.035, respectively). The characteristics of the combination of isoenhancement, homogeneous enhancement, and synchronous wash-in/out for MFP had a high accuracy of 90%. Capsular enhancement with heterogeneous enhancement inside for SPTP had an accuracy of 97.1%. CONCLUSION CEUS enhancement patterns have potentially great value in the differentiation of iso-/hyperenhanced pancreatic lesions.
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Affiliation(s)
- Lan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China. Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China. Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Tiantian Dong
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China. Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Ci Yin
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China. Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Ming Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China. Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Yuanyuan Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen, Chengguan District, Lanzhou, China. Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
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Dynamic contract-enhanced CT-based radiomics for differentiation of pancreatobiliary-type and intestinal-type periampullary carcinomas. Clin Radiol 2021; 77:e75-e83. [PMID: 34753589 DOI: 10.1016/j.crad.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022]
Abstract
AIM To investigate whether computed tomography (CT) radiomics can differentiate pancreatobiliary-type from intestinal-type periampullary carcinomas. MATERIALS AND METHODS CT radiomics of 96 patients (54 pancreatobiliary type and 42 intestinal type) with surgically confirmed periampullary carcinoma were assessed retrospectively. Volumes of interest (VOIs) were delineated manually. Radiomic features were extracted from preoperative CT images. A single-phase model and combined-phase model were constructed. Five-fold cross-validation and five machine-learning algorithms were utilised for model construction. The diagnostic performance of the models was evaluated by receiver operating characteristic (ROC) curves, and indicators included area under the curve (AUC), accuracy, sensitivity, specificity, and precision. ROC curves were compared using DeLong's test. RESULTS A total of 788 features were extracted on each phase. After feature selection using least absolute shrinkage and selection operator (LASSO) algorithm, the number of selected optimal feature was 18 (plain scan), nine (arterial phase), two (venous phase), 23 (delayed phase), 15 (three enhanced phases), and 29 (all phases), respectively. For the single-phase model, the delayed-phase model using the logistic regression (LR) algorithm showed the best prediction performance with AUC, accuracy, sensitivity, specificity, and precision of 0.89, 0.83, 0.80, 0.88, and 0.93, respectively. Two combined-phase models showed better results than the single-phase models. The model of all phases using the LR algorithm showed the best prediction performance with AUC, accuracy, sensitivity, specificity, and precision of 0.96, 0.88, 0.90, 0.93, and 0.92, respectively. CONCLUSION Radiomic models based on preoperative CT images can differentiate pancreatobiliary-type from intestinal-type periampullary carcinomas, in particular, the model of all phases using the LR algorithm.
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Kulkarni NM, Mannelli L, Zins M, Bhosale PR, Arif-Tiwari H, Brook OR, Hecht EM, Kastrinos F, Wang ZJ, Soloff EV, Tolat PP, Sangster G, Fleming J, Tamm EP, Kambadakone AR. White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part II, update on imaging techniques and screening of pancreatic cancer in high-risk individuals. Abdom Radiol (NY) 2020; 45:729-742. [PMID: 31768594 DOI: 10.1007/s00261-019-02290-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive gastrointestinal malignancy with a poor 5-year survival rate. Its high mortality rate is attributed to its aggressive biology and frequently late presentation. While surgical resection remains the only potentially curative treatment, only 10-20% of patients will present with surgically resectable disease. Over the past several years, development of vascular bypass graft techniques and introduction of neoadjuvant treatment regimens have increased the number of patients who can undergo resection with a curative intent. While the role of conventional imaging in the detection, characterization, and staging of patients with PDAC is well established, its role in monitoring treatment response, particularly following neoadjuvant therapy remains challenging because of the complex anatomic and histological nature of PDAC. Novel morphologic and functional imaging techniques (such as DECT, DW-MRI, and PET/MRI) are being investigated to improve the diagnostic accuracy and the ability to measure response to therapy. There is also a growing interest to detect PDAC and its precursor lesions at an early stage in asymptomatic patients to increase the likelihood of achieving cure. This has led to the development of pancreatic cancer screening programs. This article will review recent updates in imaging techniques and the current status of screening and surveillance of individuals at a high risk of developing PDAC.
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Affiliation(s)
- Naveen M Kulkarni
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | | | - Marc Zins
- Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France
| | - Priya R Bhosale
- Abdominal Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1473, Houston, TX, 77030-400, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona College of Medicine, 1501 N. Campbell Ave, P.O. Box 245067, Tucson, AZ, 85724, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro 4, Boston, MA, 02215-5400, USA
| | - Elizabeth M Hecht
- Department of Radiology, Columbia University Medical Center, 622 W 168th St, PH1-317, New York, NY, 10032, USA
| | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Cancer, 161 Fort Washington Avenue, Suite: 862, New York, NY, 10032, USA
| | - Zhen Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Erik V Soloff
- Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Parag P Tolat
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Guillermo Sangster
- Department of Radiology, Ochsner LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Jason Fleming
- Gastrointestinal Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Eric P Tamm
- Abdominal Imaging Department, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1473, Houston, TX, 77030-400, USA
| | - Avinash R Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA
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Tom WJ, Xu X, Vahdat N, Cassidy F, Aganovic L. Follicular pancreatitis: A rare pancreatic inflammatory pseudotumor. Clin Imaging 2020; 59:39-44. [PMID: 31756593 PMCID: PMC6938461 DOI: 10.1016/j.clinimag.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/16/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023]
Abstract
Inflammatory pseudotumors imitate neoplasms on imaging but actually represent focal inflammation. We report a case of follicular pancreatitis, which is a recently recognized distinct form of mass-forming focal chronic pancreatitis pathologically characterized by lymphoid infiltration with abundant reactive germinal centers. In our patient, follicular pancreatitis manifested as a pancreatic tail mass that was resected due to imaging findings, which were suggestive of pancreatic malignancy. We performed a literature review of this rare condition and present a summary of reported imaging findings. The most distinguishing feature from pancreatic adenocarcinoma is the enhancement pattern, as follicular pancreatitis enhances more than the surrounding pancreatic parenchyma on delayed post-contrast images which is unusual for pancreatic adenocarcinoma. If this benign diagnosis is suggested on imaging, unnecessary surgery and its potential complications may be avoided.
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Affiliation(s)
- W James Tom
- Department of Radiology, University of California San Diego, San Diego, CA, USA.
| | - Xiangdong Xu
- Department of Pathology, University of California San Diego, San Diego, CA, USA; Department of Pathology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Noushin Vahdat
- Department of Radiology, University of California San Diego, San Diego, CA, USA; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Fiona Cassidy
- Department of Radiology, University of California San Diego, San Diego, CA, USA; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Lejla Aganovic
- Department of Radiology, University of California San Diego, San Diego, CA, USA; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
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Rozenblum L, Mokrane FZ, Yeh R, Sinigaglia M, Besson F, Seban RD, Chougnet CN, Revel-Mouroz P, Zhao B, Otal P, Schwartz LH, Dercle L. The role of multimodal imaging in guiding resectability and cytoreduction in pancreatic neuroendocrine tumors: focus on PET and MRI. Abdom Radiol (NY) 2019; 44:2474-2493. [PMID: 30980115 DOI: 10.1007/s00261-019-01994-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms that secrete peptides and neuro-amines. pNETs can be sporadic or hereditary, syndromic or non-syndromic with different clinical presentations and prognoses. The role of medical imaging includes locating the tumor, assessing its extent, and evaluating the feasibility of curative surgery or cytoreduction. Pancreatic NETs have very distinctive phenotypes on CT, MRI, and PET. PET have been demonstrated to be very sensitive to detect either well-differentiated pNETs using 68Gallium somatostatin receptor (SSTR) radiotracers, or more aggressive undifferentiated pNETS using 18F-FDG. A comprehensive interpretation of multimodal imaging guides resectability and cytoreduction in pNETs. The imaging phenotype provides information on the differentiation and proliferation of pNETs, as well as the spatial and temporal heterogeneity of tumors with prognostic and therapeutic implications. This review provides a structured approach for standardized reading and reporting of medical imaging studies with a focus on PET and MR techniques. It explains which imaging approach should be used for different subtypes of pNET and what a radiologist should be looking for and reporting when interpreting these studies.
