Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography.
OBJECTIVE
To prospectively assess accuracy of magnetic resonance (MR) imaging, MR cholangiopancreatography (MRCP), and MR angiography in patients suspected of having pancreatic tumors.


METHODS
Sixty-six patients suspected of having pancreatic tumors underwent MR imaging (unenhanced and contrast material-enhanced MR, MRCP, and contrast-enhanced MR angiography). Two blinded readers prospectively analyzed the images by consensus, and results were correlated with surgery, biopsy, or follow-up findings. Results were tabulated in two-by-two tables.


RESULTS
MR assessment of pancreatic lesion status (differentiation of benign vs malignant) resulted in 60 correct diagnoses (accuracy, 91%), and six (10%) false diagnoses. Among histologically proved malignant tumors, MR imaging yielded correct diagnoses in 42 of 44 patients (sensitivity, 95%; 95% CI: 85%, 99%), whereas 18 of 22 patients with benign findings were classified correctly. At MR imaging, findings in four patients with chronic pancreatitis were wrongly categorized as malignant tumors (specificity, 82%; 95% CI: 60%, 95%), and in one patient, a distal common bile duct carcinoma was not detected. In no patient with pancreatic adenocarcinoma was this tumor misdiagnosed as benign. In patients with malignant tumors who underwent resection, local-regional tumor growth and vascular infiltration were accurately classified in 89% and 94%, respectively. MR imaging depicted histologically proved synchronous hepatic metastases in 82%. The positive and negative predictive values for cancer nonresectability were 90% and 83%, respectively, and the accuracy, sensitivity, and specificity were 85%, 69%, and 95%, respectively.


CONCLUSIONS
Unenhanced and contrast-enhanced MR imaging with MRCP and MR angiography offers potential as a noninvasive tool for assessment of patients suspected of having pancreatic tumors.
Lopez Hänninen
Enrique
E
Department of Radiology, Charité Medical University Center, Campus Virchow Clinic, Humboldt University, Augustenburger Platz 1, D-13353 Berlin, Germany. enrique.lopez_hoenninen@charite.de
Amthauer
Holger
H
Hosten
Norbert
N
Ricke
Jens
J
Böhmig
Michael
M
Langrehr
Jan
J
Hintze
Rainer
R
Neuhaus
Peter
P
Wiedenmann
Bertram
B
Rosewicz
Stefan
S
Felix
Roland
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts; D002908:Chronic Disease; D003138:Common Bile Duct Neoplasms / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010179:Pancreas; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D010195:Pancreatitis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity