Progression of parenchymal and ductal findings in patients with chronic pancreatitis: A 4-year follow-up MRI study

Steinkohl, Emily; Olesen, Søren Schou; Mark, Esben Bolvig; Hansen, Tore; Kuhlmann, Louise; Drewes, Asbjørn Mohr; Frøkjær, Jens Brøndum

doi:10.1016/j.ejrad.2020.108868

Cited by 27 publications

(19 citation statements)

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“…Since the pancreatic ductal system comprise only 4% of the normal pancreas [ 19 , 20 ], the diagnosis of non-calcific CP can be elusive or delayed when using ductal imaging alone [ 21 , 22 ]. MRI parenchymal signal changes may provide a more comprehensive evaluation of CP [ 6 – 8 ], potentially earlier detection of the pathophysiology, considering acinar cells comprise up to 85% of the normal pancreas [ 23 ]. Prior studies suggest that using ductal imaging has a moderate interobserver agreement [ 4 ] and using parenchymal imaging features may yield a more objective evaluation of CP [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies suggest that using ductal imaging has a moderate interobserver agreement [ 4 ] and using parenchymal imaging features may yield a more objective evaluation of CP [ 5 ]. Consensus guidelines highlighted the potential benefit of parenchymal imaging [ 6 – 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, diagnosis of CP can be elusive and delayed in patients without moderate-to-severe ductal abnormalities on MRCP or calcifications seen on CT. Prior retrospective studies, expert panel reviews, and consensus guidelines have suggested that parenchymal MRI findings such as T1 signal intensity ratio and quantitative relaxation time, pancreas volume, fat fraction, extracellular volume fraction can be helpful for diagnostic evaluation of CP [ 6 – 10 ]. In addition, quantitative MR imaging offers several advantages over conventional non-quantitative imaging, including quantitative measurement of the tissue relaxometry values (in vivo characterization of tissues), simplicity of analysis by allowing population-based comparisons, and cross-platform compatibility [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Quantitative MRI of chronic pancreatitis: results from a multi-institutional prospective study, magnetic resonance imaging as a non-invasive method for assessment of pancreatic fibrosis (MINIMAP)

et al. 2022

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Purpose To determine if quantitative MRI techniques can be helpful to evaluate chronic pancreatitis (CP) in a setting of multi-institutional study. Methods This study included a subgroup of participants ( n = 101) enrolled in the Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies (PROCEED) study (NCT03099850) from February 2019 to May 2021. MRI was performed on 1.5 T using Siemens and GE scanners at seven clinical centers across the USA. Quantitative MRI parameters of the pancreas included T1 relaxation time, extracellular volume (ECV) fraction, apparent diffusion coefficient (ADC), and fat signal fraction. We report the diagnostic performance and mean values within the control ( n = 50) and CP ( n = 51) groups. The T1, ECV and fat signal fraction were combined to generate the quantitative MRI score (Q-MRI). Results There was significantly higher T1 relaxation time; mean 669 ms (± 171) vs. 593 ms (± 82) ( p = 0.006), ECV fraction; 40.2% (± 14.7) vs. 30.3% (± 11.9) ( p < 0.001), and pancreatic fat signal fraction; 12.2% (± 5.5) vs. 8.2% (± 4.4) ( p < 0.001) in the CP group compared to controls. The ADC was similar between groups ( p = 0.45). The AUCs for the T1, ECV, and pancreatic fat signal fraction were 0.62, 0.72, and 0.73, respectively. The composite Q-MRI score improved the diagnostic performance (cross-validated AUC: 0.76). Conclusion Quantitative MR parameters evaluating the pancreatic parenchyma (T1, ECV fraction, and fat signal fraction) are helpful in the diagnosis of CP. A Q-MRI score that combines these three MR parameters improves diagnostic performance. Further studies are warranted with larger study populations including patients with acute and recurrent acute pancreatitis and longitudinal follow-ups. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s00261-022-03654-7.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantitative MRI of chronic pancreatitis: results from a multi-institutional prospective study, magnetic resonance imaging as a non-invasive method for assessment of pancreatic fibrosis (MINIMAP)

et al. 2022

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“…Patterns of structural changes in hereditary pancreatitis [34] and autoimmune pancreatitis [35] are also reported. Finally, decreasing pancreatic size following disease progression has been demonstrated [36]. Reports exploring independent associations between aetiological risk factors and patterns of structural changes using multivariate analyses in large CP cohorts are scarce.…”

