Korean Journal of Radiology

  • 제17권4호
  • /
  • Pages.509-521
  • /
  • 2016
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Multidetector CT and Gadobutrol-Enhanced MR Imaging for Evaluation of Small, Solid Pancreatic Lesions

  • Choi, Tae Won (Department of Radiology, Seoul National University Hospital) ;
  • Lee, Jeong Min (Department of Radiology, Seoul National University Hospital) ;
  • Kim, Jung Hoon (Department of Radiology, Seoul National University Hospital) ;
  • Yu, Mi Hye (Department of Radiology, Konkuk University Medical Center) ;
  • Han, Joon Koo (Department of Radiology, Seoul National University Hospital) ;
  • Choi, Byung Ihn (Department of Radiology, Seoul National University Hospital)
  • 투고 : 2015.08.27
  • 심사 : 2016.04.07
  • 발행 : 2016.07.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To compare multidetector computed tomography (MDCT) and MRI for lesion conspicuity, as well as the detection and characterization of small solid pancreatic lesions (SPLs). Materials and Methods: 193 patients with small SPLs (< 3 cm) and 52 patients with normal pancreas who underwent both multiphasic MDCT and gadobutrol-enhanced MRI were included in our study. Two radiologists blinded to the pathologic diagnoses independently reviewed those images, and determined the detection of "SPL per se" and "SPL in consideration of secondary features", the lesion conspicuity, the probability of pancreatic ductal adenocarcinoma (PDAC), and the most likely specific diagnosis. Results: The sensitivity of MRI for "detection of SPL per se" was significantly higher than that of CT in both reviewers: 92.7% (179/193) and 97.9% (189/193), respectively, for reviewer 1 (p = 0.031) and 90.7% (175/193) and 99.5% (192/193), respectively, for reviewer 2 (p < 0.001). In addition, MRI provided better lesion conspicuity than MDCT for both reviewers (p < 0.001). However, CT and MRI did not show significant difference in sensitivity for "detection of SPL in consideration of secondary features", specificity for SPL detection, and differentiation of PDAC vs. non-PDAC (p > 0.05). The accuracies of CT and MRI for making a specific diagnosis were as follows: 85.7% (210/245) vs. 86.9% (213/245), respectively, for reviewer 1 (p = 0.736), and 91.8% (225/245) vs. 93.5% (229/245), respectively, for reviewer 2 (p = 0.454). Conclusion: MRI showed better lesion conspicuity than MDCT, but did not show significantly different diagnostic performance compared with MDCT for detecting and characterizing small SPLs.

