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Lopes Vendrami C, Hammond NA, Escobar DJ, Zilber Z, Dwyer M, Moreno CC, Mittal PK, Miller FH. Imaging of pancreatic serous cystadenoma and common imitators. Abdom Radiol (NY) 2024:10.1007/s00261-024-04337-1. [PMID: 38825609 DOI: 10.1007/s00261-024-04337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 06/04/2024]
Abstract
Pancreatic cystic neoplasms are lesions comprised of cystic components that show different biological behaviors, epidemiology, clinical manifestations, imaging features, and malignant potential and management. Benign cystic neoplasms include serous cystic neoplasms (SCAs). Other pancreatic cystic lesions have malignant potential, such as intraductal papillary mucinous neoplasms and mucinous cystic neoplasms. SCAs can be divided into microcystic (classic appearance), honeycomb, oligocystic/macrocystic, and solid patterns based on imaging appearance. They are usually solitary but may be multiple in von Hippel-Lindau disease, which may depict disseminated involvement. The variable appearances of SCAs can mimic other types of pancreatic cystic lesions, and cross-sectional imaging plays an important role in their differential diagnosis. Endoscopic ultrasonography has helped in improving diagnostic accuracy of pancreatic cystic lesions by guiding tissue sampling (biopsy) or cyst fluid analysis. Immunohistochemistry and newer techniques such as radiomics have shown improved performance for preoperatively discriminating SCAs and their mimickers.
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Affiliation(s)
- Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Nancy A Hammond
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - David J Escobar
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Zachary Zilber
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Meaghan Dwyer
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA, 30322, USA
| | - Pardeep K Mittal
- Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA, 30912, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
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Lee JE, Lee S, Park HJ, Hwang JA, Choi SY, Lee J. Imaging classification of pancreatic ductal adenocarcinoma with histological large duct pattern. Eur Radiol 2024:10.1007/s00330-024-10810-8. [PMID: 38806802 DOI: 10.1007/s00330-024-10810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 03/24/2024] [Accepted: 04/08/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES To investigate the imaging features of pancreatic ductal adenocarcinoma (PDAC) with histological large duct pattern. METHODS Our study included 37 patients (mean age, 66.5 years; 22 women) with surgically proven PDAC with histological large duct pattern, whose imaging features were classified into four types: Type I, solid mass; Type II, predominantly cystic mass with intracystic solid components; Type III, predominantly solid mass with intratumoral cysts; and Type IV, solid mass with peritumoral retention cysts or pseudocysts. Two radiologists independently analyzed both CT and MRI images for the morphological type, presence of abrupt main pancreatic duct (MPD) cutoff, adjacent vascular invasion, diffusion restriction, and reached consensus. RESULTS On CT, 26 patients (70.3%) had Type I tumors, five (13.5%) had Type II, three (8.1%) had Type III, and three (8.1%) had Type IV. Among the 26 patients with Type I tumors on CT, 16 had tumors with multiple intratumoral cysts within the solid mass on MRI and were subsequently classified as Type III. Accordingly, 10 patients (27.0%) were classified as Type I, five (13.5%) as Type II, 19 (51.7%) as Type III, and three (8.1%) as Type IV on MRI. Of the 37 patients, 27 (73.0%) had an abrupt MPD cutoff, 15 (40.5%) had adjacent vascular invasion, and 25 (67.6%) had diffusion restriction on MRI. CONCLUSIONS Predominantly solid pancreatic masses with small intratumoral cysts visualized on MRI may be a characteristic imaging finding of PDAC with histological large duct pattern, and differentiate it from conventional PDAC or other cystic pancreatic tumors. CLINICAL RELEVANCE STATEMENT Radiologists should be familiar with the various imaging features of PDAC with histological large duct pattern and should be aware that it may mimic other solid or cystic tumors of the pancreas. KEY POINTS Imaging features of pancreatic ductal adenocarcinoma with histological large duct pattern can be classified into four types. This pathology more frequently appears as a predominantly solid mass with intratumoral cysts on MRI than on CT. Adding MRI to CT may help identify pancreatic ductal adenocarcinoma with histological large duct pattern.
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Affiliation(s)
- Ji Eun Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Gyeonggi-do, Republic of Korea
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Hee Jun Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Seo-Youn Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Jisun Lee
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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Ansari G, Mirza-Aghazadeh-Attari M, Afyouni S, Mohseni A, Shahbazian H, Kamel IR. Utilization of texture features of volumetric ADC maps in differentiating between serous cystadenoma and intraductal papillary neoplasms. Abdom Radiol (NY) 2024; 49:1175-1184. [PMID: 38378839 DOI: 10.1007/s00261-024-04187-x] [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] [Received: 07/10/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION The rising incidence of incidental detection of pancreatic cystic neoplasms has compelled radiologists to determine new diagnostic methods for the differentiation of various kinds of lesions. We aim to demonstrate the utility of texture features extracted from ADC maps in differentiating intraductal papillary mucinous neoplasms (IPMN) from serous cystadenomas (SCA). METHODS This retrospective study was performed on 136 patients (IPMN = 87, SCA = 49) split into testing and training datasets. A total of 851 radiomics features were extracted from volumetric contours drawn by an expert radiologist on ADC maps of the lesions. LASSO regression analysis was used to determine the most predictive set of features and a radiomics score was developed based on their respective coefficients. A hyper-optimized support vector machine was then utilized to classify the lesions based on their radiomics score. RESULTS A total of four Wavelet features (LHL/GLCM/LCM2, HLL/GLCM/LCM2, /LLL/First Order/90percent, /LLL/GLCM/MCC) were selected from all of the features to be included in our classifier. The classifier was optimized by altering hyperparameters and the trained model was applied to the validation dataset. The model achieved a sensitivity of 92.8, specificity of 90%, and an AUC of 0.97 in the training data set, and a sensitivity of 83.3%, specificity of 66.7%, and AUC of 0.90 in the testing dataset. CONCLUSION A support vector machine model trained and validated on volumetric texture features extracted from ADC maps showed the possible beneficence of these features in differentiating IPMNs from SCAs. These results are in line with previous regarding the role of ADC maps in classifying cystic lesions and offers new evidence regarding the role of texture features in differentiation of potentially neoplastic and benign lesions.
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Affiliation(s)
- Golnoosh Ansari
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Mohammad Mirza-Aghazadeh-Attari
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Shadi Afyouni
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Alireza Mohseni
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Haneyeh Shahbazian
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA.
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Fukukura Y, Kanki A. Quantitative Magnetic Resonance Imaging for the Pancreas: Current Status. Invest Radiol 2024; 59:69-77. [PMID: 37433065 DOI: 10.1097/rli.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
ABSTRACT Magnetic resonance imaging (MRI) is important for evaluating pancreatic disorders, and anatomical landmarks play a major role in the interpretation of results. Quantitative MRI is an effective diagnostic modality for various pathologic conditions, as it allows the investigation of various physical parameters. Recent advancements in quantitative MRI techniques have significantly improved the accuracy of pancreatic MRI. Consequently, this method has become an essential tool for the diagnosis, treatment, and monitoring of pancreatic diseases. This comprehensive review article presents the currently available evidence on the clinical utility of quantitative MRI of the pancreas.
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Affiliation(s)
- Yoshihiko Fukukura
- From the Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
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Miller FH, Lopes Vendrami C, Hammond NA, Mittal PK, Nikolaidis P, Jawahar A. Pancreatic Cancer and Its Mimics. Radiographics 2023; 43:e230054. [PMID: 37824413 DOI: 10.1148/rg.230054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the most common primary pancreatic malignancy, ranking fourth in cancer-related mortality in the United States. Typically, PDAC appears on images as a hypovascular mass with upstream pancreatic duct dilatation and abrupt duct cutoff, distal pancreatic atrophy, and vascular encasement, with metastatic involvement including lymphadenopathy. However, atypical manifestations that may limit detection of the underlying PDAC may also occur. Atypical PDAC features include findings related to associated conditions such as acute or chronic pancreatitis, a mass that is isointense to the parenchyma, multiplicity, diffuse tumor infiltration, associated calcifications, and cystic components. Several neoplastic and inflammatory conditions can mimic PDAC, such as paraduodenal "groove" pancreatitis, autoimmune pancreatitis, focal acute and chronic pancreatitis, neuroendocrine tumors, solid pseudopapillary neoplasms, metastases, and lymphoma. Differentiation of these conditions from PDAC can be challenging due to overlapping CT and MRI features; however, certain findings can help in differentiation. Diffusion-weighted MRI can be helpful but also can be nonspecific. Accurate diagnosis is pivotal for guiding therapeutic planning and potential outcomes in PDAC and avoiding biopsy or surgical treatment of some of these mimics. Biopsy may still be required for diagnosis in some cases. The authors describe the typical and atypical imaging findings of PDAC and features that may help to differentiate PDAC from its mimics. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Zins in this issue.
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Affiliation(s)
- Frank H Miller
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
| | - Nancy A Hammond
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
| | - Pardeep K Mittal
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
| | - Paul Nikolaidis
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
| | - Anugayathri Jawahar
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611 (F.H.M., C.L.V., N.A.H., P.N., A.J.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA (P.K.M.)
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Tornel-Avelar AI, Velarde Ruiz-Velasco JA, Pelaez-Luna M. Pancreatic cancer, autoimmune or chronic pancreatitis, beyond tissue diagnosis: Collateral imaging and clinical characteristics may differentiate them. World J Gastrointest Oncol 2023; 15:925-942. [PMID: 37389107 PMCID: PMC10302998 DOI: 10.4251/wjgo.v15.i6.925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 06/14/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies and is developing into the 2nd leading cause of cancer-related death. Often, the clinical and radiological presentation of PDAC may be mirrored by other inflammatory pancreatic masses, such as autoimmune pancreatitis (AIP) and mass-forming chronic pancreatitis (MFCP), making its diagnosis challenging. Differentiating AIP and MFCP from PDAC is vital due to significant therapeutic and prognostic implications. Current diagnostic criteria and tools allow the precise differentiation of benign from malignant masses; however, the diagnostic accuracy is imperfect. Major pancreatic resections have been performed in AIP cases under initial suspicion of PDAC after a diagnostic approach failed to provide an accurate diagnosis. It is not unusual that after a thorough diagnostic evaluation, the clinician is confronted with a pancreatic mass with uncertain diagnosis. In those cases, a re-evaluation must be entertained, preferably by an experienced multispecialty team including radiologists, pathologists, gastroenterologists, and surgeons, looking for disease-specific clinical, imaging, and histological hallmarks or collateral evidence that could favor a specific diagnosis. Our aim is to describe current diagnostic limitations that hinder our ability to reach an accurate diagnosis among AIP, PDAC, and MFCP and to highlight those disease-specific clinical, radiological, serological, and histological characteristics that could support the presence of any of these three disorders when facing a pancreatic mass with uncertain diagnosis after an initial diagnostic approach has been unsuccessful.
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Affiliation(s)
- Ana I Tornel-Avelar
- Department of Gastroenterology, Hospital Civil of Guadalajara “Fray Antonio Alcalde”, Guadalajara 44340, Jalisco, Mexico
| | | | - Mario Pelaez-Luna
- Research Division School of Medicine/Department of Gastroenterology, Universidad Nacional Autonoma de México/National Institute of Medical Sciences and Nutrition “Salvador Zubiran”, Tlalpan 14000, Mexico City, Mexico
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Eklund MJ, States LJ, Acord MR, Alazraki AL, Behr GG, El-Ali AM, Morin CE, Saigal G, Shet NS, Thacker PG, Trout AT. Imaging of pediatric pancreas tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29975. [PMID: 36215203 PMCID: PMC10642208 DOI: 10.1002/pbc.29975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022]
Abstract
Primary pancreatic tumors in children are rare with an overall age-adjusted incidence of 0.018 new cases per 100,000 pediatric patients. The most prevalent histologic type is the solid pseudopapillary neoplasm, followed by pancreatoblastoma. This paper describes relevant imaging modalities and presents consensus-based recommendations for imaging at diagnosis and follow-up.
