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Purpose
Our purpose was to validate the T1 SIR (T1 score) as an imaging biomarker for the staging of CP in a large, multi-institutional, prospective study.
Methods
The prospective study population included 820 participants enrolled in the PROCEED study from nine clinical centers between June 2017 and December 2021. A radiologist at each institutio...
Citations
... IVIM imaging consists of DWI with multiple b-values and estimation of both perfusion fraction, diffusion, and pseudo-diffusion. It has recently been between the pancreas and a reference organ (typically the spleen), where a recent study reported reduced T1 SIR with progressive stages of CP [39]. ...
Purpose of Review
Imaging of the pancreas in chronic pancreatitis (CP) has become increasingly valuable. This is driven by increased clinical focus on diagnosis, grading, and monitoring of CP, together with technical advancements. This review provides insights into routine radiological imaging of CP, current research trends and future directions in advanced CP imaging techniques, and finally developments in advanced image analysis.
Recent Findings
Current routine imaging, using computed tomography, magnetic resonance imaging (MRI), and ultrasound, plays a major role in diagnosing, staging, and monitoring of CP. Each modality has strengths and limitations, and the use often depends on local practice and expertise. In clinical research, there is a clear trend towards the use of advanced imaging techniques that focus on identifying non-invasive biomarkers representing the underlying pancreatic pathophysiology. Several primarily MRI-based techniques show great promise in especially detecting early stages of CP. Regarding advanced image analysis, there is a trend towards using artificial intelligence with automated pancreas segmentation, extraction of radiomic features, and classification algorithms. These advancements have the potential to identify improved imaging biomarkers for CP.
Summary
Overall, new advances within radiological pancreatic imaging and image analysis may be a significant contributor to improving the management of CP patients.
... In one of these studies, including 60 surgical specimens, the T1 score and AVR had a higher correlation for pancreatic fibrosis than the Cambridge score [33]. If the spleen is removed or deemed unreliable (e.g., iron deposition), the T1 score can be obtained using the paraspinal muscle as a reference organ [35]. ...
Purpose
To determine the diagnostic performance of parenchymal MRI features differentiating CP from controls.
Methods
This prospective study performed abdominal MRI scans at seven institutions, using 1.5 T Siemens and GE scanners, in 50 control and 51 definite CP participants, from February 2019 to May 2021. MRI parameters included the T1-weighted signal intensity ratio of the pancreas (T1 score), arterial-to-venous enhancement ratio (AVR) during venous and delayed phases, pancreas volume, and diameter. We evaluated the diagnostic performance of these parameters individually and two semi-quantitative MRI scores derived using logistic regression: SQ-MRI Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume).
Results
When compared to controls, CP participants showed a significantly lower mean T1 score (1.11 vs. 1.29), AVR venous (0.86 vs. 1.45), AVR delayed (1.07 vs. 1.57), volume (54.97 vs. 80.00 ml), and diameter of the head (2.05 vs. 2.39 cm), body (2.25 vs. 2.58 cm), and tail (1.98 vs. 2.51 cm) (p < 0.05 for all). AUCs for these individual MR parameters ranged from 0.66 to 0.79, while AUCs for the SQ-MRI scores were 0.82 and 0.81 for Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume), respectively. After propensity-matching adjustments for covariates, AUCs for Models A and B of the SQ-MRI scores increased to 0.92 and 0.93, respectively.
Conclusion
Semi-quantitative parameters of the pancreatic parenchyma, including T1 score, enhancement ratio, pancreas volume, diameter and multi-parametric models combining these parameters are helpful in diagnosis of CP. Longitudinal analyses including more extensive population are warranted to develop new diagnostic criteria for CP.
Graphical abstract
... There are longterm studies looking into the benefit of MRI in evaluation of CP under the Chronic Pancreatitis, Diabetes, and Pancreatic Cancer Consortium (129). Most recently, the T1 signal intensity ratio (T1 score) has been proposed as an imaging biomarker for the staging of the CP (130). Quantitative MRI biomarkers of the pancreas, including T1 relaxation time, extracellular volume fraction, apparent diffusion coefficient, and fat signal fraction, have also been found to be helpful in diagnosis of CP (131). ...
In the article cited above, the affiliations for authors Stephen J. Pandol and Maike Sander were inadvertently transposed. The correct affiliation for Stephen J. Pandol is Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA. The correct affiliation for Maike Sander is Department of Pediatrics and Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA.
The online version of the article (https://doi.org/10.2337/db22-0942) has been updated with the correct affiliations.
