gadoxetic-acid-disodium and Pancreatic-Neoplasms

To compare contrast-enhanced transabdominal ultrasonography (CE-US) following contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) with enhanced magnetic resonance imaging using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB-MRI) in the diagnosis of liver metastases in patients with pancreatic cancer.. Patients who underwent contrast-enhanced computed tomography for possible pancreatic cancer and required further evaluation with CH-EUS were enrolled in this study, and the diagnostic performance of CE-US following CH-EUS for liver metastasis was compared with that of EOB-MRI.. A total of 228 patients were included in the final analysis. Two hundred thirty-four hepatic lesions were found in 81 patients, and 178 lesions were finally diagnosed as metastases. EOB-MRI had a higher sensitivity (0.837 vs 0.949), while CE-US had a higher specificity and positive predictive value (PPV) (0.982 and 0.993 vs 0.911 and 0.971, respectively) in the diagnosis of liver metastasis. CE-US with defect reperfusion imaging had a higher diagnostic performance than EOB-MRI (0.866 vs 0.667) in the differentiation between liver metastasis and abscess.. EOB-MRI had a higher sensitivity than CE-US for diagnosing liver metastasis in patients with pancreatic cancer, but CE-US following CH-EUS demonstrated a higher specificity and PPV than EOB-MRI and was especially useful in the differentiation between liver metastasis and abscess.

Topics: Abscess; Contrast Media; Endosonography; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Pancreatic Neoplasms; Ultrasonography

Topics: Adenocarcinoma; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Pancreatic Neoplasms; Retrospective Studies

Gadoxetic acid-enhanced magnetic resonance imaging (MRI) is useful in detecting liver metastases from pancreatic ductal adenocarcinoma (PDAC). However, the long examination time limits its utility in the initial workup of patients with PDAC.. To evaluate the incremental value of an abbreviated gadoxetic acid-enhanced MRI for the detection of liver metastases in patients with PDAC.. Retrospective.. Patients (N = 130) with potentially resectable PDAC (women, 58 [44.6%]).. 1.5 T and 3 T; gradient dual-echo T1-weighted (in-phase and opposed-phase), fat-suppressed fast spin-echo T2-weighted, single-shot echo-planar diffusion-weighted, and three-dimensional fat-suppressed T1-weighted gradient-echo dynamic contrast-enhanced and hepatobiliary phase sequences, as well as contrast-enhanced computed tomography (CECT).. Three radiologists independently reviewed three different image sets to detect liver metastases: set 1, CECT alone; set 2, CECT and abbreviated MRI comprising fat-suppressed T2-weighted, diffusion-weighted, and hepatobiliary phase images; and set 3, CECT and standard gadoxetic acid-enhanced MRI.. Figure of merit (FOM) was compared using the jackknife alternative free-response receiver operating characteristics, and other per-lesion and per-patient diagnostic parameters for each image set were compared using McNemar's and Fisher's test. P < 0.05 was considered statistically significant.. A total of 43 liver metastases were identified in 13 patients. Reader-averaged FOM to detect liver metastases were significantly higher for sets 2 (0.884) and 3 (0.886) than for set 1 (0.609), while they were comparable between sets 2 and 3 (P = 0.96). The mean per-patient sensitivities, negative predictive values, and accuracies were significantly higher for sets 2 and 3 than for set 1, while those between sets 2 and 3 were not significantly different (not applicable, P > 0.99, and P > 0.99, respectively).. Gadoxetic acid-enhanced MRI combined with CECT had higher diagnostic performance than CECT alone for the detection of liver metastases in patients with PDAC. The incremental values were comparable for the abbreviated MRI and standard MRI.. 3 TECHNICAL EFFICACY: Stage 2.