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Affiliation(s)
- Meryle J Eklund
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael R Acord
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adina L Alazraki
- Departments of Pediatrics and Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Gerald G Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander M El-Ali
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gaurav Saigal
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Narendra S Shet
- Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Paul G Thacker
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Nannan L, Gsell W, Belderbos S, Gallet C, Wouters J, Brassart-Pasco S, Himmelreich U, Brassart B. A multimodal imaging study to highlight elastin-derived peptide pro-tumoral effect in a pancreatic xenograft model. Br J Cancer 2023; 128:2000-2012. [PMID: 37002342 PMCID: PMC10206107 DOI: 10.1038/s41416-023-02242-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/28/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is highly malignant with a very poor prognosis due to its silent development and metastatic profile with a 5-year survival rate below 10%. PDAC is characterised by an abundant desmoplastic stroma modulation that influences cancer development by extracellular matrix/cell interactions. Elastin is a key element of the extracellular matrix. Elastin degradation products (EDPs) regulate numerous biological processes such as cell proliferation, migration and invasion. The aim of the present study was to characterise for the first time the effect of two EDPs with consensus sequences "GxxPG" and "GxPGxGxG" (VG-6 and AG-9) on PDAC development. The ribosomal protein SA (RPSA) has been discovered recently, acting as a new receptor of EDPs on the surface of tumour cells, contributing to poor prognosis. METHODS Six week-old female Swiss nude nu/nu (Nu(Ico)-Foxn1nu) mice were subcutaneously injected with human PDAC MIA PaCa-2/eGFP-FLuc+ cells, transduced with a purpose-made lentiviral vector, encoding green fluorescent protein (GFP) and Photinus pyralis (firefly) luciferase (FLuc). Animals were treated three times per week with AG-9 (n = 4), VG-6 (n = 5) or PBS (n = 5). The influence of EDP on PDAC was examined by multimodal imaging (bioluminescence imaging (BLI), fluorescence imaging (FLI) and magnetic resonance imaging (MRI). Tumour volumes were also measured using a caliper. Finally, immunohistology was performed at the end of the in vivo study. RESULTS After in vitro validation of MIA PaCa-2 cells by optical imaging, we demonstrated that EDPs exacerbate tumour growth in the PDAC mouse model. While VG-6 stimulated tumour growth to some extent, AG-9 had greater impact on tumour growth. We showed that the expression of the RPSA correlates with a possible effect of EDPs in the PDAC model. Multimodal imaging allowed for longitudinal in vivo follow-up of tumour development. In all groups, we showed mature vessels ending in close vicinity of the tumour, except for the AG-9 group where mature vessels are penetrating the tumour reflecting an increase of vascularisation. CONCLUSIONS Our results suggest that AG-9 strongly increases PDAC progression through an increase in tumour vascularisation.
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Affiliation(s)
- Lise Nannan
- KU Leuven, Department of Imaging and Pathology/Biomedical MRI, Leuven, Belgium
- CNRS UMR 7369 Matrice Extracellulaire et Dynamique Cellulaire, Reims, France
- Université de Reims Champagne Ardenne, Laboratoire de Biochimie Médicale et Biologie Moléculaire, Reims, France
| | - Willy Gsell
- KU Leuven, Department of Imaging and Pathology/Biomedical MRI, Leuven, Belgium
| | - Sarah Belderbos
- KU Leuven, Department of Imaging and Pathology/Biomedical MRI, Leuven, Belgium
| | - Célia Gallet
- CNRS UMR 7369 Matrice Extracellulaire et Dynamique Cellulaire, Reims, France
- Université de Reims Champagne Ardenne, Laboratoire de Biochimie Médicale et Biologie Moléculaire, Reims, France
| | - Jens Wouters
- KU Leuven, Department of Imaging and Pathology/Biomedical MRI, Leuven, Belgium
| | - Sylvie Brassart-Pasco
- CNRS UMR 7369 Matrice Extracellulaire et Dynamique Cellulaire, Reims, France
- Université de Reims Champagne Ardenne, Laboratoire de Biochimie Médicale et Biologie Moléculaire, Reims, France
| | - Uwe Himmelreich
- KU Leuven, Department of Imaging and Pathology/Biomedical MRI, Leuven, Belgium
| | - Bertrand Brassart
- CNRS UMR 7369 Matrice Extracellulaire et Dynamique Cellulaire, Reims, France.
- Université de Reims Champagne Ardenne, Laboratoire de Biochimie Médicale et Biologie Moléculaire, Reims, France.
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Xu Y, Luo HJ, Ren J, Guo LM, Niu J, Song X. Diffusion-weighted imaging-based radiomics in epithelial ovarian tumors: Assessment of histologic subtype. Front Oncol 2022; 12:978123. [PMID: 36544703 PMCID: PMC9762272 DOI: 10.3389/fonc.2022.978123] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background Epithelial ovarian tumors (EOTs) are a group of heterogeneous neoplasms. It is importance to preoperatively differentiate the histologic subtypes of EOTs. Our study aims to investigate the potential of radiomics signatures based on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps for categorizing EOTs. Methods This retrospectively enrolled 146 EOTs patients [34 with borderline EOT(BEOT), 30 with type I and 82 with type II epithelial ovarian cancer (EOC)]. A total of 390 radiomics features were extracted from DWI and ADC maps. Subsequently, the LASSO algorithm was used to reduce the feature dimensions. A radiomics signature was established using multivariable logistic regression method with 3-fold cross-validation and repeated 50 times. Patients with bilateral lesions were included in the validation cohort and a heuristic selection method was established to select the tumor with maximum probability for final consideration. A nomogram incorporating the radiomics signature and clinical characteristics was also developed. Receiver operator characteristic, decision curve analysis (DCA), and net reclassification index (NRI) were applied to compare the diagnostic performance and clinical net benefit of predictive model. Results For distinguishing BEOT from EOC, the radiomics signature and nomogram showed more favorable discrimination than the clinical model (0.915 vs. 0.852 and 0.954 vs. 0.852, respectively) in the training cohort. In classifying early-stage type I and type II EOC, the radiomics signature exhibited superior diagnostic performance over the clinical model (AUC 0.905 vs. 0.735). The diagnostic efficacy of the nomogram was the same as that of the radiomics model with NRI value of -0.1591 (P = 0.7268). DCA also showed that the radiomics model and combined model had higher net benefits than the clinical model. Conclusion Radiomics analysis based on DWI, and ADC maps serve as an effective quantitative approach to categorize EOTs.
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Affiliation(s)
- Yi Xu
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hong-Jian Luo
- Department of Radiology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, Guizhou, China
| | | | - Li-mei Guo
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jinliang Niu
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaoli Song
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,*Correspondence: Xiaoli Song,
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Luo Y, Zhang S, Tan W, Lin G, Zhuang Y, Zeng H. The Diagnostic Efficiency of Quantitative Diffusion Weighted Imaging in Differentiating Medulloblastoma from Posterior Fossa Tumors: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12112796. [PMID: 36428860 PMCID: PMC9689934 DOI: 10.3390/diagnostics12112796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
Medulloblastoma (MB) is considered the most common and highly malignant posterior fossa tumor (PFT) in children. The accurate preoperative diagnosis of MB is beneficial in choosing the appropriate surgical methods and treatment strategies. Diffusion-weighted imaging (DWI) has improved the accuracy of differential diagnosis of posterior fossa tumors. Nonetheless, further studies are needed to confirm its value for clinical application. This study aimed to evaluate the performance of DWI in differentiating MB from other PFT. A literature search was conducted using databases PubMed, Embase, and Web of Science for studies reporting the diagnostic performance of DWI for PFT from January 2000 to January 2022. A bivariate random-effects model was employed to evaluate the pooled sensitivities and specificities. A univariable meta-regression analysis was used to assess relevant factors for heterogeneity, and subgroup analyses were performed. A total of 15 studies with 823 patients were eligible for data extraction. Overall pooled sensitivity and specificity of DWI were 0.94 (95% confident interval [CI]: 0.89-0.97) and 0.94 (95% CI: 0.90-0.96) respectively. The area under the curve (AUC) of DWI was 0.98 (95% CI: 0.96-0.99). Heterogeneity was found in the sensitivity (I2 = 62.59%) and the specificity (I2 = 35.94%). Magnetic field intensity, region of interest definition and DWI diagnostic parameters are the factors that affect the diagnostic performance of DWI. DWI has excellent diagnostic accuracy for differentiating MB from other PFT. Hence, it is necessary to set DWI as a routine examination sequence for posterior fossa tumors.
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Affiliation(s)
- Yi Luo
- Shantou University Medical College, 22 Xinling Road, Jinping District, Shantou 515041, China
- Department of Radiology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen 518038, China
| | - Siqi Zhang
- Shantou University Medical College, 22 Xinling Road, Jinping District, Shantou 515041, China
- Department of Radiology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen 518038, China
| | - Weiting Tan
- Shenzhen Children’s Hospital of China Medical University, 7019 Yitian Road, Futian District, Shenzhen 518038, China
| | - Guisen Lin
- Department of Radiology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen 518038, China
| | - Yijiang Zhuang
- Department of Radiology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen 518038, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children’s Hospital, 7019 Yitian Road, Futian District, Shenzhen 518038, China
- Correspondence:
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11
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Farrukh J, Balasubramaniam R, James A, Wadhwani SS, Albazaz R. Pancreatic adenocarcinoma: imaging techniques for diagnosis and management. Br J Hosp Med (Lond) 2022; 83:1-12. [PMID: 35653327 DOI: 10.12968/hmed.2022.0065] [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] [Indexed: 12/17/2023]
Abstract
Pancreatic cancer is a leading cause of death from cancer but only a minority of patients with pancreatic ductal adenocarcinomas are eligible for curative resection. The increasing role of neoadjuvant therapy provides hope of improving outcomes. However, progress is also reliant on advances in imaging that can identify disease earlier and accurately assess treatment response. Computed tomography remains the cornerstone in evaluation of resectability, offering excellent spatial resolution. However, in high-risk patients, additional magnetic resonance imaging and positron emission tomography-computed tomography may further guide treatment decisions. Conventional computed tomography can be limited in its ability to determine disease response after neoadjuvant therapy. Dual-energy computed tomography and computed tomography or magnetic resonance imaging perfusion studies emerging as potentially better alternatives. Combined with pioneering advances in radiomic analysis, these modalities also show promise in analysing tumour heterogeneity and thereby more accurately predicting outcomes. This article reviews these imaging techniques.
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Affiliation(s)
- Jawaad Farrukh
- Department of Radiology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ravivarma Balasubramaniam
- Department of Radiology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Anitha James
- Department of Radiology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Sharan S Wadhwani
- Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Raneem Albazaz
- Department of Radiology, St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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12
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Zhang X, Zeng Z, Liu H, Xu L, Sun X, Xu J, Song G. Recent development of a magneto-optical nanoplatform for multimodality imaging of pancreatic ductal adenocarcinoma. NANOSCALE 2022; 14:3306-3323. [PMID: 35170601 DOI: 10.1039/d1nr08394e] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer. Given its inconspicuous and atypical early symptoms and hidden location, most patients have already reached the terminal stage before diagnosis. At present, the diagnosis of PDAC mainly depends on serological and imaging examinations. However, serum tests cannot identify specific tumor locations and each imaging technology has its own defects, bringing great challenges to the early diagnosis of PDAC. Therefore, it is of great significance to find new strategies for the early and accurate diagnosis of PDAC. In recent years, a magneto-optical nanoplatform integrating near infrared fluorescence, photoacoustic, magnetic resonance imaging, etc. has attracted widespread attention, giving full play to the complementary advantages of each imaging modality. Herein, we summarize the recent advances of imaging modalities in the diagnosis of pancreatic cancer, and then discuss in detail the construction and modification of magneto or/and optical probes for multimodal imaging, and advances in early diagnosis using the combination of various imaging modalities, which can provide potential tools for the early diagnosis or even intraoperative navigation and post-treatment follow-up of PDAC patients.
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Affiliation(s)
- Xuan Zhang
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, P. R. China.
- Department of Ophthalmology and Otolaryngology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, P. R. China.
| | - Zhiming Zeng
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, P. R. China.
