Preoperative evaluation of pancreatic cancer: comparison of gadolinium-enhanced dynamic MRI with MR cholangiopancreatography versus MDCT.
OBJECTIVE
To determine the accuracy of magnetic resonance imaging (MRI) including dynamic imaging using three-dimensional gradient-echo (3D-GRE) sequences and MR cholangiopancreatograpy (MRCP) compared with that of multidetector row CT (MDCT) with regard to resectability in pancreas cancer.


METHODS
From February 2004 to July 2008, 54 patients (32 men, 22 women: age range, 28-83 years; mean age, 63.1 years old) with surgically proven pancreatic carcinoma, who had undergone preoperative gadolinium-enhanced 3D-GRE MRI with MRCP and triple-phase MDCT, were included in this retrospective study. Two, clinically experienced attending radiologists independently reviewed the two image sets. These readers evaluated the tumor conspicuity, presence of vascular invasion, choledochal and duodenal invasion, lymph node metastases, distant metastasis, and tumor resectability. The results were compared with the surgical and histopathologic findings using receiver operating characteristic analysis (Az) and kappa statistics.


RESULTS
Curative resections were performed on 42 patients. Regarding the tumor conspicuity, MRI had a significantly higher Az value compared with MDCT according to both reviewers (P < 0.05). The accuracy of resectability was Az = 0.753 and 0.768 on MRI and Az = 0.829 and 0.762 on MDCT for each reviewer, and the difference in the accuracy of resectability was not significant between MRI and MDCT for either reviewer (P > 0.05). Two imaging sets showed a similar diagnostic performance in the evaluation of vascular involvement, lymph node metastasis, and distant metastasis.


CONCLUSIONS
Dynamic 3D-GRE MRI with MRCP shows superior tumor conspicuity and similar diagnostic performance compared with MDCT in evaluating the resectability of pancreatic cancer.
Park
Hee Sun
HS
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Lee
Jeong Min
JM
Choi
Hei Kyung
HK
Hong
Sung Hyun
SH
Han
Joon Koo
JK
Choi
Byung Ihn
BI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007472:Iohexol / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives*; D008875:Middle Aged; D009367:Neoplasm Staging; D015588:Observer Variation; D009942:Organometallic Compounds; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D007472:Iohexol; D008536:Meglumine; C038192:iopromide