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Affiliation(s)
- Laura Rozenblum
- Sorbonne Université, Service de Médecine Nucléaire, AP-HP, Hôpital La Pitié-Salpêtrière, 75013, Paris, France
| | - Fatima-Zohra Mokrane
- Radiology Department, Toulouse University Hospital, 1 Avenue du Professeur Jean Poulhes, 31059, Toulouse, France
- Department of Radiology, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Randy Yeh
- Memorial Sloan Kettering Cancer Center, Molecular Imaging and Therapy Service, New York, NY, USA
| | - Mathieu Sinigaglia
- Department of Imaging and Nuclear Medicine, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Florent Besson
- Paris Sud University, Kremlin Bicêtre Hospital, Paris, France
| | - Romain-David Seban
- Department of Nuclear Medicine, Institut Curie-René Huguenin, Saint-Cloud, France
| | - Cecile N Chougnet
- Department of Endocrine Oncology, Hôpital Saint Louis, Paris, France
| | - Paul Revel-Mouroz
- Radiology Department, Toulouse University Hospital, 1 Avenue du Professeur Jean Poulhes, 31059, Toulouse, France
| | - Binsheng Zhao
- Department of Radiology, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Philippe Otal
- Radiology Department, Toulouse University Hospital, 1 Avenue du Professeur Jean Poulhes, 31059, Toulouse, France
| | - Lawrence H Schwartz
- Department of Radiology, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Laurent Dercle
- Department of Radiology, New York Presbyterian Hospital, Columbia University, New York, NY, USA.
- UMR 1015, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, 94805, France.
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Wolbrink DRJ, Kolwijck E, Ten Oever J, Horvath KD, Bouwense SAW, Schouten JA. Management of infected pancreatic necrosis in the intensive care unit: a narrative review. Clin Microbiol Infect 2019; 26:18-25. [PMID: 31238118 DOI: 10.1016/j.cmi.2019.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Severe acute pancreatitis is marked by organ failure and (peri)pancreatic necrosis with local complications such as infected necrosis. Infection of these necrotic collections together with organ failure remain the major causes of admission to an intensive care unit (ICU) in acute pancreatitis. Appropriate treatment of infected necrosis is essential to reduce morbidity and mortality. Overall knowledge of the treatment options within a multidisciplinary team-with special attention to the appropriate use of antimicrobial therapy and invasive treatment techniques for source control-is essential in the treatment of this complex disease. OBJECTIVES To address the current state of microbiological diagnosis, antimicrobial treatment, and source control for infected pancreatic necrosis in the ICU. SOURCES A literature search was performed using the Medline and Cochrane libraries for articles subsequent to 2003 using the keywords: infected necrosis, pancreatitis, intensive care medicine, treatment, diagnosis and antibiotic(s). CONTENT This narrative review provides an overview of key elements of diagnosis and treatment of infected pancreatic necrosis in the ICU. IMPLICATIONS In pancreatic necrosis it is essential to continuously (re)evaluate the indication for antimicrobial treatment and invasive source control. Invasive diagnostics (e.g. through fine-needle aspiration, FNA), preferably prior to the start of broad-spectrum antimicrobial therapy, is advocated. Antimicrobial stewardship principles apply: paying attention to altered pharmacokinetics in the critically ill, de-escalation of broad-spectrum therapy once cultures become available, and early withdrawal of antibiotics once source control has been established. This is important to prevent the development of antimicrobial resistance, especially in a group of patients who may require repeated courses of antibiotics during the prolonged course of their illness.
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Affiliation(s)
- D R J Wolbrink
- Radboud University Medical Centre, Department of Surgery, Nijmegen, the Netherlands; Dutch Pancreatitis Study Group, the Netherlands(†)
| | - E Kolwijck
- Radboud Centre for Infectious Diseases, Department of Medical Microbiology, Nijmegen, the Netherlands
| | - J Ten Oever
- Radboud Centre for Infectious Diseases, Department of Internal Medicine, Nijmegen, the Netherlands
| | - K D Horvath
- University of Washington, Department of Surgery, Seattle, WA 98195, USA
| | - S A W Bouwense
- Radboud University Medical Centre, Department of Surgery, Nijmegen, the Netherlands; Dutch Pancreatitis Study Group, the Netherlands(†)
| | - J A Schouten
- Radboud Centre for Infectious Diseases, Department of Intensive Care, Nijmegen, the Netherlands.
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Abstract
Chronic pancreatitis (CP) is an important gastrointestinal cause of morbidity worldwide. It can severely impair the quality of life besides life-threatening acute and long-term complications. Pain and pancreatic exocrine insufficiency (leading to malnutrition) impact the quality of life. Acute complications include pseudocysts, pancreatic ascites, and vascular complications. Long-term complications are diabetes mellitus and pancreatic cancer. Early diagnosis of CP is crucial to alter the natural course of the disease. However, majority of the cases are diagnosed in the advanced stage. The role of various imaging techniques in the diagnosis of CP is discussed in this review.
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Affiliation(s)
- Rohan Kamat
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
| | - Pankaj Gupta
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Surinder Rana
- Department of Gastroenterology, PGIMER, Chandigarh, India
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Jha P, Yeh BM, Zagoria R, Collisson E, Wang ZJ. The Role of MR Imaging in Pancreatic Cancer. Magn Reson Imaging Clin N Am 2018; 26:363-373. [DOI: 10.1016/j.mric.2018.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
MRI has transformed from the theoretical, investigative realm to mainstream clinical medicine over the past four decades and has become a core component of the diagnostic toolbox in the practice of gastroenterology (GI). Its success is attributable to exquisite contrast and the ability to isolate specific proton species through the use of different pulse sequences (i.e., T1-weighted, T2-weighted, diffusion-weighted) and exploiting extracellular and hepatobiliary contrast agents. Consequently, MRI has gained preeminence in various GI clinical applications: liver and pancreatic lesion evaluation and detection, liver transplantation evaluation, pancreatitis evaluation, Crohn's disease evaluation (using MR enterography) rectal cancer staging and perianal fistula evaluation. MR elastography, in concert with technical innovations allowing for fat and iron quantification, provides a noninvasive approach, or "MRI virtual liver biopsy" for diagnosis and management of chronic liver diseases. In the future, the arrival of ultra-high-field MR systems (7 T) and the ability to perform magnetic resonance spectroscopy in the abdomen promise even greater diagnostic insight into chronic liver disease.
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Rodriguez O, Schaefer ML, Wester B, Lee YC, Boggs N, Conner HA, Merkle AC, Fricke ST, Albanese C, Koliatsos VE. Manganese-Enhanced Magnetic Resonance Imaging as a Diagnostic and Dispositional Tool after Mild-Moderate Blast Traumatic Brain Injury. J Neurotrauma 2016; 33:662-71. [PMID: 26414591 PMCID: PMC4827293 DOI: 10.1089/neu.2015.4002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) caused by explosive munitions, known as blast TBI, is the signature injury in recent military conflicts in Iraq and Afghanistan. Diagnostic evaluation of TBI, including blast TBI, is based on clinical history, symptoms, and neuropsychological testing, all of which can result in misdiagnosis or underdiagnosis of this condition, particularly in the case of TBI of mild-to-moderate severity. Prognosis is currently determined by TBI severity, recurrence, and type of pathology, and also may be influenced by promptness of clinical intervention when more effective treatments become available. An important task is prevention of repetitive TBI, particularly when the patient is still symptomatic. For these reasons, the establishment of quantitative biological markers can serve to improve diagnosis and preventative or therapeutic management. In this study, we used a shock-tube model of blast TBI to determine whether manganese-enhanced magnetic resonance imaging (MEMRI) can serve as a tool to accurately and quantitatively diagnose mild-to-moderate blast TBI. Mice were subjected to a 30 psig blast and administered a single dose of MnCl2 intraperitoneally. Longitudinal T1-magnetic resonance imaging (MRI) performed at 6, 24, 48, and 72 h and at 14 and 28 days revealed a marked signal enhancement in the brain of mice exposed to blast, compared with sham controls, at nearly all time-points. Interestingly, when mice were protected with a polycarbonate body shield during blast exposure, the marked increase in contrast was prevented. We conclude that manganese uptake can serve as a quantitative biomarker for TBI and that MEMRI is a minimally-invasive quantitative approach that can aid in the accurate diagnosis and management of blast TBI. In addition, the prevention of the increased uptake of manganese by body protection strongly suggests that the exposure of an individual to blast risk could benefit from the design of improved body armor.