Topics: Adenocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Pancreatic Neoplasms; Retrospective Studies; Sensitivity and Specificity

To evaluate the relationship between the patterns of hepatobiliary phase (HBP) contrast uptake in liver metastases on gadoxetic acid-enhanced MR imaging and overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC).. This retrospective study was approved by our institutional review board and written informed consent was waived. A total of 57 patients (30 men and 27 women; age range, 46-92 years; mean age, 64.9 ± 9.2 years) with PDAC and liver metastasis who had undergone gadoxetic acid-enhanced MR imaging were included. The internal morphologies of the nodules were classified as heterogeneous or homogeneous on HBP images (20 min). During patient-by-patient analysis, patients with both patterns of nodules were classified as belonging to the heterogeneous group. Kaplan-Meier analysis and log-rank test were conducted for univariate analysis and Cox proportional hazards regression was conducted for multivariate analysis to evaluate prognostic factors for OS in patients with PDAC and liver metastasis.. A total of 199 liver metastases were analyzed, among which 138 nodules (69%) demonstrated heterogeneous hypointensity, while 61 nodules (31%) demonstrated homogeneous hypointensity. Homogeneous hypointense nodules were encountered in 18 patients (32%; homogeneous group), heterogeneous in 29 patients (51%), and both patterns co-existed in 10 patients (17%; heterogeneous group). The heterogeneous group exhibited lower OS rates than the homogeneous group (mean OS, 48.5 months vs 23.9 months; p = 0.032).. Hepatobiliary contrast uptake pattern in liver metastasis on HBP images can be a potential imaging biomarker to predict OS in patients with PDAC and liver metastasis.. • Majority of the liver metastases were heterogeneous (69%) after gadoxetic acid-enhanced MR imaging. • Patients with heterogeneous hypointense nodules demonstrated lower overall survival rate. • Hepatobiliary contrast uptake pattern in liver metastasis is possibly associated with patients' prognosis.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Pancreatic Neoplasms; Prognosis; Retrospective Studies

To evaluate gadoxetic acid-enhanced liver MRI (EOB-MRI) versus contrast-enhanced computed tomography (CECT) for preoperative detection of liver metastasis (LM) and reduction of open-close laparotomies for pancreatic ductal adenocarcinoma (PDAC).. Sixty-six patients with PDAC had undergone preoperative EOB-MRI and CECT. LM detection by EOB-MRI and CECT and their impact on surgical planning, open-close laparotomies were compared by clinical and radiology reports and retrospective analysis of imaging by two blinded independent readers. Histopathology or imaging follow-up was the reference standard. Statistical analysis was performed at patient and lesion levels with two-sided McNemar tests.. EOB-MRI showed higher sensitivity versus CECT (71.7% [62.1-80.0] vs. 34% [25.0-43.8]; p = 0.009), comparable specificity (98.6%, [96.9-99.5] vs. 100%, [99.1-100], and higher AUROC (85.1%, [80.4-89.9] vs. 66.9%, [60.9-73.1]) for LM detection. An incremental 7.6% of patients were excluded from surgery with a potential reduction of up to 13.6% in futile open-close laparotomies due to LM detected on EOB-MRI only.. Preoperative EOB-MRI has superior diagnostic performance in detecting LM from PDAC. This better informs surgical eligibility with potential reduction of futile open-close laparotomies from attempted curative intent pancreatic cancer surgery.

Topics: Adult; Aged; Aged, 80 and over; Female; Gadolinium DTPA; Humans; Laparotomy; Liver; Magnetic Resonance Imaging; Male; Middle Aged; Pancreatic Neoplasms; Preoperative Care; Retrospective Studies