... There are longterm studies looking into the benefit of MRI in evaluation of CP under the Chronic Pancreatitis, Diabetes, and Pancreatic Cancer Consortium (129). Most recently, the T1 signal intensity ratio (T1 score) has been proposed as an imaging biomarker for the staging of the CP (130). Quantitative MRI biomarkers of the pancreas, including T1 relaxation time, extracellular volume fraction, apparent diffusion coefficient, and fat signal fraction, have also been found to be helpful in diagnosis of CP (131). ...
The Integrated Physiology of the Exocrine and Endocrine Compartments in Pancreatic Diseases workshop was a 1.5-day scientific conference at the National Institutes of Health (Bethesda, MD) that engaged clinical and basic science investigators interested in diseases of the pancreas. This report provides a summary of the proceedings from the workshop. The goals of the workshop were to forge connections and identify gaps in knowledge that could guide future research directions. Presentations were segregated into six major theme areas, including 1) pancreas anatomy and physiology, 2) diabetes in the setting of exocrine disease, 3) metabolic influences on the exocrine pancreas, 4) genetic drivers of pancreatic diseases, 5) tools for integrated pancreatic analysis, and 6) implications of exocrine–endocrine cross talk. For each theme, multiple presentations were followed by panel discussions on specific topics relevant to each area of research; these are summarized here. Significantly, the discussions resulted in the identification of research gaps and opportunities for the field to address. In general, it was concluded that as a pancreas research community, we must more thoughtfully integrate our current knowledge of normal physiology as well as the disease mechanisms that underlie endocrine and exocrine disorders so that there is a better understanding of the interplay between these compartments.
... There are longterm studies looking into the benefit of MRI in evaluation of CP under the Chronic Pancreatitis, Diabetes, and Pancreatic Cancer Consortium (129). Most recently, the T1 signal intensity ratio (T1 score) has been proposed as an imaging biomarker for the staging of the CP (130). Quantitative MRI biomarkers of the pancreas, including T1 relaxation time, extracellular volume fraction, apparent diffusion coefficient, and fat signal fraction, have also been found to be helpful in diagnosis of CP (131). ...
The "Integrated Physiology of the Exocrine and Endocrine Compartments in Pancreatic Diseases" Workshop was a 1.5-day scientific conference at the National Institutes of Health (Bethesda, MD) that engaged clinical and basic science investigators interested in diseases of the pancreas. This report summarizes the workshop proceedings. The goal of the workshop was to forge connections and identify gaps in knowledge that could guide future research directions. Presentations were segregated into 6 major themes, including (a) Pancreas Anatomy and Physiology; (b) Diabetes in the Setting of Exocrine Disease; (c) Metabolic Influences on the Exocrine Pancreas; (d) Genetic Drivers of Pancreatic Diseases; (e) Tools for Integrated Pancreatic Analysis; and (f) Implications of Exocrine-Endocrine Crosstalk. For each theme, there were multiple presentations followed by panel discussions on specific topics relevant to each area of research; these are summarized herein. Significantly, the discussions resulted in the identification of research gaps and opportunities for the field to address. In general, it was concluded that as a pancreas research community, we must more thoughtfully integrate our current knowledge of the normal physiology as well as the disease mechanisms that underlie endocrine and exocrine disorders so that there is a better understanding of the interplay between these compartments.
Chronic pancreatitis results from repeated episodes of pancreatic inflammation and associated fibrosis leading to the loss of functional exocrine and endocrine pancreatic function. The disease is manifested by abdominal pain, deterioration in quality of life, food maldigestion and malabsorption, diabetes, and an increased risk for pancreatic adenocarcinoma. This review summarizes the latest evidence on the diagnosis and management of chronic pancreatitis and its manifestations. In particular, this review discusses advances in understanding of the role of genetic disorders in the mechanisms of the disease and surgical options for patients refractory to medical therapy. Furthermore, clinical trials are under way to develop medical therapeutics.
Acute pancreatitis (AP) is inflammation of the pancreas, which may be due to a wide variety of etiologies that share a final common pathway of premature activation of pancreatic enzymes and resultant autodigestion of pancreatic parenchyma. Acute pancreatitis is easy to diagnose clinically, with the presence of at least 2 of the 3 criteria (upper abdominal pain, serum amylase or lipase level greater than 3 times the upper limit of normal, or characteristic findings on imaging studies) of the revised Atlanta classification. However, postmortem imaging examinations of pancreatitis are extremely rare, and very few successful cases have been reported. Here, we present a case report of a single patient who underwent autopsy and postmortem imaging. Postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMRI) showed peripancreatic inflammation and acute peripancreatic fluid collection in the left anterior pararenal space, which is consistent with the examination by autopsy. The advantages of PMMRI in AP have also been demonstrated. Our study also confirmed the advantage of PMCT angiography in the diagnosis of AP. To the best of our knowledge, this is the first report of PMCT and PMMRI combined with postmortem pathology in the diagnosis of AP.
