Pancreatic Steatosis and Fibrosis: Quantitative Assessment with Preoperative Multiparametric MR Imaging

Yoon, Jeong Hee; Lee, Jeong Min; Lee, Kyuho; Kim, Sun Whe; Kang, Mee Joo; Jang, Jin Young; Kannengießer, Stephan; Han, Joon Koo; Choi, Byung Ihn

doi:10.1148/radiol.2015142254

Cited by 92 publications

(101 citation statements)

References 45 publications

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“…However, the fat fraction on MRI was a significant factor that correlated with advanced fibrosis of the pancreas, and the fat fraction increased as the degree of fibrosis rose. Furthermore, the fat fraction on histologic examination was not correlated with a subjective assessment of pancreatic texture[18]. Our study showed similar results, and the RSID tended to be higher in the hard pancreas group than in the soft pancreas group, though the difference was not statistically significantly different.…”

Section: Discussionsupporting

confidence: 63%

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Pancreatic hardness: Correlation of surgeon’s palpation, durometer measurement and preoperative magnetic resonance imaging features

Hong¹,

Choi²,

Park³

et al. 2017

WJG

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AIMTo evaluate the correlation between subjective assessments of pancreatic hardness based on the palpation, objective measurements using a durometer, and magnetic resonance imaging (MRI) findings for assessing pancreatic hardness.METHODSEighty-three patients undergoing pancreatectomies were enrolled. An experienced surgeon subjectively evaluated the pancreatic hardness in the surgical field by palpation. The pancreatic hardness was also objectively evaluated using a durometer. Preoperative MRI findings were evaluated by a radiologist in terms of the apparent diffusion coefficient (ADC) values, the relative signal intensity decrease (RSID) of the pancreatic parenchyma, and the diameter of the pancreatic parenchyma and duct. Durometer measurement results, ADC values, RSID, pancreatic duct and parenchyma diameters, and the ratio of the diameters of the duct and parenchyma were compared between pancreases judged to be soft or hard pancreas on the palpation. A correlation analysis was also performed between the durometer and MRI measurements.RESULTSThe palpation assessment classified 44 patients as having a soft pancreas and 39 patients as having a hard pancreas. ADC values were significantly lower in the hard pancreas group. The ductal diameter and duct-to-pancreas ratio were significantly higher in the hard pancreas group. For durometer measurements, a correlation analysis showed a positive correlation with the ductal diameter and the duct-to-pancreas ratio and a negative correlation with ADC values.CONCLUSIONHard pancreases showed lower ADC values, a wider pancreatic duct diameter and a higher duct-to-pancreas ratio than soft pancreases. Additionally, the ADC values, diameter of the pancreatic duct and duct-to-pancreas ratio were closely correlated with the durometer results.

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Section: Discussionsupporting

confidence: 63%

“…Advanced MR techniques, such as intravoxel incoherent motion (IVIM) and MR elastography (MRE), have been applied to evaluate pancreas stiffness[17,18]. However, we used more common techniques, including DWI and in- and opposed-phase chemical shift images, because such emerging techniques are not generally available at all institutions.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic hardness: Correlation of surgeon’s palpation, durometer measurement and preoperative magnetic resonance imaging features

Hong¹,

Choi²,

Park³

et al. 2017

WJG

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“…Our results concur with a recent study of 165 patients who underwent MRCP and subsequent pancreatectomy and reported a positive correlation between the pancreatic fibrosis and FSF. 18 We observed a weak positive correlation between FSF and T 1 signal in the control group; however, there was no correlation in the mild CP group. Since fat tissue has a significantly shorter T 1 relaxation time, the presence of relatively higher FSF in CP group might have lowered the average values of T 1 relaxation times in this group.…”