To compare the diagnostic accuracy of dynamic contrast-enhanced phases, hepatobiliary phase (HBP), and diffusion-weighted imaging (DWI) for the detection of liver metastases from neuroendocrine tumor (NET).. Sixty-seven patients with suspected NET liver metastases underwent gadoxetic acid-enhanced MRI. Three radiologists read four imaging sets separately and independently: DWI, T2W+dynamic, T2WI+HBP, and DWI+HBP. Reference standard included all imaging, histological findings, and clinical data. Sensitivity and specificity were calculated and compared for each imaging set. Interreader agreement was evaluated by intraclass correlation coefficient (ICC). Univariate logistic regression was performed to evaluate lesion characteristics (size, ADC, and enhancing pattern) associated to false positive and negative lesions.. Six hundred twenty-five lesions (545 metastases, 80 benign lesions) were identified. Detection rate was significantly higher combining DWI+HBP than the other imaging sets (sensitivity 86% (95% confidence interval (CI) 0.845-0.878), specificity 94% (95% CI 0.901-0.961)). The sensitivity and specificity of the other sets were 82% and 65% for DWI, 88% and 69% for T2WI, and 90% and 82% for HBP+T2WI, respectively. The interreader agreement was statistically higher for both HBP sets (ICC = 0.96 (95% CI 0.94-0.97) for T2WI+HBP and ICC = 0.91 (95% CI 0.87-0.94) for DWI+HBP, respectively) compared with that for DWI (ICC = 0.76 (95% CI 0.66-0.83)) and T2+dynamic (ICC = 0.85 (95% CI 0.79-0.9)). High ADC values, large lesion size, and hypervascular pattern lowered the risk of false negative.. Given the high diagnostic accuracy of combining DWI+HBP, gadoxetic acid-enhanced MRI is to be considered in NET patients with suspected liver metastases. Fast MRI protocol using T2WI, DWI, and HBP is of interest in this population.. • The combined set of diffusion-weighted (DW) and hepatobiliary phase (HBP) images yields the highest sensitivity and specificity for neuroendocrine liver metastasis (NELM) detection. • Gadoxetic acid should be the contrast agent of choice for liver MRI in NET patients. • The combined set of HBP and DWI sequences could also be used as a tool of abbreviated MRI in follow-up or assessment of treatment such as somatostatin analogs.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biometry; Contrast Media; Diffusion Magnetic Resonance Imaging; False Positive Reactions; Female; Gadolinium DTPA; Gastrointestinal Tract; Humans; Image Processing, Computer-Assisted; Intestinal Neoplasms; Liver Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Pancreatic Neoplasms; Regression Analysis; Sensitivity and Specificity; Stomach Neoplasms; Young Adult

To compare hepatocellular phase imaging after intravenous gadoxetate disodium with other MRI pulse sequences and with extracellular agent for assessing hepatic metastases from gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN).. In this IRB-approved, HIPAA-compliant retrospective study, we included 30 patients (15 women, mean age: 58 years, range 44-77 years) with GEP-NEN metastatic to the liver, who underwent MRI with gadoxetate disodium. Six MRI sequences were reviewed by two radiologists to score tumor-liver interface (TLI) on a 5-point scale, to assess lesion detectability in different liver segments (divided into 3 zones/patient), and to measure lesion size. Contrast-to-noise ratio (CNR) was calculated on each sequence. In 19 patients, lesion size and CNR on dynamic imaging with gadopentetate dimeglumine was compared with hepatocellular phase. Wilcoxon signed-rank test was used to compare TLI scores, lesion size, and median CNR, using Bonferroni correction for multiple testing. Interobserver agreement for TLI was analyzed using Krippendorff's alpha, and for lesion size using concordance correlation coefficient (CCC) and mean relative difference.. Hepatocellular phase had the best TLI (mean TLI for reader 1 = 1.2, reader 2 = 1.3) compared to all other sequences (p < 0.0001) with excellent interobserver agreement (Krippendorff's alpha = 1.0), maximum lesion detectability (61/90 zones), highest interobserver agreement for lesion measurement (CCC 0.9875 and smallest mean relative difference - 1.567%), and highest median CNR (31.2, p < 0.008). Hepatocellular phase also had the highest CNR when compared with gadopentetate imaging.. Hepatocellular phase imaging offers significant advantages for assessment of hepatic metastasis in GEP-NEN, and should be routinely considered for follow-up of these patients.

