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Observational Study
. 2021 Oct;46(10):4817-4827.
doi: 10.1007/s00261-021-03199-1. Epub 2021 Jul 5.

High signal intensity on diffusion-weighted magnetic resonance images is a useful finding for detecting early-stage pancreatic cancer

Akira Kurita  1   2 , Yoshiharu Mori  3 , Yuko Someya  4 , Shigeto Kubo  4 , Shunjiro Azuma  3 , Kosuke Iwano  3 , Satoshi Ikeda  4 , Ryosuke Okumura  4 , Shujiro Yazumi  3
Affiliations
Observational Study

High signal intensity on diffusion-weighted magnetic resonance images is a useful finding for detecting early-stage pancreatic cancer

Akira Kurita et al. Abdom Radiol (NY). 2021 Oct.

Abstract

Purpose: Early detection of pancreatic ductal adenocarcinoma (PDAC) may improve the prognosis. We evaluated novel imaging findings that may contribute to early detection.

Methods: This single-center, retrospective study enrolled 37 patients with a localized main pancreatic duct (MPD) stricture and no obvious pancreatic mass. All patients underwent endoscopic retrograde cholangiopancreatography and brush sampling with cytology and serial pancreatic juice aspiration cytologic examination via endoscopic naso-pancreatic drainage. Patients with cytology-confirmed malignancy underwent surgical resection. The remaining patients were followed by contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and endoscopic retrograde cholangiopancreatography.

Results: Twenty patients had confirmed malignancy (cancer group) and 17 did not (non-cancer group). Age, MPD stricture location, and PDAC risk factors were similar, but the sex predominance and symptom rate differed between the two groups. In the cancer group, 17 patients were diagnosed by cytology and three by clinical symptoms. CECT, MRI, and endoscopic ultrasonography (EUS) revealed no solid tumors in either group. CECT revealed no significant differences between groups. Diffusion-weighted MRI revealed significant differences in the signal intensity between groups. EUS detected indistinct and small hypoechoic areas in 70% and 41.2% of patients in the cancer and non-cancer groups, respectively. In the cancer group, 11 were diagnosed with cancer at the first indication, and nine were diagnosed at follow-up; the prognosis did not differ between these two subgroups.ss CONCLUSIONS: High signal intensity in diffusion-weighted MRI may be useful for detecting early-stage PDAC and may be an indication for surgical resection even without pathologic confirmation.

Clinical trial registration: The study was a registered at the University Hospital Medical Information Network (UMIN000039623).

Keywords: Diagnostic modality; Early diagnosis; Pancreatic cancer.

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Conflict of interest statement

The authors disclose no conflicts.

Figures

Fig. 1
Fig. 1
Flowchart of patients throughout the study
Fig. 2
Fig. 2
Study algorithm
Fig. 3
Fig. 3
a High signal intensity around the stricture in the diffusion-weighted image (arrowhead). b apparent diffusion coefficient values by 2 readers were 1.65 and 1.62 (× 10−3mm2/s), respectively. c Focal pancreatic parenchyma atrophy and main pancreatic duct stricture without a visible mass on computed tomography (arrowhead). d pancreatography shows a high-grade pancreatic duct stricture in the pancreatic tail
Fig. 4
Fig. 4
Resected pancreas with carcinoma in situ. High-grade pancreatic intraepithelial neoplasia in the periphery of the pancreas (hematoxylin & eosin, orig. mag. 40X). a Main pancreatic duct is indicated by the arrowhead. b Area in the red box
Fig. 5
Fig. 5
Comparison of the prognosis for patients diagnosed at the first indication and those diagnosed during follow-up
See this image and copyright information in PMC

Comment in

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