키워드

참고문헌

  1. Low G, Panu A, Millo N, Leen E. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics 2011;31:993-1015 https://doi.org/10.1148/rg.314105731
  2. Saif MW. Pancreatic neoplasm in 2011: an update. JOP 2011;12:316-321
  3. Tamm EP, Balachandran A, Bhosale PR, Katz MH, Fleming JB, Lee JH, et al. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin North Am 2012;50:407-428 https://doi.org/10.1016/j.rcl.2012.03.008
  4. Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology 2014;270:248-260 https://doi.org/10.1148/radiol.13131184
  5. Conlon KC, Klimstra DS, Brennan MF. Long-term survival after curative resection for pancreatic ductal adenocarcinoma. Clinicopathologic analysis of 5-year survivors. Ann Surg 1996;223:273-279 https://doi.org/10.1097/00000658-199603000-00007
  6. Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 2006;13:1035-1046 https://doi.org/10.1245/ASO.2006.08.011
  7. Kim JH, Lee JM, Park JH, Kim SC, Joo I, Han JK, et al. Solid pancreatic lesions: characterization by using timing bolus dynamic contrast-enhanced MR imaging assessment--a preliminary study. Radiology 2013;266:185-196 https://doi.org/10.1148/radiol.12120111
  8. Paspulati RM. Multidetector CT of the pancreas. Radiol Clin North Am 2005;43:999-1020, viii https://doi.org/10.1016/j.rcl.2005.07.001
  9. Tempero MA, Arnoletti JP, Behrman SW, Ben-Josef E, Benson AB 3rd, Casper ES, et al. Pancreatic Adenocarcinoma, version 2.2012: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw 2012;10:703-713 https://doi.org/10.6004/jnccn.2012.0073
  10. Yoon SH, Lee JM, Cho JY, Lee KB, Kim JE, Moon SK, et al. Small (${\leq}20$ mm) pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology 2011;259:442-452 https://doi.org/10.1148/radiol.11101133
  11. Blouhos K, Boulas KA, Tselios DG, Katsaouni SP, Mauroeidi B, Hatzigeorgiadis A. Surgically proved visually isoattenuating pancreatic adenocarcinoma undetected in both dynamic CT and MRI. Was blind pancreaticoduodenectomy justified? Int J Surg Case Rep 2013;4:466-469 https://doi.org/10.1016/j.ijscr.2013.02.010
  12. Kim JH, Park SH, Yu ES, Kim MH, Kim J, Byun JH, et al. Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology 2010;257:87-96 https://doi.org/10.1148/radiol.10100015
  13. Kang KM, Lee JM, Yoon JH, Kiefer B, Han JK, Choi BI. Intravoxel incoherent motion diffusion-weighted MR imaging for characterization of focal pancreatic lesions. Radiology 2014;270:444-453 https://doi.org/10.1148/radiol.13122712
  14. Yu MH, Lee JY, Kim MA, Kim SH, Lee JM, Han JK, et al. MR imaging features of small solid pseudopapillary tumors: retrospective differentiation from other small solid pancreatic tumors. AJR Am J Roentgenol 2010;195:1324-1332 https://doi.org/10.2214/AJR.10.4452
  15. Jang KM, Kim SH, Kim YK, Park MJ, Lee MH, Hwang J, et al. Imaging features of small $({\leq}3cm)$ pancreatic solid tumors on gadoxetic-acid-enhanced MR imaging and diffusion-weighted imaging: an initial experience. Magn Reson Imaging 2012;30:916-925 https://doi.org/10.1016/j.mri.2012.02.017
  16. Hur BY, Lee JM, Lee JE, Park JY, Kim SJ, Joo I, et al. Magnetic resonance imaging findings of the mass-forming type of autoimmune pancreatitis: comparison with pancreatic adenocarcinoma. J Magn Reson Imaging 2012;36:188-197 https://doi.org/10.1002/jmri.23609
  17. Rao SX, Zeng MS, Cheng WZ, Yao XZ, Jin DY, Ji Y. Small solid tumors (< or = 2 cm) of the pancreas: relative accuracy and differentiation of CT and MR imaging. Hepatogastroenterology 2011;58:996-1001
  18. Otsuki M, Chung JB, Okazaki K, Kim MH, Kamisawa T, Kawa S, et al. Asian diagnostic criteria for autoimmune pancreatitis: consensus of the Japan-Korea Symposium on Autoimmune Pancreatitis. J Gastroenterol 2008;43:403-408 https://doi.org/10.1007/s00535-008-2205-6