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Affiliation(s)
- Olga Rodriguez
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Michele L. Schaefer
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brock Wester
- Research and Exploratory Development Department, Johns Hopkins University, Applied Physics Laboratory, Laurel, Maryland
| | - Yi-Chien Lee
- Department of Oncology, Georgetown University Medical Center, Washington DC
| | - Nathan Boggs
- Research and Exploratory Development Department, Johns Hopkins University, Applied Physics Laboratory, Laurel, Maryland
| | - Howard A. Conner
- Research and Exploratory Development Department, Johns Hopkins University, Applied Physics Laboratory, Laurel, Maryland
| | - Andrew C. Merkle
- Research and Exploratory Development Department, Johns Hopkins University, Applied Physics Laboratory, Laurel, Maryland
| | - Stanley T. Fricke
- Pediatric and Integrative Systems Biology, George Washington University, Washington, DC
| | - Chris Albanese
- Department of Oncology, Georgetown University Medical Center, Washington DC
- Department of Pathology, Georgetown University Medical Center, Washington DC
| | - Vassilis E. Koliatsos
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Al Ansari N, Ramalho M, Semelka RC, Buonocore V, Gigli S, Maccioni F. Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: An update. World J Radiol 2015; 7:361-374. [PMID: 26644822 PMCID: PMC4663375 DOI: 10.4329/wjr.v7.i11.361] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/27/2015] [Accepted: 10/08/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic ductal adenocarcinoma is the most common malignant tumor of the pancreas. The remaining pancreatic tumors are a diverse group of pancreatic neoplasms that comprises cystic pancreatic neoplasms, endocrine tumors and other uncommon pancreatic tumors. Due to the excellent soft tissue contrast resolution, magnetic resonance imaging (MRI) is frequently able to readily separate cystic from noncystic tumors. Cystic tumors are often easy to diagnose with MRI; however, noncystic non-adenocarcinoma tumors may show a wide spectrum of imaging features, which can potentially mimic ductal adenocarcinoma. MRI is a reliable technique for the characterization of pancreatic lesions. The implementation of novel motion-resistant pulse sequences and respiratory gating techniques, as well as the recognized benefits of MR cholangiopancreatography, make MRI a very accurate examination for the evaluation of pancreatic masses. MRI has the distinctive ability of non-invasive assessment of the pancreatic ducts, pancreatic parenchyma, neighbouring soft tissues, and vascular network in one examination. MRI can identify different characteristics of various solid pancreatic lesions, potentially allowing the differentiation of adenocarcinoma from other benign and malignant entities. In this review we describe the MRI protocols and MRI characteristics of various solid pancreatic lesions. Recognition of these characteristics may establish the right diagnosis or at least narrow the differential diagnosis, thus avoiding unnecessary tests or procedures and permitting better management.
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Abstract
OBJECTIVES The purpose of this study was to determine qualitative pancreatic magnetic resonance imaging (MRI) features that must be present to predict abnormal pancreatic secretory function in patients evaluated for chronic pancreatitis (CP). METHODS The MRIs of study subjects were reviewed by 2 abdominal radiologists; qualitative parenchyma and ductal features were recorded. Endoscopic pancreatic function test (ePFT) results (reference standard) were classified as normal (peak pancreatic fluid bicarbonate [HCO3-] ≥75 meq/L) or abnormal (<75). Abnormal ePFT was further classified as mild/moderate (74-65) and marked deficiency (<65). Statistical analysis was performed to assess the association between MRI features and abnormal ePFT. RESULTS The study cohort was composed of 93 subjects, mean age 49 years (range, 18-78 years), 65% females. Univariate analysis identified 9 qualitative MRI features significantly (P < 0.05) associated with abnormal pancreatic secretory function. Number of MRI features increases as peak pancreatic fluid [HCO3-] decreases (Pearson r = -0.629; P = 0.001). Receiver operating characteristic curve analysis determined that a threshold of 6 or more associated MRI features 64% sensitive and 94% specific for marked bicarbonate deficiency. CONCLUSIONS Qualitative MRI parenchymal and ductal features are associated with CP. Presence of 6 or more features results in a higher specificity for the diagnosis of CP in advanced disease.
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Bi L, Dong Y, Jing C, Wu Q, Xiu J, Cai S, Huang Z, Zhang J, Han X, Liu Q, Lv S. Differentiation of pancreatobiliary-type from intestinal-type periampullary carcinomas using 3.0T MRI. J Magn Reson Imaging 2015; 43:877-86. [PMID: 26395453 DOI: 10.1002/jmri.25054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 09/06/2015] [Accepted: 09/08/2015] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To differentiate pancreatobiliary-type from intestinal-type periampullary carcinomas using combined magnetic resonance cholangiopancreatography (MRCP), contrast-enhanced MRI, and diffusion-weighted imaging (DWI). MATERIALS AND METHODS MRI (3.0T) results of 41 patients with pathologically confirmed periampullary carcinoma were retrospectively assessed. Two radiologists, blinded to histologic type of each tumor, evaluated image findings independently. MRCP image features, enhancement pattern, and apparent diffusion coefficient (ADC) values were analyzed. Independent-sample t-test, chi-square, or Fisher's exact test were used to determine differential image findings between the pancreatobiliary-type and the intestinal-type group. Cohen's κ statistic or interclass correlation coefficient (ICC) were used to evaluate interobserver agreement between two observers. Univariate and multiple logistic regression analysis were performed to identify MRI features with predictive values. RESULTS On the basis of hematoxylin-eosin staining, 27 patients were classified as having pancreatobiliary-type carcinomas, and 14 patients the intestinal type. The pancreatobiliary-type carcinomas more commonly showed progressive enhancement than the intestinal type (P = 0.003). The minimum ADC (ADCmin ) value of the pancreatobiliary-type group ([0.95 ± 0.21] × 10(-3) mm(2) /s) was significantly lower than the intestinal-type group ([1.10 ± 0.25] × 10(-3) mm(2) /s) (P = 0.047). For interobserver agreement, the κ values and ICCs for all parameters exceeded 0.8, indicating almost perfect agreement. At multiple logistic regression analysis, the enhancement pattern was the only significant independent predictor (P = 0.011, odds ratio [OR] = 0.105). When the enhancement pattern and ADCmin were used in combination, we could identify 70.4% of pancreatobiliary-type and 78.6% of intestinal-type carcinomas. CONCLUSION Progressive enhancement and low ADCmin values suggest a pancreatobiliary-type periampullary carcinoma.