Topics: Adult; Aged; Contrast Media; Female; Gadolinium DTPA; Humans; Intestinal Neoplasms; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neuroendocrine Tumors; Pancreatic Neoplasms; Retrospective Studies; Stomach Neoplasms

We aimed to identify features that differentiate hepatic microabscess from hepatic metastasis on gadoxetic acid-enhanced MRI in patients with periampullary cancer.. We included 72 patients (31 patients with 83 hepatic microabscesses and 41 patients with 71 hepatic metastases) who had a history of periampullary cancer and underwent gadoxetic acid-enhanced MRI. Image analysis was performed for margin, signal intensity, rim enhancement, perilesional hyperaemia, pattern on DWI and dynamic phases, and size discrepancy between sequences by consensus of two observers.. Multivariate analysis revealed that the following significant parameters favour microabscess: a history of bile duct cancer, perilesional hyperaemia, persistent arterial rim enhancement through the transitional phase (TP), and size discrepancy between T1WI and T2WI and between T1WI and hepatobiliary phase image (HBPI). The diagnostic accuracy for microabscess was highest (90.9%) when showing a size discrepancy ≥30% between T1WI and HBPI or persistent arterial rim enhancement through the TP. When the lesion was positive for both these variables, specificity reached 100%.. The combination of a size discrepancy between T1WI and HBPI and persistent arterial rim enhancement through the TP represents a reliable MRI feature for distinguishing between hepatic microabscess and metastasis in patients with periampullary cancer.. • Gadoxetic acid-enhanced MRI is useful for distinguishing hepatic microabscess from metastasis. • Hepatic microabscess showed significant size discrepancy ≥30% between T1WI and HBPI. • Arterial rim enhancement persistent through the TP indicates hepatic microabscess.

Topics: Abscess; Aged; Ampulla of Vater; Bile Duct Neoplasms; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Pancreatic Neoplasms; Retrospective Studies; Sensitivity and Specificity

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/mm

Topics: Adenocarcinoma, Mucinous; Adult; Aged; Carcinoma, Pancreatic Ductal; Carcinoma, Papillary; Cholangiopancreatography, Magnetic Resonance; Consensus; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Pancreas; Pancreatic Neoplasms; Practice Guidelines as Topic; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

The purpose of this study was to assess value of contrast-enhanced MRI, MRCP, and DWI for differentiating mass-forming autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC).. This study included 15 patients with mass-forming AIP and 79 with PDAC who underwent gadoxetic acid-enhanced MRI with DWI and MRCP. Two radiologists evaluated the MRI findings in consensus. Statistically significant imaging findings were identified through univariate and multivariate analyses, and their diagnostic performance for predicting mass-forming AIP was analyzed.. In the univariate analysis, multiplicity, similar or high signal intensity on portal phase and 3- and 20-minute delayed phase images, homogeneous enhancement, no peripancreatic fat infiltration, no internal cystic or necrotic portion, capsulelike rim, no upstream pancreatitis, no vascular invasion, and duct penetrating sign were more frequently observed (p < 0.05) in mass-forming AIP. The apparent diffusion coefficient (ADC) value was also significantly lower for mass-forming AIP than for PDAC (0.96 ± 0.14 versus 1.13 ± 0.23 × 10(-3) mm(2)/s; p < 0.001). The optimal cutoff value of ADC for differentiating mass-forming AIP from PDAC was 0.9407 × 10(-3) mm(2)/s. In multivariate analysis, homogeneous enhancement (p = 0.001), duct penetrating sign (p < 0.001), and ADC value less than 0.9407 × 10(-3) mm(2)/s (p < 0.001) were significant for differentiating mass-forming AIP from PDAC. When two of these three criteria were combined, 80% (12/15) of mass-forming AIPs were identified with specificity of 98.7%. When all three criteria were satisfied, specificity was 100%.. Contrast-enhanced MRI with MRCP and DWI may be helpful for differentiating mass-forming AIP from PDAC.

