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Abstract
Differentiation between pancreatic carcinoma (PC) and mass-forming focal pancreatitis (FP) is invariably difficult. For the differential diagnosis, we qualitatively and quantitatively assessed the value of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in PC and FP in the present study. This study included 32 PC and 18 FP patients with histological confirmation who underwent DCE-MRI and DWI. The time-signal intensity curve (TIC) of PC and FP were classified into 5 types according to the time of reaching the peak, namely, type I, II, III, IV, and V, respectively, and two subtypes, namely, subtype-a (washout type) and subtype-b (plateau type) according to the part of the TIC profile after the peak. Moreover, the mean and relative apparent diffusion coefficient (ADC) value between PC and FP on DWI were compared. The type V TIC was only recognized in PC group (P < 0.01). Type IV b were more frequently observed in PC (P = 0.036), while type- IIa (P < 0.01), type- Ia (P = 0.037) in FP. We also found a significant difference in the mean and relative ADC value between PC and FP. The combined image set of DCE-MRI and DWI yielded an excellent sensitivity, specificity, and diagnostic accuracy (96.9%, 94.4%, and 96.0%). The TIC of DCE-MRI and ADC value of DWI for pancreatic mass were found to provide reliable information in differentiating PC from FP, and the combination of DCE-MRI and DWI can achieve a higher sensitivity, specificity, and diagnostic accuracy.
Highlights
The accurate diagnosis of mass-forming focal pancreatitis (FP) is extremely critical because FP has a different prognosis and treatment strategy in comparison with pancreatic carcinoma (PC) [1,2,3]
In differentiating the focal pancreatic masses with Dynamic contrast-enhanced magnetic resonance imaging (MRI) (DCE-MRI) between PC and FP, results from the present study demonstrated that PC exhibits a specific time-signal intensity curve (TIC) in comparison with FP
The type-V TIC was a peculiar profile to PC since no FP demonstrated this TIC type
Summary
The accurate diagnosis of mass-forming focal pancreatitis (FP) is extremely critical because FP has a different prognosis and treatment strategy in comparison with pancreatic carcinoma (PC) [1,2,3]. Magnetic resonance imaging (MRI) of the pancreas has increasingly been used as the primary imaging study of choice [5]. With advances in imaging technologies including diffusion-weighted imaging (DWI), MRI can improve detection and characterization of pancreatic lesions, as well as staging of tumors and inflammation [8]. Dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) have been widely implemented as prominent imaging techniques. Pancreatic time-signal intensity curve (TIC) from DCE-MRI was revealed to provide valuable data for differentiating PC www.impactjournals.com/oncotarget from FP and for detecting the PC associated with chronic pancreatitis [10]. DWI detects random water motion within vital tissues and produces a representative apparent diffusion coefficient (ADC) value. ADC values have been already utilized to discriminate benign from malignant lesions for the abdominal diseases and ADC values of malignant pancreatic lesions are remarkably lower than those of benign ones [11, 12]
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