- Department of Ophthalmology and Otolaryngology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, P. R. China.
| | - Huiyi Liu
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, P. R. China.
| | - Li Xu
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, P. R. China.
| | - Xin Sun
- College of Mechanical and Electrical Engineering, Central South University, Changsha 410083, P. R. China
| | - Jing Xu
- Department of Ophthalmology and Otolaryngology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, P. R. China.
| | - Guosheng Song
- State Key Laboratory of Chemo/Biosensing and Chemometrics, College of Chemistry and Chemical Engineering, Hunan University, Changsha 410082, P. R. China.
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13
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Glutig K, Krüger PC, Oberreuther T, Nickel MD, Teichgräber U, Lorenz M, Mentzel HJ, Krämer M. Preliminary results of abdominal simultaneous multi-slice accelerated diffusion-weighted imaging with motion-correction in patients with cystic fibrosis and impaired compliance. Abdom Radiol (NY) 2022; 47:2783-2794. [PMID: 35596778 PMCID: PMC9300552 DOI: 10.1007/s00261-022-03549-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of this prospective study was to compare scan time, image quality, signal-to-noise Ratio (SNR), and apparent diffusion coefficient (ADC) values of simultaneous multi-slice accelerated diffusion-weighted imaging with motion-correction (DWI SMS Moco) to standard diffusion-weighted imaging (sDWI) in free-breathing abdominal magnetic resonance imaging (MRI) in pediatric and young adult patients with cystic fibrosis (CF). MATERIAL AND METHODS 16 patients (7 male and 9 female, 12-41 years old) with CF were examined prospectively in a single-center from November 2020 to March 2021 on a 1.5 Tesla clinical MR scanner. The characteristics of overall image quality and delimitability of mesenteric lymph nodes were evaluated using a 5-point Likert scale by two experienced pediatric radiologists independently from each other. Quantitative parameters with SNR and ADC values were assessed in 8 different locations and compared using a Wilcoxon signed-rank test. RESULTS The acquisition time for DWI SMS Moco was 32% shorter than for sDWI. Regarding quality comparison, overall image quality and delimitability of mesenteric lymph nodes were significant higher in DWI SMS Moco (p ≤ 0.05 for both readers). The readers preferred DWI SMS Moco to sDWI in all cases (16/16). Mean SNR values from DWI SMS Moco and sDWI were similar in 7 from 8 locations. The ADC values showed no significant difference between DWI SMS Moco and sDWI in any of the evaluated locations (p > 0.05). CONCLUSIONS The DWI SMS Moco improves overall image quality and delimitability of mesenteric lymph nodes compared to sDWI with similar SNR and ADC values and a distinguished reduction of scan time in free-breathing by one third. We conclude that MRI with DWI SMS Moco could be helpful in monitoring the effect of the high-efficiency modulator (HEM) therapy in cystic fibrosis (CF) patients homozygous or heterozygous for F508del in the abdomen.
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Affiliation(s)
- Katja Glutig
- Department of Radiology, Section Pediatric Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Paul-Christian Krüger
- Department of Radiology, Section Pediatric Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Theresa Oberreuther
- Department of Radiology, Section Pediatric Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | | | - Ulf Teichgräber
- Department of Radiology, Jena University Hospital, Jena, Germany
| | - Michael Lorenz
- Cystic Fibrosis Centre, Department of Paediatrics, Jena University Hospital, Jena, Germany
| | - Hans-Joachim Mentzel
- Department of Radiology, Section Pediatric Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Martin Krämer
- Department of Radiology, Jena University Hospital, Jena, Germany
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14
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Miller FH, Lopes Vendrami C, Recht HS, Wood CG, Mittal P, Keswani RN, Gabriel H, Borhani AA, Nikolaidis P, Hammond NA. Pancreatic Cystic Lesions and Malignancy: Assessment, Guidelines, and the Field Defect. Radiographics 2021; 42:87-105. [PMID: 34855543 DOI: 10.1148/rg.210056] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The widespread use of high-spatial-resolution cross-sectional imaging has led to an increase in detection of incidental pancreatic cystic lesions. These lesions are a diverse group, ranging from indolent and premalignant lesions to invasive cancers. The diagnosis of several of these lesions can be suggested on the basis of their imaging appearance, while many other lesions require follow-up imaging and/or aspiration. The smaller cystic lesions, often branch-duct intraductal papillary mucinous neoplasms, have overlapping imaging characteristics that make diagnostic assessment of the natural history and malignancy risk confusing. Expert panels have developed societal guidelines, based on a consensus, for surveillance of these lesions. However, these guidelines are often inconsistent and are constantly evolving as additional scientific data are accumulated. Identification of features associated with increased risk of malignancy is important for proper management. The concept of field defect, whereby pancreatic adenocarcinoma develops at a site different from the site of the pancreatic cyst, adds to the complexity of screening guidelines. As a result of the differences in guidelines, key stakeholders (eg, radiologists, gastroenterologists, and surgeons) must review and come to a consensus regarding which guideline, or combination of guidelines, to follow at their individual institutions. Standardized reporting and macros are helpful for ensuring the uniformity of interpretations. Radiologists play a critical role in the detection and characterization of pancreatic cystic lesions, in the follow-up recommendations for these lesions, and in the detection of associated cancer. An invited commentary by Zaheer is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Frank H Miller
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Camila Lopes Vendrami
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Hannah S Recht
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Cecil G Wood
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Pardeep Mittal
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Rajesh N Keswani
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Helena Gabriel
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Amir A Borhani
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Paul Nikolaidis
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
| | - Nancy A Hammond
- From the Departments of Radiology (F.H.M., C.L.V., H.S.R., C.G.W., H.G., A.A.B., P.N., N.A.H.) and Gastroenterology (R.N.K.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair Street, Suite 800, Chicago, IL 60611; and Department of Radiology, Medical College of Georgia, Augusta, Ga (P.M.)
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15
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Kamal O, McTavish S, Harder FN, Van AT, Peeters JM, Weiss K, Makowski MR, Karampinos DC, Braren RF. Noise reduction in diffusion weighted MRI of the pancreas using an L1-regularized iterative SENSE reconstruction. Magn Reson Imaging 2021; 87:1-6. [PMID: 34808306 DOI: 10.1016/j.mri.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/16/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To prospectively evaluate an L1 regularized iterative SENSE reconstruction (L1-R SENSE) to eliminate band-like artifacts frequently seen with parallel imaging (SENSE) at high acceleration factors in high resolution diffusion weighted magnetic resonance imaging of the pancreas. METHODS Fourteen patients with pancreatic ductal adenocarcinoma (PDAC) underwent respiratory triggered DWI ss-EPI at a resolution of 2.5 × 2.5 × 3 mm3 with uniform undersampling in the phase encoding direction (AP axis) with an acceleration factor of 4. Data were reconstructed using the standard SENSE reconstruction routine of the vendor and an iterative SENSE reconstruction employing L1 regularization after a wavelet sparsifying transformation (L1-R SENSE). Retrospective reconstruction of the data with a lower number of averages was performed using both reconstruction methods. Two radiologists independently assessed noise artifacts, anatomical details and image quality (IQ) subjectively with a 4-point scale. Apparent diffusion coefficient (ADC) and covariance (CV) of ADC estimated from images reconstructed at a different number of averages for PDAC and the normal pancreas were assessed. RESULTS L1-R SENSE resulted in higher IQ and less noise artifacts than SENSE. Anatomical details were significantly higher for SENSE in one reader. Mean ADC of PDAC and normal pancreas were significantly higher for L1-R SENSE than SENSE. L1-R SENSE revealed lower CV of ADC for normal pancreas compared to SENSE, whereas no difference was noted for PDAC. CONCLUSION Compared with traditional SENSE reconstruction, L1-R SENSE effectively reduces band-like noise and improves the robustness of the ADC estimation from acquisitions using single-shot DW-EPI of the pancreas.
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Affiliation(s)
- Omar Kamal
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany; Department of Diagnostic Radiology, Oregon Health and Science University, Oregon, USA
| | - Sean McTavish
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felix N Harder
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Anh T Van
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | | | | | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rickmer F Braren
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), Munich partner site, Germany.
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16
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Halankar J, Jhaveri K, Metser U. Cystic lesions of the pancreatico-biliary tree: A schematic MRI approach. Indian J Radiol Imaging 2021; 27:167-176. [PMID: 28744077 PMCID: PMC5510314 DOI: 10.4103/ijri.ijri_226_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although a common occurrence, cystic lesions of the pancreatico-biliary tree (PBT) may pose a diagnostic dilemma because they encompass a large number of neoplastic and benign processes with varied clinical symptoms. Knowledge of lesion classification and characterization are essential in making an accurate prospective diagnosis. This is necessary for identifying clinically significant cystic masses, which at times may require invasive intervention from indolent, nonneoplastic lesions, for which surveillance may suffice. Today, there is an arsenal of modalities for assessing the PBT, however, magnetic resonance imaging (MRI) remains at the forefront for characterizing cystic morphology and fluid content, internal septations, solid component, enhancement patterns, as well as assessing the surrounding normal structures. This pictorial review aims to review the spectrum of MRI features, which will aid in the differential diagnoses of cystic lesions of the PBT and mimickers, enabling the radiologist to reach a more confident diagnosis.
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Affiliation(s)
- Jaydeep Halankar
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kartik Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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17
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Sato H, Liss AS, Mizukami Y. Large-duct pattern invasive adenocarcinoma of the pancreas–a variant mimicking pancreatic cystic neoplasms: A minireview. World J Gastroenterol 2021; 27:3262-3278. [PMID: 34163110 PMCID: PMC8218369 DOI: 10.3748/wjg.v27.i23.3262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/09/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer currently has no subtypes that inform clinical decisions; hence, there exists an opportunity to rearrange the morphological and molecular taxonomy that guides a better understanding of tumor characteristics. Nonetheless, accumulating studies to date have revealed the large-duct type variant, a unique subtype of pancreatic ductal adenocarcinoma (PDA) with cystic features. This subtype often radiographically mimics intraductal papillary mucinous neoplasms (IPMNs) and involves multiple small cysts occasionally associated with solid masses. The “bunch-of-grapes” sign, an imaging characteristic of IPMNs, is absent in large-duct PDA. Large-duct PDA defines the mucin profile, and genetic alterations are useful in distinguishing large-duct PDA from IPMNs. Histologically, neoplastic ducts measure over 0.5 mm, forming large ductal elements. Similar to classic PDAs, this subtype is frequently accompanied by perineural invasion and abundant desmoplastic reactions, and KRAS mutations in codon 12 are nearly ubiquitous. Despite such morphological similarities with IPMNs, the prognosis of large-duct PDA is equivalent to that of classic PDA. Differential diagnosis is therefore essential.
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Affiliation(s)
- Hiroki Sato
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Andrew Scott Liss
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Yusuke Mizukami
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo 0650033, Hokkaido, Japan
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18
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Geng R, Zhang Y, Starekova J, Rutkowski DR, Estkowski L, Roldán-Alzate A, Hernando D. Characterization and correction of cardiovascular motion artifacts in diffusion-weighted imaging of the pancreas. Magn Reson Med 2021; 86:1956-1969. [PMID: 34142375 DOI: 10.1002/mrm.28846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE To assess the effects of cardiovascular-induced motion on conventional DWI of the pancreas and to evaluate motion-robust DWI methods in a motion phantom and healthy volunteers. METHODS 3T DWI was acquired using standard monopolar and motion-compensated gradient waveforms, including in an anatomically accurate pancreas phantom with controllable compressive motion and healthy volunteers (n = 8, 10). In volunteers, highly controlled single-slice DWI using breath-holding and cardiac gating and whole-pancreas respiratory-triggered DWI were acquired. For each acquisition, the ADC variability across volunteers, as well as ADC differences across parts of the pancreas were evaluated. RESULTS In motion phantom scans, conventional DWI led to biased ADC, whereas motion-compensated waveforms produced consistent ADC. In the breath-held, cardiac-triggered study, conventional DWI led to heterogeneous DW signals and highly variable ADC across the pancreas, whereas motion-compensated DWI avoided these artifacts. In the respiratory-triggered study, conventional DWI produced heterogeneous ADC across the pancreas (head: 1756 ± 173 × 10-6 mm2 /s; body: 1530 ± 338 × 10-6 mm2 /s; tail: 1388 ± 267 × 10-6 mm2 /s), with ADCs in the head significantly higher than in the tail (P < .05). Motion-compensated ADC had lower variability across volunteers (head: 1277 ± 102 × 10-6 mm2 /s; body: 1204 ± 169 × 10-6 mm2 /s; tail: 1235 ± 178 × 10-6 mm2 /s), with no significant difference (P ≥ .19) across the pancreas. CONCLUSION Cardiovascular motion introduces artifacts and ADC bias in pancreas DWI, which are addressed by motion-robust DWI.
