Characteristic magnetic resonance features of focal autoimmune pancreatitis useful for differentiation from pancreatic cancer

Abstract

Purpose: To identify characteristic magnetic resonance (MR) features of focal autoimmune pancreatitis (f-AIP) useful for differentiation from pancreatic cancer (PC).

Methods: We retrospectively analyzed MR imaging findings of 20 f-AIP lesions and 40 PC lesions smaller than 40 mm in diameter. On fat-suppressed T2-weighted images and dynamic contrast-enhanced fat-suppressed T1-weighted images (DCE-T1WI), we classified MR features of internal signal intensity for each lesion into homogeneous, speckled, or target type. We assessed the sensitivity, specificity, and accuracy of these findings in the diagnosis of f-AIP. We also investigated the incidence of previously reported findings for differentiation between f-AIP and PC.

Results: Speckled enhancement within a hypointense or isointense lesion on pancreatic phase DCE-T1WI (speckled type) was observed more frequently in f-AIP than in PC, with high sensitivity, high specificity, and high accuracy. Hypointensity to hyperintensity surrounding a less enhanced focal area on DCE-T1WIs (target type) and upper stream main pancreatic duct dilatation were observed more frequently in PC than in f-AIP.

Conclusion: Speckled enhancement inside an f-AIP lesion on pancreatic phase DCE-T1WI was useful for differentiation from PC.