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Affiliation(s)
- Lei Bi
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
| | - Yin Dong
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
| | - Changqing Jing
- Department of Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
| | - Qingzhong Wu
- Department of Science and Education, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
| | - Jianjun Xiu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
| | - Shifeng Cai
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
| | - Zhaoqin Huang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
| | - Jie Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
| | - Xue Han
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
| | - Qingwei Liu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
| | - Shouchen Lv
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China
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Arai T, Kobayashi A, Yokoyama T, Ohya A, Fujinaga Y, Shimizu A, Motoyama H, Furusawa N, Sakai H, Uehara T, Kadoya M, Miyagawa SI. Signal intensity of the pancreas on magnetic resonance imaging: Prediction of postoperative pancreatic fistula after a distal pancreatectomy using a triple-row stapler. Pancreatology 2015; 15:380-6. [PMID: 26118649 DOI: 10.1016/j.pan.2015.05.479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/19/2015] [Accepted: 05/28/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to evaluate the impact of the pancreatic signal intensity (SI) on magnetic resonance imaging (MRI) findings for predicting the development of pancreatic fistula (PF) after a distal pancreatectomy (DP) involving a triple-row stapler closure. METHODS A multivariate logistic regression analysis was used to identify risk factors for clinical PF, as defined by the International Study Group on Pancreatic Fistula grade B or C. The pancreas-to-muscle SI ratio was evaluated using fat-suppressed T1-weighted MRI. RESULTS Of the 41 enrolled patients, 8 (19.5%) developed clinical PF. The pancreatic thickness (≥15 mm) and SI ratio (≥1.3) were identified as independent predictors of clinical PF in a multivariate analysis. Clinical PF was observed in one patient with a thick pancreas and a low SI ratio (14.3%), whereas it was observed in 60% of the patients with a thick pancreas and a high SI ratio. The area under the receiver operating characteristic curve for a predictive model consisting of the two factors was 0.87 (95% confidence interval, 0.75 to 0.99), the level of which tended to be greater than that for pancreatic thickness alone (0.81, p = 0.09). CONCLUSIONS The SI ratio as evaluated using MRI might be useful for predicting clinical PF in patients with the pancreatic thickness ≥15 mm after DP involving a stapler closure.
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Affiliation(s)
- Takuma Arai
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Akira Kobayashi
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Takahide Yokoyama
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Ayumi Ohya
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Akira Shimizu
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Hiroaki Motoyama
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Norihiko Furusawa
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Hiroshi Sakai
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Masumi Kadoya
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Shin-Ichi Miyagawa
- First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
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Jang KM, Kim SH, Kim YK, Song KD, Lee SJ, Choi D. Missed pancreatic ductal adenocarcinoma: Assessment of early imaging findings on prediagnostic magnetic resonance imaging. Eur J Radiol 2015; 84:1473-1479. [PMID: 26032128 DOI: 10.1016/j.ejrad.2015.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/10/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate the early imaging findings and growth rate of pancreatic ductal adenocarcinoma (PDAC), and to assess whether MR imaging detects early PDAC better than CT. MATERIALS AND METHODS The institutional review board approved this retrospective study and waived the requirement for informed consent. Twenty-two patients were included, and two radiologists, by consensus, assessed the presence of focal lesions, interruption of the main pancreatic duct (MPD), MPD dilatation, and pancreatitis, volume doubling time (VDT) of PDAC on prediagnostic MR imaging. Two other observers independently reviewed three image sets (CT images, unenhanced MR images, and unenhanced and contrast-enhanced MR images) for the detection of early PDAC. Paired Wilcoxon signed rank test and receiver operating characteristic (ROC) curve analysis were used for statistical analyses. RESULTS In 20 (90.9%) patients, prediagnostic MR exams showed abnormality, and all of them showed focal lesions on the first abnormal prediagnostic MR exams. Thirteen lesions (65%) showed no MPD interruption and one lesion (5%) was accompanied by pancreatitis. The mean VDT of PDAC was 151.7 days (range, 18.3-417.8 days). Diagnostic performance of unenhanced MR images (Az, 0.971-0.989) and combined unenhanced and contrast-enhanced MR images (Az, 0.956-0.963) was significantly better than that of CT images (Az, 0.565-0.583; p<0.01) for both observers, CONCLUSION The most common early imaging finding of PDAC on prediagnostic MR exams was a focal lesion with no MPD interruption with a mean volume doubling time of five months. MR imaging was superior to CT for the detection of early PDAC.
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Affiliation(s)
- Kyung Mi Jang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, Korea.
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, Korea
| | - Soon Jin Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, Korea
| | - Dongil Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul, Korea
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MRI manifestations of pancreatic disease, especially pancreatitis, in the pediatric population. AJR Am J Roentgenol 2014; 201:W877-92. [PMID: 24261395 DOI: 10.2214/ajr.13.10834] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Although pancreatitis is an uncommon entity in children, the pediatric population can develop serious and long-lasting complications, including pseudocyst, necrosis, hemorrhage, vascular thrombosis, vascular pseudoaneurysm, abscess, and pancreaticopleural fistula. CT has historically been the mainstay for noninvasive imaging of the pancreas. This modality is limited in the pediatric population because of poorly developed retroperitoneal fat planes, difficulty in evaluating the ductal anatomy, and the use of ionizing radiation. MRI with MRCP provides superior soft-tissue resolution and improved visualization of ductal anatomy and can delineate complications of pancreatitis, while avoiding exposure to potentially harmful radiation. CONCLUSION For these reasons, we advocate abdominal MRI with MRCP as the preferred modality for pancreatic evaluation in the pediatric population. The purpose of this article is to briefly discuss the normal anatomy and embryologic development of the pancreas, review standard sequences for routine abdominal MRI and MRCP in pediatric patients, discuss the normal appearance of the pancreas and biliary tree on MRI sequences, and use examples to illustrate the MRI appearance of common and uncommon manifestations of pancreatic disease in pediatric patients.
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Magnetic resonance imaging of cystic pancreatic lesions in adults: an update in current diagnostic features and management. ACTA ACUST UNITED AC 2013; 39:48-65. [DOI: 10.1007/s00261-013-0048-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Heyn C, Sue-Chue-Lam D, Jhaveri K, Haider MA. MRI of the pancreas: problem solving tool. J Magn Reson Imaging 2013; 36:1037-51. [PMID: 23090915 DOI: 10.1002/jmri.23708] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Advances in MR hardware and pulse sequence design over the years have improved the quality and robustness of MR imaging of the pancreas. Today, MRI is an indispensible tool for studying the pancreas and can provide useful information not attainable with other noninvasive or minimally invasive imaging techniques. In the present review, specific cases are reviewed where the strengths of MRI demonstrate the utility of this imaging modality as a problem solving tool.
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Affiliation(s)
- Chris Heyn
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Watanabe Y, Dohke M, Ishimori T, Amoh Y, Oda K, Okumura A, Mitsudo K, Dodo Y. High-Resolution MR Cholangiopancreatography. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/10408379891244181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wasnik AP, Mazza MB, Lalchandani UR, Liu PS. Normal and Variant Abdominal Anatomy on Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2011; 19:521-45; viii. [DOI: 10.1016/j.mric.2011.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Shin SS, Armao DM, Burke LM, Kim HJ, Skrzynia C, Otey CA, Semelka RC. Comparison of the incidence of pancreatic abnormalities between high risk and control patients: Prospective pilot study with 3 tesla MR imaging. J Magn Reson Imaging 2011; 33:1080-5. [DOI: 10.1002/jmri.22551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Said K, Albiin N, Lindberg B, Brismar TB, Karrar A, Permert J, Bergquist A. Pancreatic duct changes are not associated with early signs of chronic pancreatitis at magnetic resonance imaging (MRI) in patients with primary sclerosing cholangitis. Scand J Gastroenterol 2010; 45:980-6. [PMID: 20384530 DOI: 10.3109/00365521003793741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The association between chronic pancreatitis (CP) and primary sclerosing cholangitis (PSC) has been reported previously. The aims of the present study were to evaluate the presence of early pancreatic abnormalities and duct changes, using MRCP/MRI in PSC and to evaluate possible risk factors for these changes and their clinical importance. MATERIALS AND METHODS One hundred and three patients with PSC were identified among all MRI liver/pancreas referrals in 2001-2005. MRCP was used to grade pancreatic duct changes in three groups: grade 0 (normal), grade 1 (mild) and grade 2 (severe). For detection of early MRI signs of CP, the pancreas-spleen signal intensity ratio (SIR), the arterial and early venous phase ratio (A/PV ratio) and the age-related size of the pancreas were evaluated. RESULTS Pancreatic duct changes were found in 24% of the PSC patients. The pancreatic duct changes were associated with extrahepatic biliary involvement and long duration of PSC but not associated with pancreas-spleen SIR, A/PV ratio, pancreas size, previous post-ERCP or acute pancreatitis. Severe pancreatic duct changes were significantly associated to abdominal pain. Clinically significant CP was seen in one PSC patient (1%). CONCLUSIONS Pancreatic duct changes are associated with extrahepatic bile duct strictures and not with the early MRI signs of CP. Therefore, pancreatic duct changes seem to be part of the spectrum of PSC and should not be defined as CP. Pancreatic duct changes are of limited clinical importance but may contribute to abdominal pain in PSC.