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Affiliation(s)
- Ruiqi Geng
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yuxin Zhang
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jitka Starekova
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - David R Rutkowski
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Alejandro Roldán-Alzate
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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19
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Accuracy of quantitative diffusion-weighted imaging for differentiating benign and malignant pancreatic lesions: a systematic review and meta-analysis. Eur Radiol 2021; 31:7746-7759. [PMID: 33847811 DOI: 10.1007/s00330-021-07880-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/19/2021] [Accepted: 03/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND A variety of imaging techniques can be used to evaluate diffusion characteristics to differentiate malignant and benign pancreatic lesions. The diagnostic performance of diffusion parameters has not been systematic assessed. PURPOSE We aimed to investigate the diagnostic efficacy of quantitative diffusion-weighted imaging (DWI) for pancreatic lesions. METHODS A literature search was conducted using the PubMed, Embase, and Cochrane Library databases for studies from inception to March 30, 2020, which involves the quantitative diagnostic performance of diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) in the pancreas. Studies were reviewed according to inclusion and exclusion criteria. The quality of articles was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUATAS-2). A bivariate random-effects model was used to evaluate pooled sensitivities and specificities. Univariable meta-regression analysis was used to test the effects of factors that contributed to the heterogeneity. RESULTS A total of 31 studies involving 1558 patients were ultimately eligible for data extraction. The lowest heterogeneity was found in specificity of perfusion fraction (f) with the I2 value was 17.97% and Cochran p value was 0.28. However, high heterogeneities were found for the other parameters (all I2 > 50%). There was no publication bias found in funnel plot (p = 0.30) for the apparent diffusion coefficient (ADC) parameter. The pooled sensitivities for ADC, f, pure diffusion coefficient (D), and pseudo diffusivity coefficient (D*) were 83%, 81%, 76%, and 84%, respectively. The pooled specificities for ADC, f, D, and D* were 87%, 83%, 69%, and 81% respectively. The areas under the curves for ADC, f, D, and D* were 0.92, 0.87, 0.79, and 0.87 respectively. CONCLUSION Quantitative DWI and IVIM have a good diagnostic performance for differentiating malignant and benign pancreatic lesions. KEY POINTS • IVIM has high sensitivity and specificity (84% and 83%, respectively) for differential diagnosis of pancreatic lesions, which is comparable to that of the ADC (83% and 87%, respectively). • The ADC has an excellent diagnostic performance for differentiating malignant from benign IPMNs (sensitivity, 0.83; specificity, 0.92); the f has the best diagnostic performance for differentiating pancreatic carcinoma from PNET (sensitivity, 0.85; specificity, 0.85). • For the ADC, using a maximal b value < 800 s/mm2 has a higher diagnostic accuracy than ≥ 800 s/mm2; performing in a high field strength (3.0 T) system has a higher diagnostic accuracy than a low field strength (1.5 T) for pancreatic lesions.
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20
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Verde F, Galatola R, Romeo V, Perillo T, Liuzzi R, Camera L, Klain M, Modica R, Faggiano A, Napolitano V, Colao A, Brunetti A, Maurea S. Pancreatic Neuroendocrine Tumors in Patients with Multiple Endocrine Neoplasia Type 1: Diagnostic Value of Different MRI Sequences. Neuroendocrinology 2021; 111:696-704. [PMID: 32580192 DOI: 10.1159/000509647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND MRI is a useful imaging modality to assess the presence of pancreatic neuroendocrine tumors (PNETs), allowing repeat monitoring examinations in multiple endocrine neoplasia type 1 (MEN-1) patients. OBJECTIVES We aimed to compare the diagnostic accuracy of conventional MRI sequences to identify which sequence better depicts the presence of PNETs in MEN-1 patients. METHOD We performed a retrospective analysis of consecutive MEN-1 patients who underwent a conventional MRI protocol to monitor previously proven PNETs. MRI sequences T1-w chemical shift (CS), T2-w HASTE, fat-suppressed (FS) T2-w HASTE, diffusion-weighted imaging (DWI), and pre- and post-contrast FS T1-w sequences were independently analyzed by 2 experienced radiologists using a 3-grade score (no lesion, uncertain lesion, and certain lesion); lesion size and signal intensity were recorded. A Friedman ANOVA and a Wilcoxon pairwise test for the post hoc analysis were used. The sensitivity of each sequence was measured, and the results were analyzed with the χ2 test. RESULTS We included 21 patients with a total of 45 PNETs proven by histology, endoscopic ultrasonography-guided fine-needle aspiration, CT, and nuclear medicine studies. A statistically significant (p < 0.01) difference was observed in the detection performance of each MRI sequence, particularly between DWI (91%) and T2-w FS (85%) sequences in comparison to the others (T1-w CS, T2-w, and pre- and post-contrast FS T1-w, ≤56% for all); no significant (p = 0.5) difference was found between the detection performance of DWI and T2-w FS sequences. No correlation was observed between the qualitative score of each sequence and lesion tumor size. CONCLUSIONS DWI and T2-w FS sequences proved to be the most accurate in the detection of PNETs, thus suggesting a role for an abbreviated MRI protocol without contrast medium administration for monitoring MEN-1 patients.
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Affiliation(s)
- Francesco Verde
- Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy
| | - Roberta Galatola
- Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy,
| | - Teresa Perillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy
| | - Raffaele Liuzzi
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples, Italy
| | - Luigi Camera
- Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy
| | - Roberta Modica
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
| | - Antongiulio Faggiano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
| | - Vincenzo Napolitano
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli,", Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II,", Naples, Italy
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Liu H, Cui Y, Shao J, Shao Z, Su F, Li Y. The diagnostic role of CT, MRI/MRCP, PET/CT, EUS and DWI in the differentiation of benign and malignant IPMN: A meta-analysis. Clin Imaging 2020; 72:183-193. [PMID: 33321460 DOI: 10.1016/j.clinimag.2020.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/09/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The objective of this study was to assess the diagnostic properties of computed tomography (CT), magnetic resonance imaging (MRI/MRCP) /Magnetic Resonance Cholangiopancreatography (MRCP), positron emission tomography/computed tomography (PET/CT), endoscopic ultrasound (EUS) and diffusion-weighted magnetic resonance imaging (DWI) in distinguishing benign and malignant intraductal papillary mucinous neoplasm (IPMN). MATERIALS AND METHODS Eligible databases were searched for eligible studies, published through July 2020 on the diagnostic accuracy of these modalities. Diagnostic accuracy parameters, including sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic curves (SROC) were calculated. Meta-regression was performed to identify the source of heterogeneity. RESULTS In total, 28 studies were included. Pooled sensitivities for CT, MRI/MRCP, PET/CT, EUS and DWI were 0.7, 0.76, 0.8, 0.6 and 0.72, respectively. Pooled specificities were 0.78, 0.83, 0.9, 0.8 and 0.97. The DORs were 8, 16, 35, 6 and 88. The areas under the curve (AUC) of SROC for CT, MRI/MRCP/MRCP, PET/CT, EUS and DW were 0.8, 0.87, 0.92, 0.79 and 0.82, respectively. CONCLUSION PET/CT showed the highest AUC and the overall diagnostic accuracy results support the use of MRI/MRCP, PET/CT interchangeably as a first-line examination in the diagnosis of malignant IPMN. With regard to DWI, EUS and CT, each techniques have their advantages and supportive to MRI/MRCP.
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Affiliation(s)
- Hongjie Liu
- Department of Radiology, The Fifth Central Hospital, Tianjin, China
| | - Yu Cui
- Department of General Surgery, The Fifth Central Hospital, Tianjin, China
| | - Jianping Shao
- Department of General Surgery, The Fifth Central Hospital, Tianjin, China
| | - Zhijiang Shao
- Department of General Surgery, The Fifth Central Hospital, Tianjin, China
| | - Feng Su
- Department of General Surgery, The Fifth Central Hospital, Tianjin, China
| | - Yongyuan Li
- Department of General Surgery, The Fifth Central Hospital, Tianjin, China.
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Positron emission tomography/magnetic resonance imaging for the diagnosis and differentiation of pancreatic tumors. Nucl Med Commun 2020; 41:155-161. [PMID: 31834254 DOI: 10.1097/mnm.0000000000001125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This retrospective study aimed to evaluate the diagnostic efficiency of simultaneous positron emission tomography/magnetic resonance imaging (PET/MR) in differentiating the benign and malignant of pancreatic tumors as well as the differentiation of pancreatic cancer. METHODS A total of 62 patients with suspected pancreatic tumors, diagnosed by PET/MR examinations, were collected in this study. These patients were divided into benign group and malignant group. The characteristics of the morphological MR, apparent diffusion coefficient (ADC), the mean of standardized uptake value (SUVmean), maximum values of standardized uptake value (SUVmax), in lesions were measured, and the novel parameters SUVpeak/ADC and SUVmax/ADC were constructed. The diagnostic efficiency for differentiating the benign and malignant lesions was analyzed by receiver operating characteristic (ROC) curve, and the diagnosis efficiency for the differentiation of pancreatic cancer was analyzed by Spearman correlation analysis. RESULTS In differentiating the benign and malignant of pancreatic tumors, the diagnostic efficiency increased in the order of SUVpeak (AUROC: 0.760), SUVmax (AUROC: 0.774), T1T2 (AUROC: 0.789), ADC (AUROC: 0.817), SUVpeak/ADC (AUROC: 0.836), SUVmax/ADC (AUROC: 0.847). There was no significant correlation for SUVmax, SUVpeak, ADC, SUVpeak/ADC, and SUVmax/ADC with the differentiation of pancreatic cancer (P > 0.05). Besides, T1T2 was not significantly correlated to the differentiation of pancreatic cancer (P = 0.026, r = -0.406). CONCLUSION The integration of PET/MR imaging could be used to efficiently diagnose whether the pancreatic tumor was benign or malignant. The SUVmax/ADC was the most efficient metric, while it could not help in the differentiation of pancreatic cancer.
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Yadav RK, Jiang X, Chen J. Differentiating benign from malignant pancreatic cysts on computed tomography. Eur J Radiol Open 2020; 7:100278. [PMID: 33163586 PMCID: PMC7607418 DOI: 10.1016/j.ejro.2020.100278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
CT can distinguish between benign and premalignant or malignant pancreatic cysts. Solid component and septation were the only CT features that could differentiate benign from malignant cysts. Cyst wall enhancements on CT were more commonly observed in premalignant or malignant cysts than in benign cysts. CT is a necessary diagnostic modality to preoperatively detect and characterize pancreatic lesions.
Purpose It is important to identify features on computed tomography (CT) that can distinguish between benign and premalignant or malignant pancreatic cysts to avoid unnecessary surgeries. This study investigated the preoperative diagnostic evaluation of cystic pancreatic lesions to determine how advanced imaging and clinical factors should guide management. Methods In total, 53 patients with 27 benign and 26 premalignant or malignant cysts were enrolled. CT features of the cysts were compared using univariate and multivariate analyses. Results On univariate analysis, a solid component (p < 0.01), septation (p < 0.01), location (p < 0.01), border (p < 0.01), wall enhancement (p = 0.01), lesion margins (p < 0.01), pancreatic atrophy (p = 0.04), and a cystic wall (p < 0.01) were all significantly different between benign and premalignant or malignant cysts. On multivariate analysis, only a solid component (p < 0.01) and septation (p < 0.01) were significant. Conclusion A thin cystic wall, uniform homogeneity, a clear border, the presence of septation, pancreatic atrophy, and the absence of both wall enhancements and solid components were more frequently seen in benign cysts. A thick wall, lack of homogeneity, the presence of wall enhancements and solid components, absence of septation, only a small degree of pancreatic atrophy, and unclear borders were more frequent among premalignant or malignant cysts. The only CT features to differentiate benign from premalignant or malignant cysts were a solid component and septation.
