Computed high-b-value high-resolution DWI improves solid lesion detection in IPMN of the pancreas

Abstract

Objectives To examine the effect of high-b-value computed diffusion-weighted imaging (cDWI) on solid lesion detection and classification in pancreatic intraductal papillary mucinous neoplasm (IPMN), using endoscopic ultrasound (EUS) and histopathology as a standard of reference. Methods Eighty-two patients with known or suspected IPMN were retrospectively enrolled. Computed high-b-value images at b = 1000 s/mm2 were calculated from standard (b = 0, 50, 300, and 600 s/mm2) DWI images for conventional full field-of-view (fFOV, 3 × 3 × 4 mm3 voxel size) DWI. A subset of 39 patients received additional high-resolution reduced-field-of-view (rFOV, 2.5 × 2.5 × 3 mm3 voxel size) DWI. In this cohort, rFOV cDWI was compared against fFOV cDWI additionally. Two experienced radiologists evaluated (Likert scale 1–4) image quality (overall image quality, lesion detection and delineation, fluid suppression within the lesion). In addition, quantitative image parameters (apparent signal-to-noise ratio (aSNR), apparent contrast-to-noise ratio (aCNR), contrast ratio (CR)) were assessed. Diagnostic confidence regarding the presence/absence of diffusion-restricted solid nodules was assessed in an additional reader study. Results High-b-value cDWI at b = 1000 s/mm2 outperformed acquired DWI at b = 600 s/mm2 regarding lesion detection, fluid suppression, aCNR, CR, and lesion classification (p = < .001–.002). Comparing cDWI from fFOV and rFOV revealed higher image quality in high-resolution rFOV-DWI compared to conventional fFOV-DWI (p ≤ .001–.018). High-b-value cDWI images were rated non-inferior to directly acquired high-b-value DWI images (p = .095–.655). Conclusions High-b-value cDWI may improve the detection and classification of solid lesions in IPMN. Combining high-resolution imaging and high-b-value cDWI may further increase diagnostic precision. Clinical relevance statement This study shows the potential of computed high-resolution high-sensitivity diffusion-weighted magnetic resonance imaging for solid lesion detection in pancreatic intraductal papillary mucinous neoplasia (IPMN). The technique may enable early cancer detection in patients under surveillance. Key Points • Computed high-b-value diffusion-weighted imaging (cDWI) may improve the detection and classification of intraductal papillary mucinous neoplasms (IPMN) of the pancreas. • cDWI calculated from high-resolution imaging increases diagnostic precision compared to cDWI calculated from conventional-resolution imaging. • cDWI has the potential to strengthen the role of MRI for screening and surveillance of IPMN, particularly in view of the rising incidence of IPMNs combined with now more conservative therapeutic approaches.

Imaging of the Liver and Pancreas: The Added Value of MRI

“…Finally, DWI offers important information in the assessment of the onset of small pancreatic carcinoma by using short protocols [39]. DWI play a crucial role in the identification of worrisome feature in pancreatic cystic lesions and, according to some authors, high b-value DWI may help in the detection and classification of solid lesions in IPMN [31,32] (Figure 18), thus contributing to the differentiation between benign and malignant IPMNs [33]. On unenhanced MRI, DWI with MRCP could improve the diagnosis of malignant IPMN with a better prediction of invasive IPMN [34,35].…”

Monitoring Ca19‐9 during pancreatic cyst surveillance: Better safe than sorry?

“…However, advances in this field appear to be more in the form of new biomarkers like next generation sequencing for specific mutations, 8 serum proteome, 9 tumor microenvironment and microbiome, 10 and deep learning and artificial intelligence. 11 …”