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Affiliation(s)
- Karouk Said
- Division of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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Lewandowski RJ, Eifler AC, Bentrem DJ, Chung JC, Wang D, Woloschak GE, Yang GY, Ryu R, Salem R, Larson AC, Omary RA. Functional magnetic resonance imaging in an animal model of pancreatic cancer. World J Gastroenterol 2010; 16:3292-8. [PMID: 20614485 PMCID: PMC2900721 DOI: 10.3748/wjg.v16.i26.3292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 12/24/2009] [Accepted: 12/31/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To test the hypotheses that diffusion weighed (DW)- and transcatheter intraarterial perfusion (TRIP)-magnetic resonance imaging (MRI) can each be used to assess regional differences in tumor function in an animal pancreatic cancer model. METHODS VX2 tumors were implanted in pancreata of 6 rabbits. MRI and digital subtraction angiography (DSA) were performed 3 wk following implantation. With a 2-French catheter secured in the rabbit's gastroduodenal artery, each rabbit was transferred to an adjacent 1.5T MRI scanner. DW- and TRIP-MRI were performed to determine if necrotic tumor core could be differentiated from viable tumor periphery. For each, we compared mean differences between tumor core/periphery using a 2-tailed paired t-test (alpha = 0.05). Imaging was correlated with histopathology. RESULTS Tumors were successfully grown in all rabbits, confirmed by necropsy. On DW-MRI, mean apparent diffusion coefficient (ADC) value was higher in necrotic tumor core (2.1 +/- 0.3 mm(2)/s) than in viable tumor periphery (1.4 +/- 0.5 mm(2)/s) (P < 0.05). On TRIP-MRI, mean perfusion values was higher in tumor periphery (110 +/- 47 relative units) than in tumor core (66 +/- 31 relative units) (P < 0.001). CONCLUSION Functional MRI can be used to differentiate necrotic from viable tumor cells in an animal pancreatic cancer model using ADC (DW-MRI) and perfusion (TRIP-MRI) values.
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Adair A, Oniscu A, Wigmore SJ. Post-surgical Pancreatitis Masquerading as Recurrent Neuroendocrine Cancer. J Surg Case Rep 2010; 2010:1. [PMID: 24946304 PMCID: PMC3649111 DOI: 10.1093/jscr/2010.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neuroendocrine tumours of the pancreas can have a spectrum of behaviour from relatively benign to aggressive. Resection can result in cure although metastatic disease is described. We present an unusual case of an apparent local recurrence of previously resected neuroendocrine tumour in a young man who had undergone distal pancreatectomy. Pathological analysis demonstrated focal post-surgical pancreatitis with radiological appearances bearing striking similarity to the original primary tumour.
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Affiliation(s)
- Anya Adair
- Royal Infirmary of Edinburgh, Edinburgh, UK
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Vachiranubhap B, Kim YH, Balci NC, Semelka RC. Magnetic resonance imaging of adenocarcinoma of the pancreas. Top Magn Reson Imaging 2009; 20:3-9. [PMID: 19687720 DOI: 10.1097/rmr.0b013e3181b48392] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Magnetic resonance imaging (MRI) is a valuable tool in the assessment of the full spectrum of pancreatic disease. A standard MR protocol including noncontrast T1-weighted fat-suppressed and dynamic gadolinium-enhanced gradient-echo imagings is sensitive for the evaluation of pancreatic cancer. Optimal use of MRI in the investigation of pancreatic cancer occurs in the following circumstances: (1) detection of small non-contour-deforming tumors, (2) evaluation of local extension and vascular encasement, (3) determination of the presence of lymph node and peritoneal metastases, and (4) determination and characterization of associated liver lesions and liver metastases. The objective of this study was to describe the attribute of MRI for evaluating pancreatic cancer.
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Ku YM, Shin SS, Lee CH, Semelka RC. Magnetic resonance imaging of cystic and endocrine pancreatic neoplasms. Top Magn Reson Imaging 2009; 20:11-18. [PMID: 19687721 DOI: 10.1097/rmr.0b013e3181b4812c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article describes the appearance of miscellaneous cystic and endocrine neoplasms using magnetic resonance imaging (MRI). Magnetic resonance imaging is a useful diagnostic modality in the assessment of various pancreatic neoplasms. Pancreatic endocrine tumors are moderately low in signal intensity on T1-weighted fat-suppressed images and moderately high in signal intensity on T2-weighted fat-suppressed images and demonstrate homogeneous, ring, or diffuse heterogeneous enhancement on immediate postgadolinium gradient echo images. Cystic pancreatic neoplasms, including intraductal papillary mucinous neoplasm, are well demonstrated and subcategorized according to their characteristic cystic configurations on MRI and MR cholangiopancreatography images. Microcystic serous cystadenomas are demonstrated as a honeycombed appearance on T2-weighted images and have a central stellate scar. Mucinous cystic neoplasms usually appear as multilocular cystic masses, with benign forms of macrocystic tumors possessing uniform thickness septations and malignant forms exhibiting irregular septations and tumor nodules. The presence of tumor stroma, invasion of adjacent tissue, or liver metastases can be assessed by MRI. The connection between the pancreatic duct and the cystic tumor is usually well shown on MR cholangiopancreatography images.
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Affiliation(s)
- Young Mi Ku
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
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Bilgin M, Balci NC, Momtahen AJ, Bilgin Y, Klör HU, Rau WS. MRI and MRCP findings of the pancreas in patients with diabetes mellitus: compared analysis with pancreatic exocrine function determined by fecal elastase 1. J Clin Gastroenterol 2009; 43:165-70. [PMID: 18797409 DOI: 10.1097/mcg.0b013e3181587912] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
GOALS To review magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP) findings in patients with diabetes mellitus (DM), with pancreatic exocrine insufficiency, and with combined pancreatic exocrine insufficiency and DM. STUDY MRI/MRCP findings of 82 consecutive patients with DM (n=28), pancreatic exocrine insufficiency (n=25), and combination of both (n=29) were evaluated and compared with MRI/MRCP findings of 21 healthy volunteers with normal pancreatic exocrine function. Pancreatic exocrine function was determined by fecal elastase 1. MRCP images were evaluated according to the Cambridge classification. MRI of the pancreas was assessed for pancreatic size, signal intensity ratio (SIR), and arterial/venous enhancement ratio (A/V). RESULTS On MRI, significant difference was present in terms of mean values of pancreatic size (P<0.0001), A/V (P<0.02), and SIR (P<0.005) between the control group and groups of patients with DM, pancreatic exocrine insufficiency, and combined DM and pancreatic exocrine insufficiency. No significant difference was observed between groups of patients with DM and pancreatic exocrine function alone in terms of pancreatic size, A/V, and SIR. Chronic pancreatitis MRCP findings were present with increasing frequency in groups of DM, pancreatic exocrine insufficiency, and combination of both. CONCLUSIONS MRI/MRCP findings suggesting chronic pancreatitis may exist in patients with DM comparable to patients with pancreatic exocrine insufficiency. The frequency and severity of MRI/MRCP findings increase when the patients have combined DM and pancreatic exocrine insufficiency.
