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Usefulness of non-contrast MR imaging in distinguishing pancreatic ductal adenocarcinoma from focal pancreatitis

Published:February 20, 2019DOI:https://doi.org/10.1016/j.clinimag.2019.02.013

      Highlights

      • Non-contrast MRI was better than MDCT in differentiating pancreatic ductal adenocarcinoma from focal pancreatitis.
      • Non-contrast MRI was comparable to whole MRI in differentiating pancreatic ductal adenocarcinoma from focal pancreatitis.
      • Presence of peritumoural cyst showed the highest odds ratio for predicting pancreatic ductal adenocarcinoma.
      • The tiny peritumoural cysts on T2WI were observed in 84.5% of pancreatic ductal adenocarcinoma.

      Abstract

      Background

      Accurate differentiation between pancreatic adenocarcinoma and focal pancreatitis is challenging.

      Purpose

      To investigate the usefulness of non-contrast MRI by comparing with multidetector row CT (MDCT) and gadoxetic acid-enhanced MRI in the discrimination of pancreatic ductal adenocarcinoma (PDAC) and focal pancreatitis (FP).

      Materials and methods

      This retrospective study included 187 patients (116 with PDACs and 71 with FP) who underwent gadoxetic acid-MRI and MDCT prior to surgical resection or biopsy. The MRI features of PDAC and FP were compared by two radiologists. Then, two observers independently reviewed the three imaging sets: MDCT, non-contrast MRI (T1-, T2-weighted, and diffusion-weighted images), and MRI with and without gadoxetic acid to determine the diagnostic performances of each imaging modality in the discrimination of PDAC and FP.

      Results

      The significant features on non-contrast MRI for diagnosis of PDAC included peritumoral cyst, pancreatic duct cut-off, clear hypointensity on T1WI, and bile duct dilatation (P < 0.05). Presence of peritumoural cyst showed the highest odds ratio for predicting PDAC. Non-contrast MRI was superior to MDCT in differentiating PDAC from FP with regard to accuracy (84.5% vs 95.5% for observer 1; 85.8% vs. 96.0% for observer 2), sensitivity (83.6% vs. 98.3%; 84.5% vs 97.8%), and negative predictive value (76.3% vs. 97.0%; 77.6% vs 96.4%) (P < 0.05). We found similar diagnostic values between the non-contrast MRI and MRI with and without contrast (P > 0.05) for both observers.

      Conclusion

      Non-contrast MRI is better than MDCT and comparable to MRI with and without gadoxetic acid in differentiating PDAC from FP.

      Keywords

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