Topics: Aged; Autoimmune Diseases; Carcinoma, Pancreatic Ductal; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pancreatic Neoplasms; Pancreatitis

The aim of this study was to assess the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI)-derived pharmacokinetic parameters between two contrast agents in a murine orthotopic pancreatic cancer model and to evaluate the tumor heterogeneity and the potential association between kinetic parameters and angiogenic markers such as the microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression by immunohistochemistry.. Human pancreatic adenocarcinoma cell line MIAPaCa-2 was injected into the pancreas of BALB/C nu/nu mice. DCE-MRI was performed using Gd-DTPA and Gd-EOB-DTPA. Quantitative and semi-quantitative vascular parameters (K(trans), Kep, Ve and AUC) were calculated by using a dedicated postprocessing software program. Values were compared with tumor rim, tumor core and the entire tumor. The MVD and VEGF expressions between tumor rim and tumor core were also compared.. There were no significant differences in K(trans), Kep, Ve, and AUC values of the three groups when using Gd-DTPA. However there were significant differences in K(trans), Kep, and AUC values of the three groups when using Gd-EOB-DTPA (P=0.014, 0.022, 0.007, respectively), in addition, the K(trans) and Kep values of tumor core were significantly lower than those of the entire tumor (adjusted P=0.014 and 0.027, respectively), the AUC values of core were significantly lower than those of the entire tumor and rim (adjusted P=0.039 and 0.009, respectively). Immunohistology results revealed that MVD and VEGF expression in the tumor rim was significantly higher than that in the core. There was positive correlation between AUC and MVD, VEGF.. The murine orthotopic pancreatic cancer model provides an ideal animal model to study human pancreatic cancer. It can more sensitively semi-quantitatively and quantitatively analyze tumor angiogenesis through selecting the albumin-binding contrast agent.

Topics: Animals; Contrast Media; Disease Models, Animal; Gadolinium DTPA; Image Enhancement; Magnetic Resonance Imaging; Male; Mice; Mice, Inbred BALB C; Mice, Nude; Microvessels; Neovascularization, Pathologic; Pancreas; Pancreatic Neoplasms; Vascular Endothelial Growth Factor A

To evaluate the value of abdominal MRI with diffusion-weighted (DW) imaging for differentiation of solid-type serous cystic neoplasm (SCN) from neuroendocrine tumour (NET) in the pancreas compared with that of CT.. Ten solid-type SCNs and 15 NETs were included in the study. Qualitative and quantitative analyses were performed, and two observers independently reviewed CT and MRI images for diagnosis of solid-type SCNs. Fisher's exact test and Mann-Whitney U-test, diagnostic performance [receiver operating characteristic (ROC) curve analysis] were evaluated.. SCNs showed more frequently hypo-attenuation on unenhanced CT images and marked hyperintensity on T2-weighted images compared with NETs (p < 0.01). The density of the tumour on unenhanced CT images and the apparent diffusion coefficient (ADC) value of the tumour were significantly different between SCNs (mean 18.5 HU; mean 2.45 × 10(-3) mm(2)/s) and NETs (mean 39.2 HU; mean 1.51 × 10(-3) mm(2)/s; p < 0.001). In the differentiation of SCNs from NETs, diagnostic performance of MRI with DW images was significantly higher than that of CT imaging (p < 0.01).. Abdominal DW-MRI shows a higher diagnostic accuracy than abdominal CT imaging in the differentiation of solid-type SCNs from NETs.

Topics: Adolescent; Adult; Aged; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Male; Middle Aged; Neuroendocrine Tumors; Pancreas; Pancreatic Cyst; Pancreatic Neoplasms; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed; Young Adult

To explore the efficiency, cost, and time for examination of one-stop-shop gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in preoperative evaluation for parent donors by comparing with multidetector computer tomography combined with conventional MR cholangiopancreatography (MDCT-MRCP).. Forty parent donors were evaluated with MDCT-MRCP, and the other 40 sex-, age-, and weight-matched donors with Gd-EOB-DTPA-enhanced MRI. Anatomical variations and graft volume determined by pre- and intra-operative findings, costs and time for imaging were recorded. Image quality was ranked on a 4-point scale and compared between both groups.. Gd-EOB-DTPA-enhanced MRI provided better image quality than MDCT-MRCP for the depiction of portal veins and bile ducts by both reviewers (p < 0.05), hepatic veins by one reviewer (p < 0.05), rather hepatic arteries by both reviewers (p < 0.01). Sixty-nine living donors proceeded to liver donation with all anatomical findings accurately confirmed by intra-operative findings. The "in-room" time of Gd-EOB-DTPA-enhanced MRI was 12 min longer than MDCT-MRCP. Gd-EOB-DTPA-enhanced MRI was cheaper than MDCT-MRCP (US$519.72 vs. US$631.85).. One-stop-shop Gd-EOB-DTPA-enhanced MRI has similar diagnostic accuracy as MDCT-MRCP and can provide additional benefit in terms of costs and convenience in preoperative evaluation for parent donors.