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Key Words
- CEA, Carcinoembryonic antigen
- CPR, Curved planar reformation
- CTA, CT angiography
- DWI, Diffusion-weighted imaging
- ERCP, Endoscopic retrograde cholangiopancreatography
- FDG PET, Fluorodeoxyglucose PET
- FNA, Fine-needle aspiration
- HASTE, Half-Fourier acquisition single-shot turbo spin-echo
- IPMN, Intraductal papillary mucinous neoplasia
- MCA, Mucinous cystadenoma
- MCB, Mucinous cystic borderline tumor
- MCC, Mucinous cystadenocarcinoma
- MCN, Mucinous cystic neoplasm
- MPD, Main pancreatic duct
- MPR, Multi-planar reformation
- MRA, MR angiography
- MRCP, MR cholangiopancreatography
- MRI, Magnetic resonance imaging
- MSCT, Multi-slice helical computed tomography
- PACS, Picture archiving and communicating system
- PCN, Cystic neoplasms of the pancreas
- PDAC, Pancreatic ductal adenocarcinoma
- PET, Positron emission computed tomography
- Pancreatic cystic lesions
- Pancreatic ductal adenocarcinoma
- Pancreatic neoplasm
- ROI, Region of interest
- SCA, Serous cystadenoma
- SMA, Serous microcystic adenoma
- US, Ultrasonography
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Affiliation(s)
- Rajesh Kumar Yadav
- Second Affiliated Hospital, Department of Radiology, Sun Yat-sen University, Guangzhou 510000, China
- Corresponding author: Current Address: Novus Health Wellness, 4808 Munson St NW, OH 44718 USA.
| | - Xinhua Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jianyu Chen
- Second Affiliated Hospital, Department of Radiology, Sun Yat-sen University, Guangzhou 510000, China
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Chen X, Guo C, Cui W, Sun K, Wang Z, Chen X. CD56 Expression Is Associated with Biological Behavior of Pancreatic Neuroendocrine Neoplasms. Cancer Manag Res 2020; 12:4625-4631. [PMID: 32606955 PMCID: PMC7306468 DOI: 10.2147/cmar.s250071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose CD56 is a neural cell adhesion molecule that plays a role in the cohesiveness of neuroendocrine cells. The aim of this study was to explore the biological values of CD56 expression in pancreatic neuroendocrine neoplasms (PNENs) and its role in predicting PNENs grades. Patients and Methods A total of 138 patients with histological-proven PNENs was included (66 G1, 46 G2 and 26 G3). The clinicopathological characteristics, including mitosis count, ki67 index, chromogranin A (CgA), synaptophysin (Syn) and CD56 expression, were evaluated. We assessed the diagnostic performance of markers in predicting PNEN G3 and the association between CD56 expression and risk of G3 or organs invasion. Results Lack of CD56 immunoreaction (CD56-) was more common in PNEN G3 than G1/G2 (31% vs 0–2%, p < 0.01). The sizes of CD56- tumors were larger than CD56 positive tumors in PNEN G3 (p < 0.01). The odds ratio (OR) of CD56- expression was 13.6 [95% confidence interval (CI): 2.1–88.1] in predicting PNEN G3. The OR of CD56- expression was 6.5 (95% CI: 1.1–38.6) and 31.9 (95% CI: 1.09–938.3) in predicting organs invasion and neuroendocrine carcinoma in PNEN G3, respectively. Tumor size (area under the curve [AUC] = 0.77 and size+CD56- expression [AUC = 0.84]) had acceptable performance in predicating PNEN G3. Conclusion Lack of CD56 immunoreaction may be a predictor and biological behavior marker for PNEN G3.
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Affiliation(s)
- Xin Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 2100029, People's Republic of China
| | - Chuangen Guo
- Department of Radiology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou 310003, People's Republic of China
| | - Wenjing Cui
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 2100029, People's Republic of China
| | - Ke Sun
- Department of Pathology, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou 310003, People's Republic of China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 2100029, People's Republic of China
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 2100029, People's Republic of China
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Abstract
MR imaging can be optimized to evaluate a spectrum of pancreatic disorders with advanced sequences aimed to provide quantitative results and increase MR diagnostic capabilities. The pancreas remains a challenging organ to image because of its small size and location deep within the body. Besides its anatomic limitations, pancreatic pathology can be difficult to identify in the early stages. For example, subtle changes in ductal anatomy and parenchymal composition seen in early chronic pancreatitis are imperceptible with other modalities, such as computed tomography. This article reviews the application of MR imaging techniques and emerging MR sequences used in pancreas imaging.
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Affiliation(s)
- Danielle V Hill
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 North University Boulevard, Suite UH0663, Indianapolis, IN 46202, USA
| | - Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 North University Boulevard, Suite UH0663, Indianapolis, IN 46202, USA.
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Granata V, Fusco R, Sansone M, Grassi R, Maio F, Palaia R, Tatangelo F, Botti G, Grimm R, Curley S, Avallone A, Izzo F, Petrillo A. Magnetic resonance imaging in the assessment of pancreatic cancer with quantitative parameter extraction by means of dynamic contrast-enhanced magnetic resonance imaging, diffusion kurtosis imaging and intravoxel incoherent motion diffusion-weighted imaging. Therap Adv Gastroenterol 2020; 13:1756284819885052. [PMID: 32499833 PMCID: PMC7243396 DOI: 10.1177/1756284819885052] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/07/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite great technical advances in imaging, such as multidetector computed tomography and magnetic resonance imaging (MRI), diagnosing pancreatic solid lesions correctly remains challenging, due to overlapping imaging features with benign lesions. We wanted to evaluate functional MRI to differentiate pancreatic tumors, peritumoral inflammatory tissue, and normal pancreatic parenchyma by means of dynamic contrast-enhanced MRI (DCE-MRI)-, diffusion kurtosis imaging (DKI)-, and intravoxel incoherent motion model (IVIM) diffusion-weighted imaging (DWI)-derived parameters. METHODS We retrospectively analyzed 24 patients, each with histopathological diagnosis of pancreatic tumor, and 24 patients without pancreatic lesions. Functional MRI was acquired using a 1.5 MR scanner. Peritumoral inflammatory tissue was assessed by drawing regions of interest on the tumor contours. DCE-MRI, IVIM and DKI parameters were extracted. Nonparametric tests and receiver operating characteristic (ROC) curves were calculated. RESULTS There were statistically significant differences in median values among the three groups observed by Kruskal-Wallis test for the DKI mean diffusivity (MD), IVIM perfusion fraction (fp) and IVIM tissue pure diffusivity (Dt). MD had the best results to discriminate normal pancreas plus peritumoral inflammatory tissue versus pancreatic tumor, to separate normal pancreatic parenchyma versus pancreatic tumor and to differentiate peritumoral inflammatory tissue versus pancreatic tumor, respectively, with an accuracy of 84%, 78%, 83% and area under ROC curve (AUC) of 0.85, 0.82, 0.89. The findings were statistically significant compared with those of other parameters (p value < 0.05 using McNemar's test). Instead, to discriminate normal pancreas versus peritumoral inflammatory tissue or pancreatic tumor and to differentiate normal pancreatic parenchyma versus peritumoral inflammatory tissue, there were no statistically significant differences between parameters' accuracy (p > 0.05 at McNemar's test). CONCLUSIONS Diffusion parameters, mainly MD by DKI, could be helpful for the differentiation of normal pancreatic parenchyma, perilesional inflammation, and pancreatic tumor.
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Affiliation(s)
- Vincenza Granata
- Radiology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Roberta Fusco
- Department of Radiology, Istituto Nazionale Tumori Fondazione G. Pascale, via Mariano Semmola, Naples 80131, Italy
| | - Mario Sansone
- Department of Electrical Engineering and Information Technologies (DIETI), University of Naples Federico II, Naples, Italy
| | - Roberto Grassi
- Radiology Unit, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Maio
- Radiology Unit, University of Naples Federico II, Naples, Italy
| | - Raffaele Palaia
- Hepatobiliary Surgical Oncology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Fabiana Tatangelo
- Diagnostic Pathology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Gerardo Botti
- Diagnostic Pathology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Robert Grimm
- Siemens Healthcare GmbH, Erlangen, Bayern, Germany
| | - Steven Curley
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Antonio Avallone
- Abdominal Oncology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
| | - Antonella Petrillo
- Radiology Unit, ‘Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale’, Naples, Italy
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27
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Elbanna KY, Jang HJ, Kim TK. Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review. Insights Imaging 2020; 11:58. [PMID: 32335790 PMCID: PMC7183518 DOI: 10.1186/s13244-020-00861-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has continued to have a poor prognosis for the last few decades in spite of recent advances in different imaging modalities mainly due to difficulty in early diagnosis and aggressive biological behavior. Early PDAC can be missed on CT due to similar attenuation relative to the normal pancreas, small size, or hidden location in the uncinate process. Tumor resectability and its contingency on the vascular invasion most commonly assessed with multi-phasic thin-slice CT is a continuously changing concept, particularly in the era of frequent neoadjuvant therapy. Coexistent celiac artery stenosis may affect the surgical plan in patients undergoing pancreaticoduodenectomy. In this review, we discuss the challenges related to the imaging of PDAC. These include radiological and clinical subtleties of the tumor, evolving imaging criteria for tumor resectability, preoperative diagnosis of accompanying celiac artery stenosis, and post-neoadjuvant therapy imaging. For each category, the key imaging features and potential pitfalls on cross-sectional imaging will be discussed. Also, we will describe the imaging discriminators of potential mimickers of PDAC.
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Affiliation(s)
- Khaled Y Elbanna
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
| | - Hyun-Jung Jang
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tae Kyoung Kim
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
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28
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Harrington KA, Shukla-Dave A, Paudyal R, Do RKG. MRI of the Pancreas. J Magn Reson Imaging 2020; 53:347-359. [PMID: 32302044 DOI: 10.1002/jmri.27148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023] Open
Abstract
MRI has played a critical role in the evaluation of patients with pancreatic pathologies, from screening of patients at high risk for pancreatic cancer to the evaluation of pancreatic cysts and indeterminate pancreatic lesions. The high mortality associated with pancreatic adenocarcinomas has spurred much interest in developing effective screening tools, with MRI using magnetic resonance cholangiopancreatography (MRCP) playing a central role in the hopes of identifying cancers at earlier stages amenable to curative resection. Ongoing efforts to improve the resolution and robustness of imaging of the pancreas using MRI may thus one day reduce the mortality of this deadly disease. However, the increasing use of cross-sectional imaging has also generated a concomitant clinical conundrum: How to manage incidental pancreatic cystic lesions that are found in over a quarter of patients who undergo MRCP. Efforts to improve the specificity of MRCP for patients with pancreatic cysts and with indeterminate pancreatic masses may be achieved with continued technical advances in MRI, including diffusion-weighted and T1 -weighted dynamic contrast-enhanced MRI. However, developments in quantitative MRI of the pancreas remain challenging, due to the small size of the pancreas and its upper abdominal location, adjacent to bowel and below the diaphragm. Further research is needed to improve MRI of the pancreas as a clinical tool, to positively affect the lives of patients with pancreatic abnormalities. This review focuses on various MR techniques such as MRCP, quantitative imaging, and dynamic contrast-enhanced imaging and their clinical applicability in the imaging of the pancreas, with an emphasis on pancreatic malignant and premalignant lesions. Level of Evidence 5 Technical Efficacy Stage 3 J. MAGN. RESON. IMAGING 2021;53:347-359.