  19. Baek JH, Lee JM, Kim SH, Kim SJ, Kim SH, Lee JY, et al. Small ( https://doi.org/10.1148/radiol.10092089
  20. Lu DS, Vedantham S, Krasny RM, Kadell B, Berger WL, Reber HA. Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. Radiology 1996;199:697-701 https://doi.org/10.1148/radiology.199.3.8637990
  21. Haradome H, Grazioli L, Tsunoo M, Tinti R, Frittoli B, Gambarini S, et al. Can MR fluoroscopic triggering technique and slow rate injection provide appropriate arterial phase images with reducing artifacts on gadoxetic acid-DTPA (Gd-EOB-DTPA)-enhanced hepatic MR imaging? J Magn Reson Imaging 2010;32:334-340 https://doi.org/10.1002/jmri.22241
  22. Hussain HK, Londy FJ, Francis IR, Nghiem HV, Weadock WJ, Gebremariam A, et al. Hepatic arterial phase MR imaging with automated bolus-detection three-dimensional fast gradient-recalled-echo sequence: comparison with test-bolus method. Radiology 2003;226:558-566 https://doi.org/10.1148/radiol.2262011593
  23. Park SH, Goo JM, Jo CH. Receiver operating characteristic (ROC) curve: practical review for radiologists. Korean J Radiol 2004;5:11-18 https://doi.org/10.3348/kjr.2004.5.1.11
  24. Kim SY, Park SH, Hong N, Kim JH, Hong SM. Primary solid pancreatic tumors: recent imaging findings updates with pathology correlation. Abdom Imaging 2013;38:1091-1105 https://doi.org/10.1007/s00261-013-0004-x
  25. Sahani DV, Shah ZK, Catalano OA, Boland GW, Brugge WR. Radiology of pancreatic adenocarcinoma: current status of imaging. J Gastroenterol Hepatol 2008;23:23-33 https://doi.org/10.1111/j.1440-1746.2007.04868.x
  26. Rha SE, Jung SE, Lee KH, Ku YM, Byun JY, Lee JM. CT and MR imaging findings of endocrine tumor of the pancreas according to WHO classification. Eur J Radiol 2007;62:371-377 https://doi.org/10.1016/j.ejrad.2007.02.036
  27. Ganeshan DM, Paulson E, Tamm EP, Taggart MW, Balachandran A, Bhosale P. Solid pseudo-papillary tumors of the pancreas: current update. Abdom Imaging 2013;38:1373-1382 https://doi.org/10.1007/s00261-013-0015-7
  28. Ferrozzi F, Bova D, Campodonico F, Chiara FD, Passari A, Bassi P. Pancreatic metastases: CT assessment. Eur Radiol 1997;7:241-245 https://doi.org/10.1007/s003300050144
  29. Klein KA, Stephens DH, Welch TJ. CT characteristics of metastatic disease of the pancreas. Radiographics 1998;18:369-378 https://doi.org/10.1148/radiographics.18.2.9536484
  30. Ng CS, Loyer EM, Iyer RB, David CL, DuBrow RA, Charnsangavej C. Metastases to the pancreas from renal cell carcinoma: findings on three-phase contrast-enhanced helical CT. AJR Am J Roentgenol 1999;172:1555-1559 https://doi.org/10.2214/ajr.172.6.10350288
  31. Palmowski M, Hacke N, Satzl S, Klauss M, Wente MN, Neukamm M, et al. Metastasis to the pancreas: characterization by morphology and contrast enhancement features on CT and MRI. Pancreatology 2008;8:199-203 https://doi.org/10.1159/000128556
  32. Lee JH, Byun JH, Kim JH, Lee SS, Kim HJ, Lee MG. Solid pancreatic tumors with unilocular cyst-like appearance on CT: differentiation from unilocular cystic tumors using CT. Korean J Radiol 2014;15:704-711 https://doi.org/10.3348/kjr.2014.15.6.704
  33. Rosenkrantz AB, Lee L, Matza BW, Kim S. Infiltrative hepatocellular carcinoma: comparison of MRI sequences for lesion conspicuity. Clin Radiol 2012;67:e105-e111 https://doi.org/10.1016/j.crad.2012.08.019
  34. Miller FH, Rini NJ, Keppke AL. MRI of adenocarcinoma of the pancreas. AJR Am J Roentgenol 2006;187:W365-W374 https://doi.org/10.2214/AJR.05.0875
  35. Takakura K, Sumiyama K, Munakata K, Ashida H, Arihiro S, Kakutani H, et al. Clinical usefulness of diffusion-weighted MR imaging for detection of pancreatic cancer: comparison with enhanced multidetector-row CT. Abdom Imaging 2011;36:457-462 https://doi.org/10.1007/s00261-011-9728-7
