title: Differentiation of pancreatobiliary-type from intestinal-type periampullary carcinomas using 3.0T MRI.
abstract: OBJECTIVE
  To differentiate pancreatobiliary-type from intestinal-type periampullary carcinomas using combined magnetic resonance cholangiopancreatography (MRCP), contrast-enhanced MRI, and diffusion-weighted imaging (DWI).
  
  
  METHODS
  MRI (3.0T) results of 41 patients with pathologically confirmed periampullary carcinoma were retrospectively assessed. Two radiologists, blinded to histologic type of each tumor, evaluated image findings independently. MRCP image features, enhancement pattern, and apparent diffusion coefficient (ADC) values were analyzed. Independent-sample t-test, chi-square, or Fisher's exact test were used to determine differential image findings between the pancreatobiliary-type and the intestinal-type group. Cohen's κ statistic or interclass correlation coefficient (ICC) were used to evaluate interobserver agreement between two observers. Univariate and multiple logistic regression analysis were performed to identify MRI features with predictive values.
  
  
  RESULTS
  On the basis of hematoxylin-eosin staining, 27 patients were classified as having pancreatobiliary-type carcinomas, and 14 patients the intestinal type. The pancreatobiliary-type carcinomas more commonly showed progressive enhancement than the intestinal type (P = 0.003). The minimum ADC (ADCmin ) value of the pancreatobiliary-type group ([0.95 ± 0.21] × 10(-3) mm(2) /s) was significantly lower than the intestinal-type group ([1.10 ± 0.25] × 10(-3) mm(2) /s) (P = 0.047). For interobserver agreement, the κ values and ICCs for all parameters exceeded 0.8, indicating almost perfect agreement. At multiple logistic regression analysis, the enhancement pattern was the only significant independent predictor (P = 0.011, odds ratio [OR] = 0.105). When the enhancement pattern and ADCmin were used in combination, we could identify 70.4% of pancreatobiliary-type and 78.6% of intestinal-type carcinomas.
  
  
  CONCLUSIONS
  Progressive enhancement and low ADCmin values suggest a pancreatobiliary-type periampullary carcinoma.
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Lei
authors.initials: L
authors.lastname: Bi
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Department of Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Changqing
authors.initials: C
authors.lastname: Jing
authors.affiliation: Department of Science and Education, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Qingzhong
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Xiu
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Shifeng
authors.initials: S
authors.lastname: Cai
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Zhaoqin
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Xue
authors.initials: X
authors.lastname: Han
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Qingwei
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, P.R. China.
authors.forename: Shouchen
authors.initials: S
authors.lastname: Lv
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D049448:Cholangiopancreatography, Magnetic Resonance; D003287:Contrast Media / Q000737:chemistry; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012372:ROC Curve; D012044:Regression Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: diffusion-weighted imaging; enhancement pattern; intestinal-type; magnetic resonance imaging; pancreatobiliary-type; periampullary carcinoma