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Affiliation(s)
- Mehmet Bilgin
- Department of Radiology, University Hospital Giessen and Marburg, Giessen, Germany
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Diffusion-weighted MRI of the pancreas: correlation with secretin endoscopic pancreatic function test (ePFT). Acad Radiol 2008; 15:1264-8. [PMID: 18790398 DOI: 10.1016/j.acra.2008.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 04/30/2008] [Accepted: 05/02/2008] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the correlation between apparent diffusion coefficient (ADC) values of the pancreas on diffusion-weighted imaging (DWI) and pancreatic exocrine function determined by HCO(3) concentration in the secretin endoscopic pancreatic function test (ePFT). MATERIALS AND METHODS Mean ADC values derived from 10 different points of the pancreatic gland on DWI were reviewed in 14 patients with normal (peak HCO(3) > or = 80 mEq/L) and 14 patients with abnormal (peak HCO(3) < 80 mEq/L) ePFT results. Magnetic resonance cholangiopancreatography (MRCP) images of the same patients were evaluated for the diagnosis of chronic pancreatitis. Correlation between ADC values and HCO(3) concentration as well as Cambridge scores in MRCP was performed using Spearman's correlation test. RESULTS Mean ADC value of the pancreas was 1.52 +/- 0.13 x 10(-3) mm(2)/s in patients with abnormal ePFT results and 1.78 +/- 0.07 x 10(-3) mm(2)/s in the normal group. There was a significant statistical difference between the ADC values of the pancreas in the two groups (P < .0001). There was also a statistically significant correlation between HCO(3) level and ADC value of the pancreas in the study patients (r = 0.771, P < .0001). Morphologic changes of the pancreas according to the Cambridge classification were also well correlated with the mean ADC values (r = -0.763, P < .0001). CONCLUSIONS Strong correlation between ADC value and pancreatic exocrine function as well as Cambridge score for chronic pancreatitis exists. Further studies are needed to determine the cut off ADC value for chronic pancreatitis.
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Hata H, Mori H, Matsumoto S, Yamada Y, Kiyosue H, Tanoue S, Hongo N, Kashima K. Fibrous stroma and vascularity of pancreatic carcinoma: correlation with enhancement patterns on CT. ACTA ACUST UNITED AC 2008; 35:172-80. [PMID: 18815826 DOI: 10.1007/s00261-008-9460-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 08/27/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To demonstrate the contrast-enhancement behavior of pancreatic carcinoma on dynamic contrast-enhanced CT (DCE-CT), and the relationship between the degree of contrast-enhancement and the vascularity (vessel density) and amount of fibrous stroma (fibrosis within the tumor) on pathological specimen. METHODS The contrast-enhancement values were measured by producing the subtracting images for obtaining largest region of interests to reduce measurement errors and variability. Vascularity was determined by immunostaining of the tissue sections with factor 8 and the fibrous stroma was determined by picrosirius staining. Correlation of the findings of DCE-CT with pathological findings was performed in 21 patients with pancreatic carcinoma. RESULTS All but one patient exhibited a gradually increasing enhancement, but there was considerably wide range in contrast-enhancement values of tumors. Examination of the overall relationship between vascularity and fibrous stroma with contrast-enhancement behavior showed that tumor with more fibrosis and higher vascularity had a higher contrast effect through all phases of dynamic study. Tumors having liver metastases tended to be less fibrotic than tumors without liver metastases. CONCLUSION The contrast-enhancement behavior of pancreatic carcinoma may be helpful in estimating vascularity and the extent of tumor fibrosis and possibility of liver metastases.
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Affiliation(s)
- Hiroyuki Hata
- Department of Radiology, Oita University Faculty of Medicine, Yufu-city, Oita, Japan
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Abstract
OBJECTIVE Abnormal pancreatic function tests have been reported to precede the imaging findings of chronic pancreatitis. Magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is increasingly accepted as the primary imaging modality for the detection of structural changes of early mild chronic pancreatitis. The aim of this study was to evaluate MRI/MRCP findings in patients with symptoms consistent with chronic pancreatitis who have normal Secretin Endoscopic Pancreatic Function test. METHODS A retrospective study of 32 patients referred for evaluation of chronic abdominal pain consistent with chronic pancreatitis and reported normal standard abdominal imaging (ultrasound, computed tomography, or MRI). All patients underwent Secretin Endoscopic Pancreatic Function testing and pancreatic MRI/MRCP at our institution. We reviewed the MRI/MRCP images in patients who had normal Secretin Endoscopic Pancreatic Function testing. MRI/MRCP images were assessed for pancreatic duct morphology, gland size, parenchymal signal and morphology, and arterial contrast enhancement. RESULTS Of the 32 patients, 23 had normal Secretin Endoscopic Pancreatic Function testing, and 8 of them had mild to marked spectrum of abnormal MRI/MRCP findings that were predominantly focal. Frequencies of the findings were as follows: pancreatic duct stricture (n=3), pancreatic duct dilatation (n=3), side branch ectasia (n=4), atrophy (n=5), decreased arterial enhancement (n=5), decreased parenchymal signal (n=1), and cavity formation (n=1). The remaining15 patients had normal pancreatic structure on MRI/MRCP. CONCLUSIONS Normal pancreatic function testing cannot exclude abnormal MRI/MRCP especially focal findings of chronic pancreatitis. Further studies needed to verify significance of these findings and establish MRI/MRCP imaging criteria for the diagnosis of chronic pancreatitis.
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Balci NC, Alkaade S, Magas L, Momtahen AJ, Burton FR. Suspected chronic pancreatitis with normal MRCP: findings on MRI in correlation with secretin MRCP. J Magn Reson Imaging 2008; 27:125-31. [PMID: 18058927 DOI: 10.1002/jmri.21241] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To review pancreatic MRI findings and their relationship with estimated pancreatic exocrine function on secretin-stimulated MR cholangiopancreatography (S-MRCP) in patients with clinically suspected chronic pancreatitis and normal baseline MRCP findings. MATERIALS AND METHODS MRI findings of 26 patients with normal pancreatic duct diameter and without side branch ectasia on MRCP were evaluated. A single radiologist assessed pancreatic size, pancreatic signal intensity ratio (SIR), and arterial enhancement ratio (A/V) at head, body, and tail of the pancreas on T(1)-weighted fat-suppressed and serial contrast-enhanced images at a single session. Combined findings were graded with a composite score. Serial S-MRCP was performed at the same session with standard MRI. Correlation and differences between MRI findings and associated grade of duodenal filling (DF) or the degree of pancreatic duct caliber change (PDC) were analyzed. RESULTS Seven patients revealed normal and 19 patients abnormal MRI findings. Significant correlation was present between the degree of DF and mean values of pancreatic size (r = 0.748), SIR (r = 0.610), A/V (r = 0.466), composite score (r = 0.833), and PDC (r = 0.554) separately. PDC correlated with SIR (r = 0.413) and composite score (r = 0.452), but not with A/V or pancreatic size. Significant differences were present between normal and abnormal DF grades in terms of mean values of associated findings of size (P = 0.001), SIR (P = 0.008), A/V (P = 0.019), and PDC (P = 0.001). CONCLUSION Patients with clinically suspected chronic pancreatitis and normal MRCP findings may have a spectrum of MRI findings that correlate with the estimated pancreatic exocrine insufficiency on S-MRCP with the increasing number of combined findings.
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Affiliation(s)
- N Cem Balci
- Department of Radiology, Saint Louis University Hospitals, St. Louis, Missouri 63110, USA.