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Affiliation(s)
- Kate A Harrington
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amita Shukla-Dave
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ramesh Paudyal
- Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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29
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Iglesias-Garcia J, de la Iglesia-Garcia D, Olmos-Martinez JM, Lariño-Noia J, Dominguez-Muñoz JE. Differential diagnosis of solid pancreatic masses. MINERVA GASTROENTERO 2020; 66:70-81. [PMID: 31994370 DOI: 10.23736/s1121-421x.20.02646-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Solid pancreatic lesions include mainly adenocarcinoma, neuroendocrine tumors pancreatic cystic neoplasms with solid component, solid pseudopapillary tumor, pancreatoblastoma, pancreatic lymphoma, and pancreatic metastasis. The most frequent pancreatic lesion is the adenocarcinoma, representing between 70% and 95% of all solid pancreatic neoplasm. The diagnosis of these lesions can be a challenge and currently, there are different imaging techniques such as CT scan, EUS and MRI with high sensitivity and specificity. The most widely used technique for the initial evaluation is the CT scan with a sensitivity between 76% and 92% for the diagnosis of pancreatic cancer. The EUS has a sensitivity for the detection of pancreatic lesions of around 98% and is accepted to be the most sensitive technique for the detection of small pancreatic tumors (<2 cm). The MRI, with a very high soft-tissue contrast resolution, provides an accuracy in the detection and staging of adenocarcinoma of 90-100%. A multimodality approach is usually necessary in patients with clinical suspicion of pancreatic lesion. The EUS is required for the local evaluation of the relation of the lesion with vessels and for tissue acquisition and the CT scan and/or MRI is usually required for the local and distance staging in case of pancreatic cancer. The purpose of this review is to provide an overview of solid pancreatic lesions and the role of the different imaging techniques in their evaluation.
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Affiliation(s)
- Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain -
| | - Daniel de la Iglesia-Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José M Olmos-Martinez
- Department of Gastroenterology and Hepatology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Lariño-Noia
- Department of Gastroenterology and Hepatology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Enrique Dominguez-Muñoz
- Department of Gastroenterology and Hepatology, Health Research Institute (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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30
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Wolske KM, Ponnatapura J, Kolokythas O, Burke LMB, Tappouni R, Lalwani N. Chronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach. Radiographics 2019; 39:1965-1982. [PMID: 31584860 DOI: 10.1148/rg.2019190011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Certain inflammatory pancreatic abnormalities may mimic pancreatic ductal adenocarcinoma at imaging, which precludes accurate preoperative diagnosis and may lead to unnecessary surgery. Inflammatory conditions that may appear masslike include mass-forming chronic pancreatitis, focal autoimmune pancreatitis, and paraduodenal pancreatitis or "groove pancreatitis." In addition, obstructive chronic pancreatitis can mimic an obstructing ampullary mass or main duct intraductal papillary mucinous neoplasm. Secondary imaging features such as the duct-penetrating sign, biliary or main pancreatic duct skip strictures, a capsulelike rim, the pancreatic duct-to-parenchyma ratio, displaced calcifications in patients with chronic calcific pancreatitis, the "double duct" sign, and vessel encasement or displacement can help to suggest the possibility of an inflammatory mass or a neoplastic process. An awareness of the secondary signs that favor a diagnosis of malignant or inflammatory lesions in the pancreas can help the radiologist to perform the differential diagnosis and determine the degree of suspicion for malignancy. Repeat biopsy or surgical resection may be necessary to achieve an accurate diagnosis and prevent unnecessary surgery for inflammatory conditions. Online supplemental material and DICOM image stacks are available for this article. ©RSNA, 2019.
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Affiliation(s)
- Kristy Marie Wolske
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Janardhana Ponnatapura
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Orpheus Kolokythas
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Lauren M B Burke
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Rafel Tappouni
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
| | - Neeraj Lalwani
- From the Departments of Radiology of Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston-Salem, NC 27157 (K.M.W., J.P., R.T., N.L.); University of Washington, Seattle, Wash (O.K.); and University of North Carolina at Chapel Hill, Chapel Hill, NC (L.M.B.B.)
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18F-FDG PET/MR in an Atypical Pediatric Solid Pseudopapillary Pancreatic Tumor. Clin Nucl Med 2019; 44:e522-e523. [PMID: 31274565 DOI: 10.1097/rlu.0000000000002671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
MR and F-FDG PET/MR images of a 15-year-old boy with recurrent mild abdominal pain and hyperamylasemia demonstrating a pancreatic head lesion hypointense on the T1-weighted and slightly hyperintense on the T2-weighted images, with very small pseudocystic areas, restricted diffusion on the apparent diffusion coefficient map, and focal FDG uptake. No other pathologic findings such as enlarged lymph nodes, vascular invasion, metastases, dilatation of the main pancreatic duct, or pathologic uptake of the parotid glands were detected. The MR features, even if atypical, together with the focal uptake, allowed the diagnosis of pediatric solid pseudopapillary pancreatic tumor, which was then confirmed by histology.
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Chouhan MD, Firmin L, Read S, Amin Z, Taylor SA. Quantitative pancreatic MRI: a pathology-based review. Br J Radiol 2019; 92:20180941. [PMID: 30982337 DOI: 10.1259/bjr.20180941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
MRI plays an important role in the clinical management of pancreatic disorders and interpretation is reliant on qualitative assessment of anatomy. Conventional sequences capturing pancreatic structure can however be adapted to yield quantitative measures which provide more diagnostic information, with a view to increasing diagnostic accuracy, improving patient stratification, providing robust non-invasive outcome measures for therapeutic trials and ultimately personalizing patient care. In this review, we evaluate the use of established techniques such as secretin-enhanced MR cholangiopancreatography, diffusion-weighted imaging, T 1, T 2* and fat fraction mapping, but also more experimental methods such as MR elastography and arterial spin labelling, and their application to the assessment of diffuse pancreatic disease (including chronic, acute and autoimmune pancreatitis/IgG4 disease, metabolic disease and iron deposition disorders) and cystic/solid focal pancreatic masses. Finally, we explore some of the broader challenges to their implementation and future directions in this promising area.
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Affiliation(s)
- Manil D Chouhan
- 1 University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL , London , UK.,2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Louisa Firmin
- 2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Samantha Read
- 2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Zahir Amin
- 2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
| | - Stuart A Taylor
- 1 University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL , London , UK.,2 Department of Imaging, University College London Hospitals (UCLH) NHS Foundation Trust , London , UK
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Ding X, Xu H, Zhou J, Xu J, Mei H, Long Q, Wang Y. Reproducibility of normalized apparent diffusion coefficient measurements on 3.0-T diffusion-weighted imaging of normal pancreas in a healthy population. Medicine (Baltimore) 2019; 98:e15104. [PMID: 30946375 PMCID: PMC6456113 DOI: 10.1097/md.0000000000015104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To prospectively compare the reproducibility of normal pancreas-normalized apparent diffusion coefficient (ADC) measurements for the normal pancreas and mean normalized ADCs at different pancreas anatomic locations.In total, 22 healthy volunteers underwent pancreatic 3.0-T magnetic resonance (MR) imaging, including axial diffusion-weighted (DW) imaging with 3 b values used (0, 400, and 800 s/mm) and with the respiratory-triggered (RT) technique. The mean ADCs from 3 regions of interest (ROIs) in 5 anatomic locations (head [H], body [B], and tail [T] of pancreas and spleen [S] and erector spinae muscles [M]) were calculated. The pancreas-normalized ADC was defined as the ratio of the ADC for the pancreas to the ADC for the spleen or erector spinae muscle. Reproducibility of ADCs and normalized ADCs was assessed by the Bland-Altman method. The ADC and normalized ADC data were analyzed by repeated-measures ANOVA.Mean ADC and normalized ADC values did not differ (P >.05) with repeated measurements at the different pancreas anatomic locations. Reproducibility of pancreas-normalized ADC measurements in each of the 3 pancreatic anatomic locations was better with the erector spinae muscle rather than the spleen used as a reference. Mean ADC and normalized ADC values significantly differed between the 3 pancreatic segments (H: 1.36 × 10 mm/s, B: 1.38 × 10 mm/s, T: 1.25 × 10 mm/s, P = .022; H/S: 1.75, B/S: 1.78, T/S: 1.59, P = .009; H/M: 0.91, B/M: 0.95, T/M: 0.85, P = .008). Mean ADC values and normalized ADC values showed a trend to decrease from the pancreatic head to tail.Our preliminary results suggest that normalized ADC measurements for the pancreas show good intra- and interobserver reproducibility, the erector spinae muscle is a better choice than the spleen for calculating normalized ADC values for the pancreas, and the normalized ADC values are lower for the pancreatic tail than other pancreatic segments.
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Diagnostic and therapeutic recommendations in pancreatic ductal adenocarcinoma. Recommendations of the Working Group of the Polish Pancreatic Club. GASTROENTEROLOGY REVIEW 2019; 14:1-18. [PMID: 30944673 PMCID: PMC6444110 DOI: 10.5114/pg.2019.83422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/15/2019] [Indexed: 02/07/2023]
Abstract
These recommendations refer to the current management in pancreatic ductal adenocarcinoma (PDAC), a neoplasia characterised by an aggressive course and extremely poor prognosis. The recommendations regard diagnosis, surgical, adjuvant and palliative treatment, with consideration given to endoscopic and surgical methods. A vast majority of the statements are based on data obtained in clinical studies and experts' recommendations on PDAC management, including the following guidelines: International Association of Pancreatology/European Pancreatic Club (IAP/EPC), American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), National Comprehensive Cancer Network (NCCN) and Polish Society of Gastroenterology (PSG) and The National Institute for Health and Care Excellence (NICE). All recommendations were voted on by members of the Working Group of the Polish Pancreatic Club. Results of the voting and brief comments are provided with each recommendation.
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Siddiqui N, Vendrami CL, Chatterjee A, Miller FH. Advanced MR Imaging Techniques for Pancreas Imaging. Magn Reson Imaging Clin N Am 2019; 26:323-344. [PMID: 30376973 DOI: 10.1016/j.mric.2018.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Advances in MR imaging with optimization of hardware, software, and techniques have allowed for an increased role of MR in the identification and characterization of pancreatic disorders. Diffusion-weighted imaging improves the detection and staging of pancreatic neoplasms and aides in the evaluation of acute, chronic and autoimmune pancreatitis. The use of secretin-enhanced MR cholangiography improves the detection of morphologic ductal anomalies, and assists in the characterization of pancreatic cystic lesions and evaluation of acute and chronic pancreatitis. Emerging MR techniques such as MR perfusion, T1 mapping/relaxometry, and MR elastography show promise in further evaluating pancreatic diseases.
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Affiliation(s)
- Nasir Siddiqui
- Department of Radiology, DuPage Medical Group, 430 Warrenville Road, Lisle, IL 60532, USA
| | - Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street Suite 800, Chicago, IL 60611, USA
| | - Argha Chatterjee
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street Suite 800, Chicago, IL 60611, USA.
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Textural analysis on contrast-enhanced CT in pancreatic neuroendocrine neoplasms: association with WHO grade. Abdom Radiol (NY) 2019; 44:576-585. [PMID: 30182253 DOI: 10.1007/s00261-018-1763-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Grades of pancreatic neuroendocrine neoplasms (PNENs) are associated with the choice of treatment strategies. Texture analysis has been used in tumor diagnosis and staging evaluation. In this study, we aim to evaluate the potential ability of texture parameters in differentiation of PNENs grades. MATERIALS AND METHODS 37 patients with histologically proven PNENs and underwent pretreatment dynamic contrast-enhanced computed tomography examinations were retrospectively analyzed. Imaging features and texture features at contrast-enhanced images were evaluated. Receiver operating characteristic curves were used to determine the cut-off values and the sensitivity and specificity of prediction. RESULTS There were significant differences in tumor margin, pancreatic duct dilatation, lymph nodes invasion, size, portal enhancement ratio (PER), arterial enhancement ratio (AER), mean grey-level intensity, kurtosis, entropy, and uniformity among G1, G2, and pancreatic neuroendocrine carcinoma (PNEC) G3 (p < 0.01). Similar results were found between pancreatic neuroendocrine tumors (PNETs) G1/G2 and PNEC G3. AER and PER showed the best sensitivity (0.86-0.94) and specificity (0.92-1.0) for differentiating PNEC G3 from PNETs G1/G2. Mean grey-level intensity, entropy, and uniformity also showed acceptable sensitivity (0.73-0.91) and specificity (0.85-1.0). Mean grey-level intensity was also showed acceptable sensitivity (91% to 100%) and specificity (82% to 91%) in differentiating PNET G1 from PNET G2. CONCLUSIONS Our data indicated that texture parameters have potential in grading PNENs, in particular in differentiating PNEC G3 from PNETs G1/G2.
