Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Added Value of Diffusion Weighted Imaging for Detecting Pancreatic Abnormality in Patients with Clinically Suspected Acute Pancreatitis

  • Nam, In Chul (Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Kim, Seung Ho (Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital) ;
  • Kim, Seon-Jeong (Department of Radiology, Myongji Hospital) ;
  • Lim, Yun-jung (Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital)
  • Received : 2016.11.29
  • Accepted : 2016.12.26
  • Published : 2016.12.31
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Abstract

Purpose: To evaluate the added value of diffusion weighted imaging (DWI) to computed tomography (CT) for detecting pancreatic abnormality in patients with clinically suspected acute pancreatitis (AP). Materials and Methods: 203 patients who underwent abdomen CT and subsequent DWI to do a workup for epigastric pain were analyzed. Two blinded radiologists independently performed an interval reading based on CT image sets first, then based on combined CT and DWI image sets. The diagnostic criterion on DWI was the increased signal intensity in the pancreas to that of the spleen. For quantitative analysis, the third radiologist measured ADC value of the pancreas in each patient. Results: For AP (n = 43), the sensitivity for detecting pancreatic abnormality increased, from 42% to 70% for reader 1 (P < 0.05) and from 44% to 72% for reader 2 (P < 0.05). For borderline pancreatitis (n = 42), the sensitivity also increased, from 10% to 26% for reader 1 (P < 0.05) and from 7% to 29% for reader 2 (P < 0.05). The mean ADC values (unit, ${\times}10^{-3}mm^2/s$) were significantly different among the three groups (for AP, $1.09{\pm}0.16$; for borderline pancreatitis, $1.28{\pm}0.2$; for control, $1.46{\pm}0.15$, P < 0.05). Conclusion: Sensitivity for detecting pancreatic abnormality increased significantly after adding DWI to CT in patients with clinically suspected AP.