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38
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Magnetic resonance imaging and magnetic resonance cholangiopancreatography findings compared with fecal elastase 1 measurement for the diagnosis of chronic pancreatitis. Pancreas 2008; 36:e33-9. [PMID: 18192870 DOI: 10.1097/mpa.0b013e318150e557] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To correlate magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance imaging (MRI) findings of the pancreas with the pancreatic exocrine function determined by fecal elastase 1 concentration. METHODS Magnetic resonance imaging and MRCP findings of 81 consecutive patients with clinically suspected chronic pancreatitis and 21 healthy volunteers were evaluated. All subjects underwent MRI/MRCP and fecal elastase 1 testing within 1 to 4 weeks' interval. Magnetic resonance cholangiopancreatography images were evaluated according to Cambridge classification. Magnetic resonance imaging of the pancreas was assessed for pancreatic size, signal, and arterial enhancement. RESULTS All volunteers had normal fecal elastase 1 levels (>200 microg/g) and normal MRI/MRCP findings. Thirty-one of 56 patients revealed MRI and/or MRCP findings despite normal fecal elastase 1 concentration. Four of 25 patients revealed normal MRI and MRCP findings despite low fecal elastase 1 concentration (<200 microg/g). Magnetic resonance imaging findings of size (P = 0.00001), arterial enhancement (P = 0.00001), and parenchymal signal (P = 0.001) were significantly different among the control group, patients with normal fecal elastase 1 levels, and patients with low fecal elastase 1 levels. Magnetic resonance cholangiopancreatography findings (P = 0.00001), pancreatic size (P = 0.00001), arterial enhancement (P = 0.014), and parenchymal signal (P = 0.004) on MRI correlated with the fecal elastase 1 concentration. CONCLUSIONS Magnetic resonance imaging/MRCP findings correlate with fecal elastase 1 concentration and may precede pancreatic exocrine insufficiency in the early stages of chronic pancreatitis.
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Abstract
Neuroendocrine tumors may arise from a wide range of organs and may occur in various locations in the body. They include carcinoid tumors, paragangliomas (pheochromocytomas), medullary thyroid carcinomas, and islet cell tumors of the pancreas. In this article the authors focus on the more common tumors with origins primarily in the abdomen, namely carcinoid, paraganglioma, and pancreatic islet cell tumors. Imaging assists in delineating the sites and extent of disease, in preoperative planning for resection of the primary tumor and metastatic disease, and in follow-up. Discussion is restricted to the main imaging modalities used in these tumors: cross-sectional imaging, namely CT and MRI, and nuclear medicine studies.
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Affiliation(s)
- Eric P Tamm
- Department of Radiology, Unit 1264, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA
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40
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Elias J, Semelka RC, Altun E, Tsurusaki M, Pamuklar E, Zapparoli M, Voultsinos V, Armao DM, Rubinas T. Pancreatic cancer: Correlation of MR findings, clinical features, and tumor grade. J Magn Reson Imaging 2007; 26:1556-63. [DOI: 10.1002/jmri.21210] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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41
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Chung EM, Travis MD, Conran RM. Pancreatic tumors in children: radiologic-pathologic correlation. Radiographics 2006; 26:1211-38. [PMID: 16844942 DOI: 10.1148/rg.264065012] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pancreatic neoplasms are rare in children and have a different histologic spectrum and prognosis than those in adults. In general, these tumors are well demarcated with expansile rather than infiltrating growth patterns. They may be quite large at diagnosis, and central cystic necrosis is common. They infrequently cause biliary duct obstruction. The imaging appearance of each neoplasm reflects its pathologic features. Pancreatoblastoma is the most common pancreatic neoplasm in young children. At imaging, pancreatoblastomas are heterogeneous and often multilocular with hyperechoic and enhancing septa. Solid-pseudopapillary tumor occurs in adolescent girls. It is heterogeneous in internal architecture, with a mixture of solid and cystic hemorrhagic and necrotic elements. This tumor is distinguished by its fibrous capsule and hemorrhagic nature, which are best shown at magnetic resonance imaging as a dark rim on T1- or T2-weighted images and hyper-intense foci on T1-weighted images, respectively. Islet cell tumors in children are insulinomas or gastrinomas. These tumors manifest early due to hormonal syndromes and are distinguished by their small size, homogeneous appearance, and intense enhancement with intravenous contrast material. All pancreatic neoplasms in children are capable of producing metastases, usually to the liver and lymph nodes; however, on the whole, these tumors have a better clinical outcome than most pancreatic tumors in adults. Knowledge of the differential diagnosis of pancreatic masses in children and their relatively good prognosis may promote correct preoperative diagnosis and appropriate treatment.
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Affiliation(s)
- Ellen M Chung
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Alaska and Fern streets NW, Washington, DC 20306-6000, USA.
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42
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Oliva MR, Mortelé KJ, Erturk SM, Ros PR. Magnetic resonance imaging of the pancreas. APPLIED RADIOLOGY 2006. [DOI: 10.37549/ar1401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | - Pablo R. Ros
- Brigham and Women’s Hospital–Harvard Medical School
- Harvard Medical School
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43
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Matos C, Bali MA, Delhaye M, Devière J. Magnetic resonance imaging in the detection of pancreatitis and pancreatic neoplasms. Best Pract Res Clin Gastroenterol 2006; 20:157-78. [PMID: 16473806 DOI: 10.1016/j.bpg.2005.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This article presents current magnetic resonance imaging techniques for the diagnosis of acute and chronic pancreatitis and pancreatic neoplasms. It emphasises the need for a comprehensive protocol combining imaging sequences of the pancreatic parenchyma with magnetic resonance angiography and secretin-enhanced magnetic resonance cholangiopancreatography in order to evaluate the full range of pancreatic inflammatory and neoplastic conditions. Imaging characteristics that may indicate a specific diagnosis are discussed.
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Affiliation(s)
- Celso Matos
- MRI division, Department of Radiology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Route de Lennik 808, B-1070 Brussels, Belgium.
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44
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Birchard KR, Semelka RC, Hyslop WB, Brown A, Armao D, Firat Z, Vaidean G. Suspected pancreatic cancer: evaluation by dynamic gadolinium-enhanced 3D gradient-echo MRI. AJR Am J Roentgenol 2005; 185:700-3. [PMID: 16120921 DOI: 10.2214/ajr.185.3.01850700] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The objective of our study was to determine the sensitivity and specificity of gadolinium-enhanced 3D gradient-echo (GRE) MR images in the detection of pancreatic cancer. CONCLUSION Dynamic gadolinium-enhanced 3D GRE images are both sensitive and specific in the detection of pancreatic cancer. Our study shows that the identification of pancreatic cancer using these images can be performed with a high degree of confidence and accuracy, making them very useful in the detection of pancreatic cancer.
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Affiliation(s)
- Katherine R Birchard
- Department of Radiology, University of North Carolina Hospitals, Chapel Hill, NC 27599-7510, USA
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45
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Zins M, Petit E, Boulay-Coletta I, Balaton A, Marty O, Berrod JL. [Imaging of pancreatic adenocarcinoma]. ACTA ACUST UNITED AC 2005; 86:759-79; quiz 779-80. [PMID: 16142070 DOI: 10.1016/s0221-0363(05)81443-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pancreatic cancer remains the fourth most common cause of cancer death. Surgery remains the only option for cure. Accurate diagnosis and staging are essential for appropriate management of patients with pancreatic cancer. This paper reviews the state of the art for imaging modalities in the diagnosis and staging of pancreatic adenocarcinoma. The crucial role of CT has increased with the new generation of multidetector CT.
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Affiliation(s)
- M Zins
- Service de Radiologie, Fondation Hôpital Saint-Joseph, Radiodiagnostic et Imagerie Médicale, 185, rue Raymond-Losserand, 75674 Paris Cedex.
