Signal characteristic and enhancement patterns of pancreatic adenocarcinoma: evaluation with dynamic gadolinium enhanced MRI.
ABSTRACT To determine the signal characteristics and enhancement patterns of proven pancreatic adenocarcinomas at 1.5 T and to compare these results with contrast enhanced computed tomography (CECT).
Twenty-five patients, mean age 73 years, with proven pancreatic adenocarcinoma were imaged at 1.5 T using in- and opposed-phase, gradient-echo (GRE), T1-weighted sequences, T2 weighting using either a short tau inversion recovery (STIR) or frequency selective, fat-suppressed turbo spin echo (TSE) sequence, and with a three-dimensional (3D), fat-suppressed, GRE T1 sequence before, during the arterial, venous, and equilibrium phases after Gadolinium administration. Fourteen of the 25 patients underwent CECT. Magnetic resonance imaging (MRI) examinations were evaluated by two observers in consensus for size, signal characteristics, and enhancement patterns, and the results were compared with CECT.
The mean size of pancreatic adenocarcinomas was 32 mm. On unenhanced T1-weighted images, 12 of 25 lesions (48%) were hypointense, 13 (52%) were isointense. On STIR/T2, 11 of 25 (44%) pancreatic adenocarcinomas were hyperintense, 14 (56%) were isointense. All 25 (100%) adenocarcinomas were hypointense during the arterial phase. Twenty (80%) and 17 (68%) remained hypointense in the venous phase and equilibrium phases, respectively. In seven of 14 (50%) cases, the pancreatic mass was iso-attenuating to the pancreatic parenchyma during both the pancreatic and venous phases of CECT.
The results of the present study showed that all 25 pancreatic adenocarcinomas were hypointense to pancreatic parenchyma during the arterial phase. Moreover, MRI may be useful in patients with a high suspicion of pancreatic carcinoma that is not visualized during CECT.
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ABSTRACT: To review the current trends in pancreatic cancer research and propose alternatives for an earlier diagnosis. A search was conducted using the PubMed and Scielo electronic databases to find statistics related to the incidence of pancreatic cancer. Pancreatic cancer is the fourth most common cause of cancer mortality in the USA; in Colombia the incidence of this neoplasia is 4.5 per 100,000 individuals; and in Peru, amongst digestive diseases, it is the fifth most common cause. In Brazil and Chile this cancer has increased in incidence, while in Mexico, it has decreased in terms of the relative percentage of gastrointestinal cancers from 1976 to 2003. Chronic pancreatitis, cigarette smoking, diabetes, obesity and dietary mutagen exposure are the most consistent risk factors implicated in the development of pancreatic cancer; however, the genetic and molecular changes underlying the epidemiological association between these factors and pancreatic cancer remain largely unknown, and only 5-10% are hereditary in nature. The prognosis for pancreatic cancer has not changed substantially for at least the last 20 years. The most useful tumor marker for pancreatic adenocarcinoma is still the carbohydrate antigen 19-9 (CA19-9). Currently, a multimodal-screening approach of endoscopic ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography are the most effective methods to detect pancreatic cancer in high-risk patients. Future options for early detection of this malignancy are focused on new molecular markers, telomerase enzyme, receptor-targeted imaging using multifunctional nanoparticles, detection of glycan changes and epigenetics.Future Oncology 07/2009; 5(5):657-68. DOI:10.2217/fon.09.32
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ABSTRACT: To determine whether the degree of enhancement of pancreatic adenocarcinoma visualized on arterial phase gadolinium-enhanced magnetic resonance imaging (MRI) correlates with the histopathological tumor grade. Thirty-nine patients with pancreatic adenocarcinoma had MRI within 14 days before tumor resection. Gadolinium-chelate-enhanced (Gd) 3-dimensional gradient echo images were acquired including the arterial phase. Tumor imaging patterns on the arterial phase images were classified for low, moderate, or high degree of enhancement and compared against conventional histological grading. Based on histological grading, there were 12 poorly differentiated, 2 poorly to moderately differentiated, 22 moderately differentiated, and 3 well-differentiated adenocarcinomas. There was agreement between the MRI arterial enhancement pattern and histological grading in 30 of 39 cases. The mean size of tumors grouped by enhancement pattern or grade was not significantly different between groups. Although minor discordance was found in 9 of the 39 cases, statistical analysis showed agreement between the degree of arterial enhancement on MRI and histological tumor differentiation; the Cohen's kappa value was 0.64 with a 95% confidence interval of 0.46-0.83. Pancreatic adenocarcinoma arterial phase enhancement correlates with the histological grade of differentiation.Pancreas 10/2009; 39(1):71-5. DOI:10.1097/MPA.0b013e3181b9ed55
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ABSTRACT: To investigate the value of high b value diffusion-weighted (DW) imaging in differentiating between pancreatic carcinoma and mass-forming chronic pancreatitis (MFCP). Fifty-one consecutive patients with pathology-proven pancreatic carcinoma (n = 37) or MFCP (n = 14) were evaluated with DW imaging (b value, 0 and 1000 s/mm(2)) at a 3-T MR system. Overall 20 healthy volunteers were evaluated as the control group. The apparent diffusion coefficient (ADC) values of normal pancreas, pancreatic carcinoma, MFCP, and mass-associated obstructive pancreatitis were measured. On high b value (1000 s/mm(2) ) DW images, both pancreatic carcinoma and MFCP were hyperintense focal lesions; mass-associated obstructive pancreatitis occurred in 17 of 37 (45.9%) pancreatic carcinoma and 8 of 14 (57.1%) MFCP. The ADC (×10(-3) mm(2) /s) of the pancreatic carcinomas (1.06 ± 0.15) was significantly lower than that of normal pancreas (1.47 ± 0.18; P < 0.01), MFCP (1.35 ± 0.14; P < 0.01) and mass-associated chronic pancreatitis (1.44 ± 0.17; P < 0.01). The ADC of MFCP was also lower than that in the normal pancreas (P = 0.025), whereas the ADC of mass-associated obstructive pancreatitis was not different from those of the MFCP (P = 0.113) and normal pancreas (P = 0.544). When 1.195 was used as the optimal cut-off value, ADC quantification obtained a sensitivity of 85.7% and a specificity of 86.5% for differentiating pancreatic carcinomas from MFCP. High b value DW imaging in combination with ADC quantification at a 3-T MR system is useful in differentiating between pancreatic carcinoma and MFCP.Journal of Digestive Diseases 10/2011; 12(5):401-8. DOI:10.1111/j.1751-2980.2011.00517.x