Topics: Adult; Bile Duct Neoplasms; Carcinoma, Pancreatic Ductal; Case-Control Studies; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Living Donors; Magnetic Resonance Imaging; Male; Multidetector Computed Tomography; Pancreatic Neoplasms; Prognosis; Prospective Studies; Risk Factors; Young Adult

Parenchyma-preserving resection for the treatment of benign pancreatic neuroendocrine tumors (NETs) has been tried, and preoperative prediction of benign pancreatic NET is important. Recently, diffusion-weighted imaging (DWI) of abdomen magnetic resonance imaging (MRI) has been used to characterize benign and malignant tumors and DWI might be helpful in prediction of benign pancreatic NETs.. To evaluate the value of gadoxetic acid-enhanced MRI and DWI in predicting benign pancreatic NETs for determination of parenchyma-preserving resection.. Our ethics committee approved this study with a waiver of informed consent given its retrospective design. We searched radiology and pathology databases from November 2010 to July 2012 to identify patients who underwent surgery for pancreatic NETs (<4 cm). Twenty patients in the benign group and 14 patients in the non-benign group were included in this study. Two radiologists analyzed the morphologic features, signal intensity on MR images including DWI (b = 800), and dynamic enhancement pattern of the tumors with consensus. The tumor-to-parenchyma ratio and tumor apparent diffusion coefficients (ADCs) were quantitatively assessed.. The benign pancreatic NETs were more often round (7/20, 35%) or ovoid (13/20, 65%) in shape and less hypovascular on the arterial phase (3/20, 15%) than were the non-benign pancreatic NETs (1/14, 7.1% and 5/14, 35.8%; 7/14, 50% respectively; P < 0.05). Main pancreatic duct dilatation by tumors was demonstrated only in non-benign pancreatic NETs (4/14, 28.4%; P = 0.021). ADC values and ratios were significantly different between benign pancreatic NETs (mean, 1.48 × 10(-3 )mm(2)/sec, 1.11 ± 0.25, each) and non-benign pancreatic NETs (mean, 1.04 × 10(-3 )mm(2)/sec, 0.74 ± 0.13, each) (P < 0.01). Other qualitative and quantitative analyses between benign and non-benign pancreatic NETs were not significantly different (P > 0.05).. Abdominal MRI with DWI may be useful for differentiating benign pancreatic NETs from non-benign pancreatic NETs, which might be helpful for determination of parenchyma-preserving resection.

Topics: Adolescent; Adult; Aged; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Male; Middle Aged; Neoplasm Grading; Neuroendocrine Tumors; Pancreatic Neoplasms; Predictive Value of Tests; Retrospective Studies; Young Adult

To investigate the dark choledochal ring sign on T2-weighted imaging (T2WI) as an indicator for pancreatic ductal adenocarcinoma (PDAC) among periampullary carcinomas.. Sixty patients with surgically confirmed periampullary cancers [30 PDACs, 15 distal common bile duct (CBD) cancers, 13 ampullary cancers, and two duodenal cancers] who underwent liver magnetic resonance imaging (MRI) were included in this study. Two reviewers independently evaluated unenhanced and gadoxetic acid-enhanced MRI (T1WI image set), and a combined T2WI and T1WI image set for differentiation between PDAC and other periampullary carcinomas using a rating scale, and the presence of the dark choledochal ring sign on T2WI, for all 60 tumours.. In PDAC, the dark choledochal ring sign on T2WI was considered positive in 23 cases by observer 1 and 24 cases by observer 2, but only in one or two CBD cancers, as determined by each observer, respectively. This resulted in sensitivities of 76.7% and 80% and specificities of 96.7% and 93.3% for observer 1 and 2, respectively, in the diagnosis of PDAC. Adding T2WI correctly led to a change of diagnosis in three and four cases of PDAC by each observer, respectively. Thus, there were significant differences between the two image sets for both observers in distinguishing between PDAC and other periampullary carcinomas (p = 0.02).. The presence of the dark choledochal ring sign on axial T2WI could be a complementary imaging feature indicative of PDAC to differentiate PDAC from other periampullary carcinomas at MRI.