  36. Park HS, Lee JM, Choi HK, Hong SH, Han JK, Choi BI. Preoperative evaluation of pancreatic cancer: comparison of gadolinium-enhanced dynamic MRI with MR cholangiopancreatography versus MDCT. J Magn Reson Imaging 2009;30:586-595 https://doi.org/10.1002/jmri.21889
  37. Vachiranubhap B, Kim YH, Balci NC, Semelka RC. Magnetic resonance imaging of adenocarcinoma of the pancreas. Top Magn Reson Imaging 2009;20:3-9 https://doi.org/10.1097/RMR.0b013e3181b48392
  38. Ichikawa T, Erturk SM, Motosugi U, Sou H, Iino H, Araki T, et al. High-b value diffusion-weighted MRI for detecting pancreatic adenocarcinoma: preliminary results. AJR Am J Roentgenol 2007;188:409-414 https://doi.org/10.2214/AJR.05.1918
  39. Prokesch RW, Chow LC, Beaulieu CF, Bammer R, Jeffrey RB Jr. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 2002;224:764-768 https://doi.org/10.1148/radiol.2243011284
  40. Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Nishie A, et al. Diagnostic value of the delayed phase image for iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography. Eur J Radiol 2009;69:139-146 https://doi.org/10.1016/j.ejrad.2007.09.012
  41. Zamboni GA, Bernardin L, Pozzi Mucelli R. Dynamic MDCT of the pancreas: is time-density curve morphology useful for the differential diagnosis of solid lesions? A preliminary report. Eur J Radiol 2012;81:e381-e385 https://doi.org/10.1016/j.ejrad.2011.11.055
  42. Kitano M, Kudo M, Yamao K, Takagi T, Sakamoto H, Komaki T, et al. Characterization of small solid tumors in the pancreas: the value of contrast-enhanced harmonic endoscopic ultrasonography. Am J Gastroenterol 2012;107:303-310 https://doi.org/10.1038/ajg.2011.354
  43. Park HS, Lee JM, Choi JY, Lee MW, Kim HJ, Han JK, et al. Preoperative evaluation of bile duct cancer: MRI combined with MR cholangiopancreatography versus MDCT with direct cholangiography. AJR Am J Roentgenol 2008;190:396-405 https://doi.org/10.2214/AJR.07.2310
  44. Sainani NI, Saokar A, Deshpande V, Fernandez-del Castillo C, Hahn P, Sahani DV. Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. AJR Am J Roentgenol 2009;193:722-731 https://doi.org/10.2214/AJR.08.1253
  45. Schmid-Tannwald C, Oto A, Reiser MF, Zech CJ. Diffusion-weighted MRI of the abdomen: current value in clinical routine. J Magn Reson Imaging 2013;37:35-47 https://doi.org/10.1002/jmri.23643
  46. Matsuki M, Inada Y, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, et al. Diffusion-weighed MR imaging of pancreatic carcinoma. Abdom Imaging 2007;32:481-483 https://doi.org/10.1007/s00261-007-9192-6
  47. Kim H, Lee JM, Yoon JH, Jang JY, Kim SW, Ryu JK, et al. Reduced field-of-view diffusion-weighted magnetic resonance imaging of the pancreas: comparison with conventional single-shot echo-planar imaging. Korean J Radiol 2015;16:1216-1225 https://doi.org/10.3348/kjr.2015.16.6.1216

피인용 문헌

  1. Imaging of hepatocellular carcinoma and image guided therapies - how we do it vol.17, pp.None, 2017, https://doi.org/10.1186/s40644-017-0110-z
  2. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal vol.18, pp.6, 2017, https://doi.org/10.3348/kjr.2017.18.6.888
  3. The borderline resectable/locally advanced pancreatic ductal adenocarcinoma staging with computed tomography/magnetic resonance imaging vol.6, pp.9, 2016, https://doi.org/10.4103/eus.eus_67_17
  4. Small pancreatic ductal carcinomas on triple-phase contrast-enhanced computed tomography: enhanced rims and the pathologic correlation vol.43, pp.12, 2016, https://doi.org/10.1007/s00261-018-1645-6
  5. Gadobutrol: A Review in Contrast-Enhanced MRI and MRA vol.38, pp.8, 2016, https://doi.org/10.1007/s40261-018-0674-9
  6. Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up of Exocrine Pancreatic Ductal Adenocarcinoma: Evidence Evaluation and Recommendations by the Italian Association of Medical Oncology vol.12, pp.6, 2016, https://doi.org/10.3390/cancers12061681