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Pancreatic duct “Icicle sign” on MRI for distinguishing autoimmune pancreatitis from pancreatic ductal adenocarcinoma in the proximal pancreas

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine reliable MRI features of autoimmune pancreatitis (AIP) in the proximal pancreas that could allow its differentiation from pancreatic ductal adenocarcinoma (PDAC).

Methods

Twenty-three patients with AIP and 61 patients with PDAC in the proximal pancreas underwent MRI. Two observers analyzed MRI for lesion morphology, hypointensity degree on T1-weighted images, enhancement pattern during dynamic phases, capsule-like rim, presence of cysts and duct penetrating sign, morphology of bile duct, and icicle appearance and tortuosity of the upstream pancreatic duct. Sensitivity and specificity for the diagnosis of AIP were calculated for each category or combined.

Results

When isointensity on the portal and late phase of MRI and/or the icicle sign of pancreatic duct are applied, 100 % sensitivity for the diagnosis of AIP in the proximal pancreas was achieved. Applying both mild T1 hypointensity similar to the spleen and the icicle sign enabled 100 % specificity for the diagnosis of AIP by differentiating it from PDAC.

Conclusion

The combination of the icicle sign in the upstream pancreatic duct and mild T1 hypointensity or isointensity on portal and late phase of dynamic MRI could be reliable MR features for the diagnosis of AIP in the proximal pancreas by allowing its differentiation from PDAC.

Key Points

• The icicle sign of the pancreatic duct is useful for diagnosing AIP.

• Mild T1 hypointensity similar to the spleen is useful for diagnosing AIP.

• Isointensity on portal and late phases MRI is useful for diagnosing AIP.

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Abbreviations

AIP:

Autoimmune pancreatitis

PDAC:

Pancreatic ductal adenocarcinoma

MRI:

Magnetic resonance imaging

MRCP:

MR cholangiopancreatography

2D:

2 dimensional

3D:

3 dimensional

AP:

Arterial phase

PVP:

Portal venous phase

T1WI:

T1-weighted images

T2WI:

T2-weighted image

AUC:

Areas under the receiver operating characteristics curve

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Acknowledgments

The guarantor of this study: Young Kon Kim M.D., Ph D. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Min Ji Kim, Ph D. of the statistics department in the Samsung Medical Centre kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, case-control study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Hae Jin Kim, Young Kon Kim, Woo Kyoung Jeong, Won Jae Lee & Dongil Choi

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  1. Hae Jin Kim
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  2. Young Kon Kim
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Correspondence to Young Kon Kim.

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Cite this article

Kim, H.J., Kim, Y.K., Jeong, W.K. et al. Pancreatic duct “Icicle sign” on MRI for distinguishing autoimmune pancreatitis from pancreatic ductal adenocarcinoma in the proximal pancreas. Eur Radiol 25, 1551–1560 (2015). https://doi.org/10.1007/s00330-014-3548-4

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  • DOI: https://doi.org/10.1007/s00330-014-3548-4

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