Topics: Adenocarcinoma; Adult; Aged; Artifacts; Common Bile Duct; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Pancreatic Neoplasms; Prevalence; Prognosis; Reproducibility of Results; Republic of Korea; Retrospective Studies; Sensitivity and Specificity

To evaluate the benefit of adding diffusion-weighted ( DW diffusion weighted ) imaging to conventional magnetic resonance (MR) imaging in the preoperative detection of small pancreatic adenocarcinoma (≤ 3.0 cm).. The institutional review board approved this retrospective study and waived the requirement for informed consent. This study included 83 patients (56 men, 27 women) with surgically confirmed pancreatic adenocarcinoma of 3.0 cm or smaller and 12 patients (nine men, three women) with histologically proven focal pancreatitis who underwent gadoxetic acid-enhanced MR imaging and DW diffusion weighted imaging at 3.0 T. Two observers reviewed the two image sets, a conventional MR image set and a combined image set including DW diffusion weighted images, to evaluate tumor conspicuity using receiver operating characteristic curve analysis. Contrast ratios between the tumor and proximal or distal pancreas on T1- and T2-weighted images, arterial and portal phase images, and DW diffusion weighted images obtained with a b value of 800 sec/mm(2) were compared by using one-way analysis of variance or Kruskal-Wallis test.. On DW diffusion weighted images, all tumors but two were delineated as completely (32 of 83, 39%) or partially (49 of 83, 59%) hyperintense. Area under the receiver operating characteristic curve values for the two observers were 0.890 and 0.884 for the conventional image set and 0.976 and 0.978 for the combined image set (P = .01 and P = .04), respectively. In regard to tumor detection, the combined image set (98%, 81 of 83 [observer 1]; 96%, 80 of 83 [observer 2]) yielded better sensitivity than the conventional image set (75%, 62 of 83 [observer 1]; 76%, 63 of 83 [observer 2]) (P < .001). Contrast ratios of tumor to proximal or distal pancreas were significantly higher with DW diffusion weighted images than with other images (P < .001).. In preoperative evaluation of small pancreatic adenocarcinoma, the addition of DW diffusion weighted imaging to conventional MR imaging improves the sensitivity of cancer detection.

Topics: Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma, Pancreatic Ductal; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Pancreatic Neoplasms; Quality Improvement; Retrospective Studies

The purpose of this study was to evaluate whether the use of diffusion-weighted MRI (DWI) increases diagnostic accuracy in the differentiation of malignant from benign intraductal papillary mucinous neoplasms (IPMNs) of the pancreas over the accuracy of contrast-enhanced MRI with MRCP.. A total of 61 patients with surgically resected IPMNs (19 malignant, 42 benign) who underwent gadoxetic acid-enhanced MRI, DWI, and MRCP were included. Two blinded observers evaluated two image sets, that is, conventional MRI with MRCP images versus combined conventional MRI with MRCP and DW images, and scored their confidence for malignancy of IPMNs. Qualitative analyses of the IPMNs were also conducted. Diagnostic performance (ROC curve analysis), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. The Fisher exact test was used to compare groups.. The diagnostic performance (area under the ROC curve [Az]) with respect to predicting malignancy of IPMNs improved significantly for both observers after additional review of DW images (p < 0.05). The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of combined conventional and DW images were higher than those of conventional MR images alone. Diffusion restriction was more often present in malignant IPMNs (78.9%) than in benign IPMNs (16.7%) (p < 0.001) with excellent interobserver agreement (ĸ = 0.965).. Compared with conventional MRI alone, adding DWI to conventional MRI improves diagnostic accuracy with increased specificity for differentiating malignant from benign IPMNs of the pancreas.