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Abstract
RATIONALE Adenocarcinoma and neuroendocrine tumors are a very rare combination of double primary pancreas tumor. PATIENT CONCERNS A Whipple operation was initially performed on a 64-year-old man to remove an adenocarcinoma. Four years after the operation, surveillance- computed tomography revealed abnormal findings of the pancreas. Recurrent adenocarcinoma and neuroendocrine tumor involving different sites of the remnant pancreas were simultaneously detected and characterized on computed tomography and magnetic resonance imaging. DIAGNOSES The patient was diagnosed with recurrent adenocarcinoma and neuroendocrine tumor in the post-operative pancreas. INTERVENTIONS Radical pancreatosplenectomy was performed. The patient underwent subsequent chemotherapy and radiotherapy. OUTCOMES No tumor recurrence was found during the 5 years of follow-up visits. LESSONS The possibility of multiple primary tumors of different histological origin should be considered when multiple different pancreatic lesions are detected on images. Computed tomography (CT) and magnetic resonance imaging (MRI) play key roles in the management of multiple tumors in the pancreas.
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Affiliation(s)
- Hee Jeong Kim
- Department of Radiology, Dankook University Hospital, Chungnam, Cheonan-si
| | - Mi-hyun Park
- Department of Radiology, Dankook University Hospital, Chungnam, Cheonan-si
| | - Byungseok Shin
- Department of Radiology, Chungnam National University College of Medicine, Daejeon, South Korea
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Can diffusion-weighted MRI replace conventional contrast enhanced MRI in the differentiation between benign and malignant pancreatic masses? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
AIM The aim of this retrospective multicentre study was to evaluate the clinical and prognostic effect of fluorine-18-fluorodeoxyglucose (F-FDG)-PET/computed tomography (CT) in the restaging process of pancreatic cancer (PC). MATERIALS AND METHODS Data from patients treated for primary PC, who underwent F-FDG-PET/CT for suspicious of disease progression, were collected. Accuracy was assessed employing conventional diagnostic procedures, multidisciplinary team case notes, further F-FDG-PET/CT scans and/or follow-up. Receiver operating characteristic curve and likelihood ratio (LR+/-) analyses were used for completion of accuracy definition. Progression-free survival (PFS) and overall survival were assessed by using Kaplan-Meier method. The Cox proportional hazards model was used to identify predictors of outcome. RESULTS Fifty-two patients (33 males and 19 females, with mean age of 59 years and range: 42-78 years) with PC were finally included in our study. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-FDG-PET were 85, 84, 90, 76, and 84%, respectively. Area under the curve was 0.84 (95% confidence intervals: 0.72-0.96; P<0.05). LR+ and LR- were 5.3 and 0.17, respectively. F-FDG-PET/CT revealed new metastatic foci in 5/52 patients (10%) and excluded suspicious lesions in 11/52 (21%). Analysis of PFS revealed F-FDG-PET/CT positivity to be associated with a worse cumulative survival rate over a 6 and 12-month period in comparison with F-FDG-PET/CT negativity (6-month PFS 95 vs. 67%, P<0.05; 12-month PFS 81 vs. 29%, P<0.05). A negative F-FDG-PET/CT result was associated with a significantly longer overall survival than a positive one (70 vs. 26% after 2 years, P<0.05). In addition, a positive F-FDG-PET/CT scan result and an maximum standardized uptake value (SUVmax) value more than 6 were significantly associated with an increased risk of disease progression (PET positivity hazard ratio=3.9, P=0.01; SUVmax>6 h=4.2, P=0.02) and death (PET positivity hazard ratio=3.5, P=0.02; SUVmax>6 h=3.7, P=0.01). CONCLUSION F-FDG-PET/CT showed high diagnostic accuracy for restaging process of PC, proving also its potential value in predicting clinical outcome after primary treatment.
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40
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Jiang L, Tang Q, Panje CM, Nie H, Zhao G, Shi H. Assessment of pancreatic colloid carcinoma using 18F-FDG PET/CT compared with MRI and enhanced CT. Oncol Lett 2018; 16:1557-1564. [PMID: 30008837 PMCID: PMC6036464 DOI: 10.3892/ol.2018.8859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/22/2018] [Indexed: 11/06/2022] Open
Abstract
Pancreatic colloid carcinoma (CC) is a rare sub-type of pancreatic adenocarcinoma which has an improved prognosis compared with pancreatic ductal carcinoma. Consequently, the early detection of CC by imaging may be of great significance in guiding patient management and therapeutic decisions. The present study aimed to analyze 18F-FDG PET/CT findings of CC in comparison to MRI and CT. PET/CT findings in 5 patients with CC were retrospectively reviewed based on visual interpretation and semi-quantitative index of SUVmax and TNR. Four patients received dual-time-point PET/CT scans. Additionally, one patient underwent contrast-enhanced CT scan, one MRI, and three received both. A total of five lesions were detected in five patients. Visually, two cases presented with mild FDG uptake, two with moderate and one with high. The mean of SUVmax and TNR was 5.1±2.2 and 2.8±0.7, respectively. Compared with CCs with low SUVmax, CCs with high SUVmax were more aggressive. No distant metastases were observed in five cases. Among four patients with dual-time-point PET/CT imaging, SUVmax increased in three cases and decreased in one case. The mean early and delayed SUVmax were 4.2±1.1 and 4.7±1.9, respectively (P>0.05). Radiological findings mainly included septated cystic components, internal sponge-like contrast-enhancement, calcification and 'salt-and-pepper sign' on MRI T2-weighted imaging. Thus, PET/CT provided additional information on metabolic tumor activity as well as locoregional and distant staging, which are important prognostic markers and may improve further patient management. However, PET/CT did not show any findings in addition to MRI and contrast-enhanced CT that were unique to CC and allowed a clear differentiation from other pancreatic malignancies.
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Affiliation(s)
- Lei Jiang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.,Nuclear Medicine Institute of Fudan University, Shanghai 200032, P.R. China.,Shanghai Institute of Medical Imaging, Shanghai 200032, P.R. China
| | - Qiying Tang
- Nuclear Medicine Institute of Fudan University, Shanghai 200032, P.R. China.,Shanghai Institute of Medical Imaging, Shanghai 200032, P.R. China.,Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Cedric M Panje
- St Gallen Cantonal Hospital, St Gallen, CH-9000 Switzerland
| | - Hongting Nie
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Guochao Zhao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China.,Nuclear Medicine Institute of Fudan University, Shanghai 200032, P.R. China.,Shanghai Institute of Medical Imaging, Shanghai 200032, P.R. China
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Raber I, Isom RT, Louie JD, Vasanawala S, Bhalla V. A Novel High-Resolution Magnetic Resonance Imaging Protocol Detects Aldosterone-Producing Adenomas in Patients With Negative Computed Tomography. Am J Hypertens 2018; 31:928-932. [PMID: 29648568 DOI: 10.1093/ajh/hpy054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/07/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Inbar Raber
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Robert Tristan Isom
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - John D Louie
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Shreyas Vasanawala
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Vivek Bhalla
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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42
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Diffusion-weighted imaging in hemorrhagic abdominal and pelvic lesions: restricted diffusion can mimic malignancy. Abdom Radiol (NY) 2018; 43:1772-1784. [PMID: 29110051 DOI: 10.1007/s00261-017-1366-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diffusion-weighted imaging (DWI) is an increasingly utilized sequence in the assessment of abdominal and pelvic lesions. Benign lesions containing hemorrhagic products, with conglomerates of tightly packed blood cells or fibers, can have restricted water diffusion on DWI and apparent diffusion coefficient maps. Such lesions can have restricted diffusion erroneously attributed to malignancy. This review illustrates benign hemorrhagic lesions displaying restricted diffusion, with histopathologic correlation in relevant cases.
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43
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Shi Z, Li X, You R, Li Y, Zheng X, Ramen K, Loosa VS, Cao D, Chen Q. Homogenously isoattenuating insulinoma on biphasic contrast-enhanced computed tomography: Little benefits of diffusion-weighted imaging for lesion detection. Oncol Lett 2018; 16:3117-3125. [PMID: 30127903 PMCID: PMC6096136 DOI: 10.3892/ol.2018.9037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/30/2018] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to evaluate the diagnostic benefit of diffusion-weighted imaging (DWI) in the detection of homogenous isoattenuating insulinoma on biphasic contrast-enhanced computed tomography (CT) preoperatively and to determine which magnetic resonance (MR) sequences exhibited the best diagnostic performance. A total of 44 consecutive patients who underwent biphasic contrast-enhanced CT and conventional MR imaging (MRI), including DWI on a 3T scanner, were identified retrospectively. Apparent diffusion coefficient (ADC) values of insulinomas and the surrounding pancreatic parenchyma were compared using a Wilcoxon signed-rank test. Receiver operating characteristic analysis was used to compare the diagnostic accuracy of four randomized image sets [T2-weighted image (WI), axial T1WI, DWI and T2WI + DWI] for each reader. Axial T1-weighted MRI exhibited the highest relative sensitivity for each reader; DWI alone exhibited the lowest relative sensitivity and the lower inter-reader agreement. There was no significant difference in lesion detection between T2WI and T2WI + DWI image sets for each reader. The ADC values of the insulinoma were significantly lower compared with those of the surrounding parenchyma. In conclusion, DWI does not benefit the detection of homogenous isoattenuating insulinoma. Axial T1WI is the optimal pulse sequence. Quantitative assessment of the tumor ADC values may be a useful tool to characterize identified pancreatic neoplasms.
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Affiliation(s)
- Zhenshan Shi
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Xiumei Li
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Ruixiong You
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Yueming Li
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Xianying Zheng
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Kamisha Ramen
- Department of Radiology, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Vikash Sahadeo Loosa
- Department of Radiology, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
| | - Qunlin Chen
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China
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Llop E, Guerrero PE, Duran A, Barrabés S, Massaguer A, Ferri MJ, Albiol-Quer M, de Llorens R, Peracaula R. Glycoprotein biomarkers for the detection of pancreatic ductal adenocarcinoma. World J Gastroenterol 2018; 24:2537-2554. [PMID: 29962812 PMCID: PMC6021768 DOI: 10.3748/wjg.v24.i24.2537] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/04/2018] [Accepted: 06/09/2018] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer (PaC) shows a clear tendency to increase in the next years and therefore represents an important health and social challenge. Currently, there is an important need to find biomarkers for PaC early detection because the existing ones are not useful for that purpose. Recent studies have indicated that there is a large window of time for PaC early detection, which opens the possibility to find early biomarkers that could greatly improve the dismal prognosis of this tumor. The present manuscript reviews the state of the art of the existing PaC biomarkers. It focuses on the anomalous glycosylation process and its role in PaC. Glycan structures of glycoconjugates such as glycoproteins are modified in tumors and these modifications can be detected in biological fluids of the cancer patients. Several studies have found serum glycoproteins with altered glycan chains in PaC patients, but they have not shown enough specificity for PaC. To find more specific cancer glycoproteins we propose to analyze the glycan moieties of a battery of glycoproteins that have been reported to increase in PaC tissues and that can also be found in serum. The combination of these new candidate glycoproteins with their aberrant glycosylation together with the existing biomarkers could result in a panel, which would expect to give better results as a new tool for early diagnosis of PaC and to monitor the disease.