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References

  1. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013;144:1252-1261 https://doi.org/10.1053/j.gastro.2013.01.068
  2. Kim CD. Current status of acute pancreatitis in Korea. Korean J Gastroenterol 2003;42:1-11
  3. Arvanitakis M, Koustiani G, Gantzarou A, et al. Staging of severity and prognosis of acute pancreatitis by computed tomography and magnetic resonance imaging-a comparative study. Dig Liver Dis 2007;39:473-482 https://doi.org/10.1016/j.dld.2007.01.015
  4. Lankisch PG, Assmus C, Lehnick D, Maisonneuve P, Lowenfels AB. Acute pancreatitis: does gender matter? Dig Dis Sci 2001;46:2470-2474 https://doi.org/10.1023/A:1012332121574
  5. de Beaux AC, Palmer KR, Carter DC. Factors influencing morbidity and mortality in acute pancreatitis; an analysis of 279 cases. Gut 1995;37:121-126 https://doi.org/10.1136/gut.37.1.121
  6. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-111 https://doi.org/10.1136/gutjnl-2012-302779
  7. Hill MC, Barkin J, Isikoff MB, Silverstein W, Kalser M. Acute pancreatitis: clinical vs. CT findings. AJR Am J Roentgenol 1982;139:263-269 https://doi.org/10.2214/ajr.139.2.263
  8. Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT. Radiology 1985;156:767-772 https://doi.org/10.1148/radiology.156.3.4023241
  9. Balthazar EJ, Freeny PC, vanSonnenberg E. Imaging and intervention in acute pancreatitis. Radiology 1994;193:297-306 https://doi.org/10.1148/radiology.193.2.7972730
  10. Viremouneix L, Monneuse O, Gautier G, et al. Prospective evaluation of nonenhanced MR imaging in acute pancreatitis. J Magn Reson Imaging 2007;26:331-338 https://doi.org/10.1002/jmri.21037
  11. Lecesne R, Taourel P, Bret PM, Atri M, Reinhold C. Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome. Radiology 1999;211:727-735 https://doi.org/10.1148/radiology.211.3.r99jn08727
  12. Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 2007;188:1622-1635 https://doi.org/10.2214/AJR.06.1403
  13. Kamisawa T, Takuma K, Anjiki H, et al. Differentiation of autoimmune pancreatitis from pancreatic cancer by diffusion-weighted MRI. Am J Gastroenterol 2010;105:1870-1875 https://doi.org/10.1038/ajg.2010.87
  14. Yencilek E, Telli S, Tekesin K, et al. The efficacy of diffusion weighted imaging for detection of acute pancreatitis and comparison of subgroups according to Balthazar classification. Turk J Gastroenterol 2014;25:553-557 https://doi.org/10.5152/tjg.2014.6416
  15. Hocaoglu E, Aksoy S, Akarsu C, Kones O, Inci E, Alis H. Evaluation of diffusion-weighted MR imaging in the diagnosis of mild acute pancreatitis. Clin Imaging 2015;39:463-467 https://doi.org/10.1016/j.clinimag.2014.10.001
  16. Shinya S, Sasaki T, Nakagawa Y, Guiquing Z, Yamamoto F, Yamashita Y. Acute pancreatitis successfully diagnosed by diffusion-weighted imaging: a case report. World J Gastroenterol 2008;14:5478-5480 https://doi.org/10.3748/wjg.14.5478
  17. Thomas S, Kayhan A, Lakadamyali H, Oto A. Diffusion MRI of acute pancreatitis and comparison with normal individuals using ADC values. Emerg Radiol 2012;19:5-9 https://doi.org/10.1007/s10140-011-0983-2
  18. Yoshikawa T, Kawamitsu H, Mitchell DG, et al. ADC measurement of abdominal organs and lesions using parallel imaging technique. AJR Am J Roentgenol 2006;187:1521-1530 https://doi.org/10.2214/AJR.05.0778
  19. Shinya S, Sasaki T, Nakagawa Y, Guiquing Z, Yamamoto F, Yamashita Y. The efficacy of diffusion-weighted imaging for the detection and evaluation of acute pancreatitis. Hepatogastroenterology 2009;56:1407-1410
  20. Kilickesmez O, Yirik G, Bayramoglu S, Cimilli T, Aydin S. Non-breath-hold high b-value diffusion-weighted MRI with parallel imaging technique: apparent diffusion coefficient determination in normal abdominal organs. Diagn Interv Radiol 2008;14:83-87
  21. Ma J, Xia L, Ma X, Zhu L, Zhang G, Yang Y. Diagnostic value of diffusion weighted imaging in acute pancreatitis. Modern Diagnosis & Treatment 2011;4:193-196
  22. Lee NK, Kim S, Kim GH, et al. Diffusion-weighted imaging of biliopancreatic disorders: correlation with conventional magnetic resonance imaging. World J Gastroenterol 2012;18:4102-4117 https://doi.org/10.3748/wjg.v18.i31.4102
  23. Oto A, Zhu F, Kulkarni K, Karczmar GS, Turner JR, Rubin D. Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn's disease. Acad Radiol 2009;16:597-603 https://doi.org/10.1016/j.acra.2008.11.009
  24. Ream JM, Dillman JR, Adler J, et al. MRI diffusionweighted imaging (DWI) in pediatric small bowel Crohn disease: correlation with MRI findings of active bowel wall inflammation. Pediatr Radiol 2013;43:1077-1085 https://doi.org/10.1007/s00247-013-2712-3
  25. Tsuchiya K, Katase S, Yoshino A, Hachiya J. Diffusionweighted MR imaging of encephalitis. AJR Am J Roentgenol 1999;173:1097-1099 https://doi.org/10.2214/ajr.173.4.10511186
  26. Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 2006;33:323-330 https://doi.org/10.1097/01.mpa.0000236733.31617.52
  27. Bortoff GA, Chen MY, Ott DJ, Wolfman NT, Routh WD. Gallbladder stones: imaging and intervention. Radiographics 2000;20:751-766 https://doi.org/10.1148/radiographics.20.3.g00ma16751

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