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Preoperative Evaluation of Pancreatic Fibrosis and Lipomatosis: Correlation of Magnetic Resonance Findings With Histology Using Magnetization Transfer Imaging and Multigradient Echo Magnetic Resonance Imaging.
- Source :
-
Investigative radiology [Invest Radiol] 2018 Dec; Vol. 53 (12), pp. 720-727. - Publication Year :
- 2018
-
Abstract
- Objectives: The purpose of this study was to evaluate the diagnostic performance of magnetization transfer (MT) imaging and multigradient echo magnetic resonance imaging (MRI) to quantify pancreatic fibrosis and lipomatosis in patients before pancreatoduodenectomy for postoperative risk stratification with histopathology as the reference standard.<br />Materials and Methods: Twenty-four patients (age, 68 ± 8 years, 16 males) prospectively underwent quantitative MT imaging using a 2-dimensional gradient echo sequence with and without MT prepulse and multigradient echo imaging on a 3 T MRI 1 day before pancreatoduodenectomy due to adenocarcinoma of the pancreatic head region (n = 20), neuroendocrine tumor (n = 3), or intraductal papillary mucinous neoplasm (n = 1). Magnetization transfer ratio (MTR) and proton density fat fraction (PDFF) were measured in pancreatic tail (PT) and at the resection margin (RM). Histopathologically, pancreatic fibrosis was graded as mild, moderate, or severe (F1-F3), lipomatosis was graded as 0% to 10%, 11% to 30%, and greater than 30% fat deposition (L1-L3). In addition, MTR and histopathologic fibrosis was assessed in pancreatic adenocarcinoma. Mann-Whitney U test and Spearman correlation were used.<br />Results: Patients with advanced pancreatic fibrosis (F3) showed a significantly higher MTR compared with the F1 group at the RM and PT (38 ± 4 vs 32.3 ± 1.6, P = 0.018 and 39.7 ± 5.5 vs 31.2 ± 1.7, P = 0.001). Spearman correlation coefficient of MTR and fibrosis grade was r = 0.532 (P = 0.011) and 0.554 (P = 0.008), respectively. Pancreatic parenchyma with advanced fat deposition (L2-L3) showed significantly higher PDFF compared with lipomatosis grade L1 (RM: P = 0.002 and PT: P = 0.001). Proton density fat fraction of pancreatic parenchyma exhibited a moderate and significant correlation with histopathologic lipomatosis grade (RM: r = 0.668 and PT: r = 0.707, P < 0.001). Magnetization transfer ratio was significantly higher in pancreatic adenocarcinoma compared with pancreatic parenchyma (44 ± 5.5 vs 36.0 ± 4.4 and 37.4 ± 5.4, P = 0.004).<br />Conclusions: Multiparametric MRI of the pancreas including MTR and PDFF maps may provide quantitative and noninvasive information on pancreatic fibrosis and lipomatosis before surgery.
- Subjects :
- Adult
Aged
Aged, 80 and over
Echo-Planar Imaging methods
Female
Fibrosis
Humans
Image Processing, Computer-Assisted methods
Lipomatosis complications
Male
Middle Aged
Pancreas diagnostic imaging
Pancreas pathology
Pancreas ultrastructure
Pancreatic Diseases complications
Pancreatic Neoplasms surgery
Lipomatosis diagnostic imaging
Magnetic Resonance Imaging methods
Pancreatic Diseases diagnostic imaging
Pancreatic Diseases pathology
Pancreatic Neoplasms complications
Preoperative Care methods
Subjects
Details
- Language :
- English
- ISSN :
- 1536-0210
- Volume :
- 53
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Investigative radiology
- Publication Type :
- Academic Journal
- Accession number :
- 30247172
- Full Text :
- https://doi.org/10.1097/RLI.0000000000000496