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Affiliation(s)
- Esther Llop
- Department of Biology, Biochemistry and Molecular Biology Unit, University of Girona, Girona 17003, Spain
- Biomedical Research Institute of Girona (IdIBGi). Parc Hospitalari Martí i Julià-Edifici M2, Salt 17190, Spain
| | - Pedro E Guerrero
- Department of Biology, Biochemistry and Molecular Biology Unit, University of Girona, Girona 17003, Spain
- Biomedical Research Institute of Girona (IdIBGi). Parc Hospitalari Martí i Julià-Edifici M2, Salt 17190, Spain
| | - Adrià Duran
- Department of Biology, Biochemistry and Molecular Biology Unit, University of Girona, Girona 17003, Spain
- Biomedical Research Institute of Girona (IdIBGi). Parc Hospitalari Martí i Julià-Edifici M2, Salt 17190, Spain
| | - Sílvia Barrabés
- Department of Biology, Biochemistry and Molecular Biology Unit, University of Girona, Girona 17003, Spain
- Biomedical Research Institute of Girona (IdIBGi). Parc Hospitalari Martí i Julià-Edifici M2, Salt 17190, Spain
| | - Anna Massaguer
- Department of Biology, Biochemistry and Molecular Biology Unit, University of Girona, Girona 17003, Spain
- Biomedical Research Institute of Girona (IdIBGi). Parc Hospitalari Martí i Julià-Edifici M2, Salt 17190, Spain
| | - María José Ferri
- Department of Biology, Biochemistry and Molecular Biology Unit, University of Girona, Girona 17003, Spain
- Biomedical Research Institute of Girona (IdIBGi). Parc Hospitalari Martí i Julià-Edifici M2, Salt 17190, Spain
- Clinic Laboratory, University Hospital Dr Josep Trueta, Girona 17007, Spain
| | - Maite Albiol-Quer
- Department of Surgery, Hepato-biliary and Pancreatic Surgery Unit, University Hospital Dr Josep Trueta, Girona 17007, Spain
| | - Rafael de Llorens
- Department of Biology, Biochemistry and Molecular Biology Unit, University of Girona, Girona 17003, Spain
- Biomedical Research Institute of Girona (IdIBGi). Parc Hospitalari Martí i Julià-Edifici M2, Salt 17190, Spain
| | - Rosa Peracaula
- Department of Biology, Biochemistry and Molecular Biology Unit, University of Girona, Girona 17003, Spain
- Biomedical Research Institute of Girona (IdIBGi). Parc Hospitalari Martí i Julià-Edifici M2, Salt 17190, Spain
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Kikuyama M, Kamisawa T, Kuruma S, Chiba K, Kawaguchi S, Terada S, Satoh T. Early Diagnosis to Improve the Poor Prognosis of Pancreatic Cancer. Cancers (Basel) 2018; 10:cancers10020048. [PMID: 29439461 PMCID: PMC5836080 DOI: 10.3390/cancers10020048] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 12/12/2022] Open
Abstract
Pancreatic cancer (PC) has a poor prognosis due to delayed diagnosis. Early diagnosis is the most important factor for improving prognosis. For early diagnosis of PC, patients with clinical manifestations suggestive of PC and high risk for developing PC need to be selected for examinations for PC. Signs suggestive of PC (e.g., symptoms, diabetes mellitus, acute pancreatitis, or abnormal results of blood examinations) should not be missed, and the details of risks for PC (e.g., familial history of PC, intraductal mucin producing neoplasm, chronic pancreatitis, hereditary pancreatitis, or life habit) should be understood. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) can be performed for diagnosing PC, but the diagnostic ability of these examinations for PC is limited. Endoscopic diagnostic procedures, such as endoscopic ultrasonography, including fine-needle aspiration, and endoscopic retrograde pancreatocholangiography, including Serial Pancreatic-juice Aspiration Cytologic Examination (SPACE), could be recommended for a detailed examination to diagnose pancreatic carcinoma earlier.
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Affiliation(s)
- Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
| | - Sawako Kuruma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
| | - Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan.
| | - Shuzo Terada
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan.
| | - Tatsunori Satoh
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan.
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46
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Jee KN. Mass forming chronic pancreatitis mimicking pancreatic cystic neoplasm: A case report. World J Gastroenterol 2018; 24:297-302. [PMID: 29375215 PMCID: PMC5768948 DOI: 10.3748/wjg.v24.i2.297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/15/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023] Open
Abstract
Mass forming chronic pancreatitis is very rare. Diagnosis could be done by the pathologic findings of focal inflammatory fibrosis without evidence of tumor in pancreas. A 34-year-old man presented with right upper abdominal pain for a few weeks and slightly elevated bilirubin level on clinical findings. Radiological findings of multidetector-row computed tomography, magnetic resonance (MR) imaging with MR cholangiopancreatography and endoscopic ultrasonography revealed focal branch pancreatic duct dilatation with surrounding delayed enhancing solid component at uncinate process and head of pancreas, suggesting branch duct type intraductal papillary mucinous neoplasm. Surgery was done and pathology revealed the focal chronic inflammation, fibrosis, and branch duct dilatation. Herein, I would like to report the first case report of mass forming chronic pancreatitis mimicking pancreatic cystic neoplasm.
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MESH Headings
- Adult
- Biopsy
- Cholangiopancreatography, Magnetic Resonance
- Diagnosis, Differential
- Endosonography
- Humans
- Male
- Multidetector Computed Tomography
- Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Pancreatic Neoplasms/diagnostic imaging
- Pancreatic Neoplasms/pathology
- Pancreaticoduodenectomy
- Pancreatitis, Alcoholic/diagnostic imaging
- Pancreatitis, Alcoholic/pathology
- Pancreatitis, Alcoholic/surgery
- Pancreatitis, Chronic/diagnostic imaging
- Pancreatitis, Chronic/pathology
- Pancreatitis, Chronic/surgery
- Predictive Value of Tests
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Affiliation(s)
- Keum Nahn Jee
- Department of Radiology, Dankook University Hospital, Chungcheongnam-do 330-715, South Korea
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47
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MRI in cystic pancreatic lesions, is it of value? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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48
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Kim M, Mi Jang K, Kim SH, Doo Song K, Jeong WK, Kang TW, Kim YK, Cha DI, Kim K, Yoo H. Diagnostic accuracy of diffusion restriction in intraductal papillary mucinous neoplasm of the pancreas in comparison with "high-risk stigmata" of the 2012 international consensus guidelines for prediction of the malignancy and invasiveness. Acta Radiol 2017; 58:1157-1166. [PMID: 28084815 DOI: 10.1177/0284185116685921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background It is debated whether diagnostic performance of diffusion-weighted imaging (DWI), which is widely used for detection and characterization of various malignant tumors, is comparable with high-risk stigmata of 2012 international consensus guidelines (ICG) for diagnosis of intraductal papillary mucinous neoplasms (IPMNs). Purpose To evaluate the diagnostic accuracy of diffusion restriction in IPMNs for prediction of malignancy and invasiveness in comparison with high-risk stigmata of 2012 ICG. Material and Methods This retrospective study was institutional review board approved and informed consent was waived. A total of 132 patients with surgically proven IPMNs (49 malignant, 83 benign) who underwent gadoxetic acid-enhanced magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and DWI with a b-value of 0, 100, and 800 s/mm2 using a 3.0 T MR system were included. Two radiologists independently evaluated imaging parameters of high-risk stigmata and worrisome features of 2012 ICG and diffusion restriction in IPMNs. Univariate and multivariate logistic regression analyses and McNemar's test were used for statistical analysis. Results The presence of diffusion restriction in IPMNs was the only independent imaging parameter for prediction of malignancy (odds ratio [OR], 11.98; 95% confidence interval [CI], 3.60-39.87; P < 0.001) and invasiveness (OR, 17.92; 95% CI, 3.91-82.03; P < 0.001) on multivariate analysis. The diagnostic accuracy and specificity of diffusion restriction were significantly improved compared to high-risk stigmata of 2012 ICG to prediction of malignant ( P = 0.006 and P < 0.001, respectively) or invasive IPMNs ( P = 0.009 and P = 0.015, respectively). Conclusion The diffusion restriction in IPMNs could be considered as another high-risk stigma of malignancy and predictor for invasiveness.
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Affiliation(s)
- Mimi Kim
- 1 Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea
| | - Kyung Mi Jang
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Hyun Kim
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung Doo Song
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Kyoung Jeong
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Wook Kang
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kon Kim
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Ik Cha
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- 3 Biostatics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Heejin Yoo
- 3 Biostatics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
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Tomizawa M, Shinozaki F, Uchida Y, Uchiyama K, Tanaka S, Sunaoshi T, Kano D, Sugiyama E, Shite M, Haga R, Fukamizu Y, Fujita T, Kagayama S, Hasegawa R, Shirai Y, Motoyoshi Y, Sugiyama T, Yamamoto S, Ishige N. Comparison of DWIBS/T2 image fusion and PET/CT for the diagnosis of cancer in the abdominal cavity. Exp Ther Med 2017; 14:3754-3760. [PMID: 29042975 DOI: 10.3892/etm.2017.4987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 02/01/2017] [Indexed: 12/15/2022] Open
Abstract
Fusion images of diffusion-weighted whole-body imaging with background body signal suppression and T2-weighted image (DWIBS/T2) demonstrate a strong signal for malignancies, with a high contrast against the surrounding tissues, and enable anatomical analysis. In the present study, DWIBS/T2 was compared with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for diagnosing cancer in the abdomen. Patient records, including imaging results of examination conducted between November 2012 and May 2014, were analyzed retrospectively. In total, 10 men (age, 73.6±9.6 years) and 8 women (age, 68.9±7.1 years) were enrolled into the current study. Of the enrolled patients, 2 were diagnosed with hepatocellular carcinoma, 1 with cholangiocellular carcinoma, 1 with liver metastasis, 2 with pancreatic ductal adenocarcinoma, 1 with renal cell carcinoma and 1 with malignant lymphoma. Benign lesions were also analyzed, including adenomyomatosis of the gallbladder (5 patients), intraductal papillary mucinous neoplasm (4 patients) and right adrenal adenoma (1 case). All the patients with cancer showed positive results on DWIBS/T2 images. However, only 7 out of 8 patients were positive with PET/CT. One patient with right renal cellular carcinoma was positive with DWIBS/T2, but negative with PET/CT. All the patients with benign lesions were negative with DWIBS/T2 and PET/CT. In conclusion, DWIBS/T2 was more sensitive in diagnosing cancer of organs in the abdominal cavity compared with PET/CT. Furthermore, negative results with DWIBS/T2 and PET/CT were useful for the diagnosis of benign lesions, such as adenomyomatosis of the gallbladder and intraductal papillary mucinous neoplasm.
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Affiliation(s)
- Minoru Tomizawa
- Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Fuminobu Shinozaki
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yoshitaka Uchida
- Diagnostic PET Imaging Center, Department of Radiology, Sannoh Hospital Medical Center, Chiba 263-0002, Japan
| | - Katsuhiro Uchiyama
- Diagnostic PET Imaging Center, Department of Radiology, Sannoh Hospital Medical Center, Chiba 263-0002, Japan
| | - Satomi Tanaka
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Takafumi Sunaoshi
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Daisuke Kano
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Eriko Sugiyama
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Misaki Shite
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Ryouta Haga
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yoshiya Fukamizu
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Toshiyuki Fujita
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Satoshi Kagayama
- Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Rumiko Hasegawa
- Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yoshinori Shirai
- Department of Surgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yasufumi Motoyoshi
- Department of Neurology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Takao Sugiyama
- Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Shigenori Yamamoto
- Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Naoki Ishige
- Department of Neurosurgery, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan
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50
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Nissan N. Modifications of pancreatic diffusion MRI by tissue characteristics: what are we weighting for? NMR IN BIOMEDICINE 2017; 30:e3728. [PMID: 28470823 DOI: 10.1002/nbm.3728] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/10/2017] [Accepted: 03/13/2017] [Indexed: 06/07/2023]
Abstract
Diffusion-weighted imaging holds the potential to improve the diagnosis and biological characterization of pancreatic disease, and in particular pancreatic cancer, which exhibits decreased values of the apparent diffusion coefficient (ADC). Yet, variable and overlapping ADC values have been reported for the healthy and the pathological pancreas, including for cancer and other benign conditions. This controversy reflects the complexity of probing the water-diffusion process in the pancreas, which is dependent upon multiple biological factors within this organ's unique physiological environment. In recent years, extensive studies have investigated the correlation between tissue properties including cellularity, vascularity, fibrosis, secretion and microstructure and pancreatic diffusivity. Understanding how the various physiological and pathological features and the underlying functional processes affect the diffusion measurement may serve to optimize the method for improved diagnostic gain. Therefore, the aim of the present review article is to elucidate the relationship between pancreatic tissue characteristics and diffusion MRI measurement.
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Affiliation(s)
- Noam Nissan
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel HaShomer 5265601, Israel
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