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46
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Abstract
MR imaging is a valuable tool in the assessment of the full spectrum of pancreatic diseases. MR imaging techniques are sensitive for the evaluation of pancreatic disorders in the following settings: (1) TI-weighted fat-suppressed and dynamic gadolinium-enhanced SGE imaging for the detection of chronic pancreatitis, ductal adeno-carcinoma, and islet-cell tumors; (2) T2-weighted fat-suppressed imaging and T2-weighted breath-hold imaging for the detection of islet-cell tumors;and (3) precontrast breath-hold SGE imaging for the detection of acute pancreatitis. Relatively specific morphologic and signal intensity features permit characterization of acute pancreatitis,chronic pancreatitis, ductal adenocarcinoma, insulinoma, gastrinoma, glucagonoma, microcystic cystadenoma, macrocystic cystadenoma, and solid and papillary epithelial neoplasm. MR imaging is effective as a problem-solving modality because it distinguishes chronic pancreatitis from normal pancreas and chronic pancreatitis with focal enlargement from pancreatic cancer in the majority of cases.MR imaging studies should be considered in the following settings: (1) in patients with elevated serum creatinine, allergy to iodine contrast, or other contraindications for iodine contrast administration; (2) in patients with prior CT imaging who have focal enlargement of the pancreas with no definable mass; (3) in patients in whom clinical history is worrisome for malignancy and in whom findings on CT imaging are equivocal or difficult to interpret; and (4) in situations requiring distinction between chronic pancreatitis with focal enlargement and pancreatic cancer. Patients with biochemical evidence of islet-cell tumors should be examined by MR imaging as the first-line imaging modality because of the high sensitivity of MR imaging for detecting the presence of islet-cell tumors and determining the presence of metastatic disease.
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Affiliation(s)
- Ertan Pamuklar
- Department of Radiology, University of North Carolina, 101 Manning Drive, CB #7510, Chapel Hill, NC 27599-7510, USA
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47
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Balthazar EJ. Pancreatitis associated with pancreatic carcinoma. Preoperative diagnosis: role of CT imaging in detection and evaluation. Pancreatology 2005; 5:330-44. [PMID: 16015017 DOI: 10.1159/000086868] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The combined occurrence of pancreatic carcinoma with acute or chronic pancreatitis is seldom seen in medical practice, but when present it is a challenging dilemma, plagued by confusing overlapping clinical findings and pitfalls in diagnostic imaging tests. This article reviews the presumptive pathophysiological aspects of this relationship, the perplexing clinical presentations and the advantages and limitations of the noninvasive imaging examinations. The role of state-of-the-art CT imaging in screening patients with acute and chronic pancreatitis is emphasized and the impute of additional more invasive tests in detecting pancreatic tumors in this cohort of patients is reviewed. The habitual use of CT imaging, followed when needed by complementary examinations, can improve on previously reported low detection rates and hopefully decrease the number of exploratory laparatomies and unnecessary major pancreatic surgical resections.
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Affiliation(s)
- E J Balthazar
- Department Radiology, New York University, Bellevue Medical Center, New York, NY 10016, USA.
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48
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Abstract
AIM: To evaluate the clinical value of MR multi-imaging techniques in diagnosing and preoperative assessment of pancreaticobiliary tumor.
METHODS: MR multi-imaging techniques, including MR cross-sectional imaging, MR cholangiopancreatography (MRCP) and 3D dynamic contrast-enhanced MR angiography (3D DCE MRA), were performed to make prospective diagnosis and preoperative evaluation in 28 patients with suspected pancreaticobiliary tumors. There were 17 cases of pancreatic adenocarcinoma, 8 cases of biliary system carcinoma and 3 cases of non-neoplastic lesions.
RESULTS: Using MR multi-imaging techniques, the accuracy in diagnosing the patients with pancreaticobiliary tumors was 89.3% (25/28). The accuracy in detecting the range of tumor invasion was 80.3% (57/71). The sensitivity, specificity, accuracy, positive and negative predictive value of MR multi-imaging techniques in preoperative assessment of the resectability of pancreaticobiliary tumor were 83.3%, 89.5%, 88.0%, 71.4%, and 94.4%, respectively. There was well diagnostic consistency between MR multi-imaging techniques and CT (κ = 0.64, P<0.01). The fusion image could be made from MRCP and 3D DCE MRA images.
CONCLUSION: MR multi-imaging techniques can integrate the advantages of various MR images. The non-invasive “all-in-one” MR imaging protocol is the efficient method in diagnosing, staging and preoperative assessment of pancreaticobiliary tumor.
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Affiliation(s)
- Liang Zhong
- Department of Radiology, Renji Hospital, Shanghai Second Medical University, 145 Shandong Zhonglu, Shanghai 200001, China.
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49
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Abstract
MR imaging has made significant advances in recent years, with an increasingly important role in the detection, characterization, and staging of pancreatic diseases. MRI is appealing as a noninvasive imaging modality as it can evaluate the pancreas, the vasculature, and the pancreaticobiliary ducts in a single examination. Advantages of MRI include its excellent soft tissue contrast resolution and anatomic detail and absence of ionizing radiation. This article reviews the utility of MRI and its use not only as a problem-solving tool but its potential use as a primary examination (similar to CT) in a wide variety of pancreatic diseases.
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Affiliation(s)
- Ana L Keppke
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University, The Feinberg School of Medicine, Chicago, IL, USA
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50
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Chebli JMF, Gaburri PD, de Souza AFM, Ornellas AT, Martins Junior EV, Chebli LA, Felga GEG, Pinto JRF. Internal pancreatic fistulas: proposal of a management algorithm based on a case series analysis. J Clin Gastroenterol 2004; 38:795-800. [PMID: 15365408 DOI: 10.1097/01.mcg.0000139051.74801.43] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Internal pancreatic fistulas (IPF) are an uncommon but well-recognized complication of chronic pancreatitis (CP) that are associated with significant morbidity and mortality. Because of their low incidence, management is still controversial. The aims of this study are to report the 8-year experience with IPF management in a Brazil University-affiliated hospital and to propose a management algorithm. STUDY A centralized diagnostic index was used to retrospectively identify all patients with IPF admitted to a teaching hospital from 1995 to 2003. The patient's medical records were reviewed for clinical features, diagnostic work-up, treatment strategies, response to therapy, and the length of hospital stay. All patients underwent contrast-enhanced computed tomography of the abdomen and endoscopic retrograde cholangiopancreatography, to guide the therapeutic modality to be offered. Conservative therapy included withholding of oral feedings in conjunction with total parenteral nutrition, octreotide subcutaneously, and multiple paracentesis or thoracentesis. Interventional therapy was either endoscopic or surgical. RESULTS IPF was identified in 11 (7.3%) of 150 patients with CP. They ranged in age from 24 to 47 years (mean 36.1), with a male to female ratio of 10:1. All patients had underlying alcoholic CP. The presentation was pancreatic ascites in 9 patients and pleural effusion in 2 cases. Five patients were undergoing the conservative treatment, all presenting main pancreatic duct (MPD) dilatation; endoscopic placement of transpapillary pancreatic duct stent was performed in 4 patients who presented partial MPD stricture or disruption; surgical therapy was performed in 2 patients exhibiting complete MPD obstruction or disruption. Stents were removed 3 to 6 weeks after initial placement. IPF resolved in 10 of 11 patients (90.9%) within 6 weeks. The resolution of IPF was faster (13 +/- 5 vs. 25 +/- 13 days, P < 0.01) and the length of hospital stay was significantly shorter (17.2 +/- 5.6 vs. 31.2 +/- 4.4 days, P < 0.01) in patients subject to interventional treatment compared with those treated conservatively. There was 1 death due to sepsis in a patient managed conservatively; no death was recorded in the interventional therapy group. There was no recurrence of IPF at a mean follow-up of 38 months. CONCLUSIONS Our results suggest that interventional therapy should be considered the best approach for the management of IPF in patients presenting MPD disruption or obstruction. Conservative therapy must be reserved for those showing MPD dilatation without ductal disruption or stricture. Early interventional therapy reduced hospital stay and convalescence, which likely resulted in lower healthcare overall costs.
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Affiliation(s)
- Julio Maria Fonseca Chebli
- Division of Gastroenterology, Department of Internal Medicine, University Hospital School of Medicine of the Universidade Federal de Juiz de Fora, Minas Gerais, Brazil
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