Section: Discussionmentioning

confidence: 99%

Aetiological risk factors are associated with distinct imaging findings in patients with chronic pancreatitis: A study of 959 cases from the Scandinavian Baltic Pancreatic Club (SBPC) imaging database

et al. 2021

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“…The authors suggested that a decrease in IPFD and restoration of β-cell function were associated with gradual normalization of the pancreas size [21]. A longitudinal MR study in which individuals with chronic pancreatitis were followed up for 4 years showed a significantly reduced TPV and increased IPFD in comparison with baseline measurements [22]. In addition to TPV reduction, a reduction in the size of the tail of the pancreas in individuals with metabolic disorders was reported.…”

Section: Discussionmentioning

confidence: 99%

Associations between Intra-Pancreatic Fat Deposition, Pancreas Size, and Pancreatic Enzymes in Health and after an Attack of Acute Pancreatitis

Skudder-Hill

Priya

et al. 2021

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Introduction: Ectopic fat deposition in the pancreas is involved in the pathogenesis of metabolic sequelae following an attack of pancreatitis. However, its relationship with the exocrine pancreas has never been explored in this setting. The aim was to investigate the associations between intra-pancreatic fat deposition (IPFD), pancreas size, and pancreatic enzymes. Methods: This cross-sectional study recruited individuals with a history of acute pancreatitis and healthy controls. All participants underwent 3T magnetic resonance imaging, from which IPFD, total pancreas volume (TPV), and pancreas diameters (across the head, body, and tail) were measured independently by 2 raters in a blinded fashion. Circulating levels of pancreatic amylase, pancreatic lipase, and chymotrypsin were measured in a fasted state. A series of linear regression analyses was conducted, accounting for possible confounders. Results: A total of 108 individuals with pancreatitis and 60 healthy controls were studied. There was a statistically significant difference in IPFD (p < 0.001), but not in TPV (p = 0.389), between the groups. In the post-pancreatitis group, IPFD was significantly inversely associated with pancreas tail diameter (β = −0.736, p = 0.036 in the most adjusted model). In the control group, IPFD was significantly inversely associated with TPV (β = −3.557, p = 0.026 in the most adjusted model). Levels of pancreatic amylase were significantly directly associated with pancreas tail diameter in the post-pancreatitis group (β = 3.891, p = 0.042 in the most adjusted model), whereas levels of pancreatic lipase were significantly inversely associated with TPV in the control group (β = −10.533, p = 0.024 in the most adjusted model). Conclusion: Increased IPFD in individuals after an attack of pancreatitis is associated with reduced pancreas tail diameter, which is in turn associated with reduced circulating levels of pancreatic amylase. The relationship between IPFD and the exocrine pancreas warrants further investigations.

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Progression of parenchymal and ductal findings in patients with chronic pancreatitis: A 4-year follow-up MRI study

Cited by 27 publications

References 33 publications

Quantitative MRI of chronic pancreatitis: results from a multi-institutional prospective study, magnetic resonance imaging as a non-invasive method for assessment of pancreatic fibrosis (MINIMAP)

Quantitative MRI of chronic pancreatitis: results from a multi-institutional prospective study, magnetic resonance imaging as a non-invasive method for assessment of pancreatic fibrosis (MINIMAP)

Aetiological risk factors are associated with distinct imaging findings in patients with chronic pancreatitis: A study of 959 cases from the Scandinavian Baltic Pancreatic Club (SBPC) imaging database

Associations between Intra-Pancreatic Fat Deposition, Pancreas Size, and Pancreatic Enzymes in Health and after an Attack of Acute Pancreatitis

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