Section: Discussionmentioning

confidence: 49%

T₁ mapping for diagnosis of mild chronic pancreatitis

Tirkes

Lin

Fogel

et al. 2016

Magnetic Resonance Imaging

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Purpose To determine if the T1 relaxation time of the pancreas can detect parenchymal changes in mild chronic pancreatitis (CP). Materials and Methods This Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study analyzed 98 patients with suspected mild CP. Patients were grouped as normal (n = 53) or mild CP (n = 45) based on history, presenting symptomatology, and concordant findings on both the secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). T1 maps were obtained in all patients using the same 3D gradient echo technique on the same 3T scanner. T1 relaxation times, fat signal fraction (FSF), and anterior–posterior (AP) diameter were correlated with the clinical diagnosis of CP. Results There was a significant difference (P < 0.0001) in the T1 relaxation times between the control (mean = 797 msec, 95% confidence interval [CI]: 730, 865) and mild CP group (mean = 1099 msec, 95% CI: 1032, 1166). A T1 relaxation time threshold value of 900 msec was 80% sensitive (95% CI: 65, 90) and 69% specific (95% CI: 56, 82) for the diagnosis of mild CP (area under the curve [AUC]: 0.81). Multiple regression analysis showed that T1 relaxation time was the only statistically significant variable correlating with the diagnosis of CP (P < 0.0001). T1 relaxation times showed a weak positive correlation with the pancreatic FSF (ρ = 0.33, P = 0.01) in the control group, but not in the mild CP group. Conclusion The T1 relaxation time of the pancreatic parenchyma was significantly increased in patients with mild CP. Therefore, T1 mapping might be used as a practical quantitative imaging technique for the evaluation of suspected mild CP.

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“…Therefore, assessment of pancreatic steatosis by preoperative CT or MRI or intraoperative histological evaluation on the frozen sections may have a role, in the future, in the prognostic evaluation of patients with PC[37,67,68,71,189,190]. …”

Section: Clinical Significancementioning

confidence: 99%

Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease

Catanzaro¹,

Cuffari²,

Italia³

et al. 2016

WJG

152

126

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After the first description of fatty pancreas in 1933, the effects of pancreatic steatosis have been poorly investigated, compared with that of the liver. However, the interest of research is increasing. Fat accumulation, associated with obesity and the metabolic syndrome (MetS), has been defined as “fatty infiltration” or “nonalcoholic fatty pancreas disease” (NAFPD). The term “fatty replacement” describes a distinct phenomenon characterized by death of acinar cells and replacement by adipose tissue. Risk factors for developing NAFPD include obesity, increasing age, male sex, hypertension, dyslipidemia, alcohol and hyperferritinemia. Increasing evidence support the role of pancreatic fat in the development of type 2 diabetes mellitus, MetS, atherosclerosis, severe acute pancreatitis and even pancreatic cancer. Evidence exists that fatty pancreas could be used as the initial indicator of “ectopic fat deposition”, which is a key element of nonalcoholic fatty liver disease and/or MetS. Moreover, in patients with fatty pancreas, pancreaticoduodenectomy is associated with an increased risk of intraoperative blood loss and post-operative pancreatic fistula.

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Pancreatic Steatosis and Fibrosis: Quantitative Assessment with Preoperative Multiparametric MR Imaging

Abstract: Multiparametric MR imaging of the pancreas, including imaging with the T2*-corrected Dixon technique and IVIM DW imaging, may yield quantitative information regarding pancreatic steatosis and fibrosis, and f was shown to be significantly associated with postoperative pancreatic fistulas.

Cited by 92 publications

References 45 publications

Pancreatic hardness: Correlation of surgeon’s palpation, durometer measurement and preoperative magnetic resonance imaging features

Pancreatic hardness: Correlation of surgeon’s palpation, durometer measurement and preoperative magnetic resonance imaging features

T₁ mapping for diagnosis of mild chronic pancreatitis

Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease

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Pancreatic Steatosis and Fibrosis: Quantitative Assessment with Preoperative Multiparametric MR Imaging

Abstract: Multiparametric MR imaging of the pancreas, including imaging with the T2*-corrected Dixon technique and IVIM DW imaging, may yield quantitative information regarding pancreatic steatosis and fibrosis, and f was shown to be significantly associated with postoperative pancreatic fistulas.

Cited by 92 publications

References 45 publications

Pancreatic hardness: Correlation of surgeon’s palpation, durometer measurement and preoperative magnetic resonance imaging features

Pancreatic hardness: Correlation of surgeon’s palpation, durometer measurement and preoperative magnetic resonance imaging features

T1 mapping for diagnosis of mild chronic pancreatitis

Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease

Contact Info

Product

Resources

About

T₁ mapping for diagnosis of mild chronic pancreatitis