Topics: Adenocarcinoma, Mucinous; Adult; Aged; Aged, 80 and over; Carcinoma, Pancreatic Ductal; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Male; Observer Variation; Pancreatic Neoplasms; Reproducibility of Results; Sensitivity and Specificity

The objective was to determine imaging features that distinguish small (≤3cm) solid pancreatic adenocarcinoma, neuroendocrine tumor (NET) and solid pseudopapillary tumor (SPT) on gadoxetic-acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighed imaging (DWI).. Twenty-four adenocarcinomas, 10 NETs and 8 SPTs were retrospectively included. Two radiologists analyzed morphologic features, signal intensity of the tumors on MR images including DWI (b=800) and dynamic enhancement pattern with consensus. Tumor-to-parenchyma ratio and tumor apparent diffusion coefficients (ADCs) were quantitatively assessed.. All adenocarcinomas had an ill-defined margin and irregular shape, and more frequently had pancreatic duct dilatation compared with other tumors (P<.05). All SPTs and all but one of the adenocarcinomas (95.8%) had no arterial enhancement with progressively increased enhancement, whereas seven NETs (70%) had arterial enhancement with progressively decreased enhancement (P<.01). The mean value of tumor-to-parenchyma ratio on arterial and portal phases was significantly higher for NETs, and the mean value of tumor ADCs was significantly lower for SPTs than for other tumors (P<.05).. Gadoxetic-acid-enhanced MRI may aid in differentiation between small adenocarcinomas, NETs and SPTs based on morphologic features with dynamic enhancement pattern in adenocarcinomas, dynamic enhancement pattern with tumor-to-parenchyma ration on arterial and portal phases in NETs, and dynamic enhancement pattern with lower ADC value in SPTs.

Topics: Carcinoma, Acinar Cell; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Male; Middle Aged; Pancreatic Neoplasms; Pilot Projects; Reproducibility of Results; Sensitivity and Specificity

To intraindividually compare gadoxetic acid-enhanced magnetic resonance (MR) imaging with contrast material-enhanced multi-detector row computed tomography (CT) in detection of pancreatic carcinoma and liver metastases.. The ethics committee approved this retrospective study with waiver of informed consent. This study included 100 patients (53 men, 47 women; mean age, 67.8 years) consisting of 54 patients with pathologically confirmed pancreatic carcinoma (mean size, 33 mm) and 46 without a pancreatic lesion. Sixty-two liver metastases (mean size, 10 mm) in 15 patients with pancreatic carcinoma were diagnosed at pathologic examination or multimodality assessment. Three readers blinded to the final diagnosis interpreted all MR (precontrast T1- and T2-weighted and gadoxetic acid-enhanced dynamic and hepatocyte phase MR images) and tetraphasic dynamic contrast-enhanced CT images and graded the presence (or absence) of pancreatic carcinoma and liver metastasis on patient-by-patient and lesion-by-lesion bases. Receiver operating characteristic analysis, McNemar test, and Fisher test were performed to compare the diagnostic performance of CT and MR imaging.. No significant differences were observed between CT and MR images in depiction of pancreatic carcinoma. However, MR imaging had greater sensitivity in depicting liver metastasis than did CT for two of the three readers in the MR imaging-versus-CT analysis (85% vs 69%, P = .046) and for all three readers in the lesion-by-lesion analysis (92%-94% vs 74%-76%, P = .030-.044).. Gadoxetic acid-enhanced MR imaging was equivalent to dynamic contrast-enhanced CT in depicting pancreatic carcinoma and had better sensitivity for depicting liver metastases, suggesting the usefulness of gadoxetic acid-enhanced MR imaging for evaluation of patients with pancreatic carcinoma.

Topics: Adenocarcinoma; Aged; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Pancreatic Neoplasms; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric; Tomography, X-Ray Computed