Pancreatic carcinoma versus chronic pancreatitis: dynamic MR imaging.
OBJECTIVE
To determine if dynamic gadolinium-enhanced magnetic resonance (MR) imaging can distinguish chronic pancreatitis from pancreatic carcinoma.


METHODS
A retrospective review of MR and pathology examination findings was performed for 24 patients with pancreatic ductal adenocarcinoma and seven with chronic pancreatitis who underwent dynamic gadolinium-enhanced breath-hold spoiled gradient-echo imaging. Arterial, portal, and delayed phase images were obtained after injection of gadopentatate dimeglumine. The MR images of 14 patients without clinical evidence of pancreatic disease were also reviewed as controls. Signal intensity (SI) was measured on the precontrast (pre) and gadolinium-enhanced (post) images of the area of the pancreas sampled at biopsy and of the nontumorous pancreas. Percentage enhancement was defined as SIpre/SIpost x 100.


RESULTS
Normal pancreas showed rapid enhancement that peaked in the arterial or portal phase. For both diseases, T1-weighted images showed hypointense masses with progressive enhancement (differences were significant [P < .05] on only delayed fat-saturated images). Differences in enhancement between either disease state and normal pancreas were significant for at least one phase. Nontumorous pancreas in patients with carcinoma showed gradual enhancement that was significantly different from that of normal pancreas.


CONCLUSIONS
Chronic pancreatitis and pancreatic carcinoma show abnormal pancreatic enhancement, but the two were not distinguished on the basis of degree and time of enhancement.
Johnson
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PT
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. johnson5@jeflin.tju.edu
Outwater
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D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D010195:Pancreatitis / Q000175:diagnosis* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D003287:Contrast Media; D019786:Gadolinium DTPA