title: Pancreatic Steatosis and Fibrosis: Quantitative Assessment with Preoperative Multiparametric MR Imaging.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of multiparametric pancreatic magnetic resonance (MR) imaging, including the T2*-corrected Dixon technique and intravoxel incoherent motion (IVIM) diffusion-weighted (DW) imaging, in the quantification of pancreatic steatosis and fibrosis, with histologic analysis as the reference standard, and to determine the relationship between MR parameters and postoperative pancreatic fistula.
  
  
  METHODS
  This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. A total of 165 patients (93 men, 72 women; mean age, 62 years) underwent preoperative 3-T MR imaging and subsequent pancreatectomy (interval, 0-77 days). Fat fractions, IVIM DW imaging parameters (true diffusion coefficient [D], pseudodiffusion coefficient [D*], and perfusion fraction [f]), pancreas-to-muscle signal intensity ratios on unenhanced T1-weighted images, and pancreatic duct sizes were compared with the fat fractions and fibrosis degrees (F0-F3) of specimens. In 95 patients who underwent pancreatoenteric anastomosis, MR parameters were compared between groups with clinically relevant postoperative pancreatic fistula and those without. The relationship between postoperative pancreatic fistula and MR parameters was evaluated by using logistic regression analysis.
  
  
  RESULTS
  Fat fractions at MR imaging showed a moderate relationship with histologic findings (r = 0.71; 95% confidence interval: 0.63, 0.78). Patients with advanced fibrosis (F2-F3) had lower D*([39.72 ± 13.64] ×10(-3)mm(2)/sec vs [32.50 ± 13.09] ×10(-3)mm(2)/sec [mean ± standard deviation], P = .004), f (29.77% ± 8.51 vs 20.82% ± 8.66, P < .001), and unenhanced T1-weighted signal intensity ratio (1.43 ± 0.26 vs 1.21 ± 0.30, P < .001) than did patients with F0-F1 disease. Clinically relevant fistula developed in 14 (15%) of 95 patients, and f was significantly associated with postoperative pancreatic fistula (odds ratio, 1.17; 95% confidence interval: 1.05, 1.30).
  
  
  CONCLUSIONS
  Multiparametric MR imaging of the pancreas, including imaging with the T2*-corrected Dixon technique and IVIM DW imaging, may yield quantitative information regarding pancreatic steatosis and fibrosis, and f was shown to be significantly associated with postoperative pancreatic fistulas.
authors.affiliation: From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.).
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Yoon
authors.affiliation: From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.).
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.).
authors.forename: Kyung Bun
authors.initials: KB
authors.lastname: Lee
authors.affiliation: From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.).
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
authors.affiliation: From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.).
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.affiliation: From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.).
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.affiliation: From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.).
authors.forename: Stephan
authors.initials: S
authors.lastname: Kannengiesser
authors.affiliation: From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.).
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.affiliation: From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Pathology (K.B.L.), and Surgery (S.W.K., M.J.K., J.Y.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H., B.I.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H., B.I.C.); and Siemens Healthcare, Erlangen, Germany (S.K.).
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005355:Fibrosis; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000473:pathology* / Q000601:surgery*; D057234:Preoperative Period; D012189:Retrospective Studies