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CT and MR features that can help to differentiate between focal chronic pancreatitis and pancreatic cancer

  • ABDOMINAL RADIOLOGY
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Abstract

Diagnosis of a focal pancreatic mass in routine clinical practice can be a challenge because patients with chronic pancreatitis may present with symptoms and imaging findings that can be difficult to distinguish from pancreatic cancer. Markers, such as cancer antigen 19-9 and carcinoembryonic antigen, are helpful if abnormal, but normal values do not rule out pancreatic cancer. One of the strongest complicating factors is that chronic pancreatitis is a risk factor for pancreatic cancer. Transition of chronic pancreatitis to pancreatic cancer is relatively rare, but it normally has a poor prognosis because diagnosis is often delayed. From a radiologic diagnosis perspective, the classic so-called double-duct sign is helpful. This sign is considered a hallmark sign of pancreatic cancer on magnetic resonance cholangiopancreatography, but it can also be identified in patients with chronic pancreatitis or with other conditions. A number of additional imaging findings or signs are, therefore, necessary. The aim of this article was to describe the strong CT and MR imaging features or integrated imaging features that can help to differentiate between pancreatic cancer and focal chronic pancreatitis.

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References

  1. Robinson PJ, Sheridan MB (2000) Pancreatitis: computed tomography and magnetic resonance imaging. Eur Radiol 10:401–408. https://doi.org/10.1007/s003300050066

    Article  CAS  PubMed  Google Scholar 

  2. Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A, Kamata N (2003) Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma. Am J Gastroenterol 98(12):2964–2999. https://doi.org/10.1111/j.1572-0241.2003.08775.x

    Article  Google Scholar 

  3. Frampas E, Morla O, Regenet N, Eugène T, Dupas B, Meurette G (2013) A solid pancreatic mass: tumour or inflammation? Diagn Interv Imaging 94:741–755. https://doi.org/10.1016/j.diii.2013.03.013

    Article  CAS  PubMed  Google Scholar 

  4. Johnson PT, Outwater EK (1999) Pancreatic carcinoma versus chronic pancreatitis: dynamic MR imaging. Radiology 212(1):213–218. https://doi.org/10.1148/radiology.212.1.r99jl16213

    Article  CAS  PubMed  Google Scholar 

  5. Kim T, Murakami T, Takamura M, Hori M, Takahashi S, Nakamori S et al (2001) Pancreatic mass due to chronic pancreatitis: correlation of CT and MR imaging features with pathologic findings. AJR Am J Roentgenol 177:367–371. https://doi.org/10.2214/ajr.177.2.1770367

    Article  CAS  PubMed  Google Scholar 

  6. Kim SW, Kim SH, Lee DH, Lee SM, Kim YS, Jang JY, Han JK (2017) Isolated main pancreatic duct dilatation: CT differentiation between benign and malignant causes. AJR Am J Roentgenol 209(5):1046–1055. https://doi.org/10.2214/AJR.17.17963

    Article  PubMed  Google Scholar 

  7. Plumley TF, Rohrmann CA, Freeny PC, Silverstein FE, Ball TJ (1982) Double duct sign: reassessed significance in ERCP. Am J Roentgenol 138:31–35. https://doi.org/10.2214/ajr.138.1.31

    Article  CAS  Google Scholar 

  8. Edge MD, Hoteit M, Patel AP, Wang X, Cai Q (2007) Clinical significance of main pancreatic duct dilation on computed tomography: single and double duct dilation. World J Gastroenterol 13(11):1701–1705. https://doi.org/10.3748/wjg.v13.i11.1701

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kim SW, Kim SH, Lee DH, Lee SM, Kim YS, Jang JY et al (2017) Isolated main pancreatic duct dilatation: CT differentiation between benign and malignant cause. AJR 209:1046–1055. https://doi.org/10.2214/AJR.17.17963

    Article  PubMed  Google Scholar 

  10. Eloubeidi M, Luz L, Tamhane A, Khan M, Buxbaum JL (2013) Ratio of pancreatic duct caliber to width of pancreatic gland by endosonography is predictive of pancreatic cancer. Pancreas 42(4):670–679. https://doi.org/10.1016/j.gie.2009.03.162

    Article  PubMed  Google Scholar 

  11. Karasawa E, Goldberg HI, Moss AA, Federle MP, London SS (1983) CT pancreatogram in carcinoma of the pancreas and chronic pancreatitis. Radiology 148(2):489–493. https://doi.org/10.1148/radiology.148.2.6867347

    Article  CAS  PubMed  Google Scholar 

  12. Tanaka S, Nakaizumi A, Ioka T, Oshikawa O, Uehara H, Nakao M et al (2002) Main pancreatic duct dilatation: a sign of high risk for pancreatic cancer. Jpn J Clin Oncol 32(10):407–411. https://doi.org/10.1093/jjco/hyf093

    Article  PubMed  Google Scholar 

  13. Elmas N, Yorulmaz İ, Oran İ, Oyar O, Özütemiz Ö, Özer H (1996) A new criterion in differentiation of pancreatitis and pancreatic carcinoma: artery to vein ratio using the superior mesenteric vessels. Abdom Imaging 21:331–333. https://doi.org/10.1007/s002619900075

    Article  CAS  PubMed  Google Scholar 

  14. Rodriguez S, Faigel D (2010) Absence of a dilated duct predicts benign disease in suspected pancreas cancer: a simple clinical rule. Dig Dis Sci 55:1161–1166. https://doi.org/10.1007/s10620-009-0889-y

    Article  PubMed  Google Scholar 

  15. Matos C, Metens T, Deviere J, Liaise N, Braude P, Van Yperen G et al (1997) Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation. Radiology 203:435–441. https://doi.org/10.1148/radiology.203.2.9114101

    Article  CAS  PubMed  Google Scholar 

  16. Ichikawa T, Sou H, Araki T, Arbab AS, Yoshikawa T, Ishigame K et al (2001) Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 221(1):107–116. https://doi.org/10.1148/radiol.2211001157

    Article  CAS  PubMed  Google Scholar 

  17. Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Nishi A et al (2009) Diagnostic value of the delayed phase image for iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography. Eur J Radiol 69(1):139–146. https://doi.org/10.1016/j.ejrad.2007.09.012

    Article  PubMed  Google Scholar 

  18. Kim HJ, Kim YK, Jeong WK, Lee WJ, Choi D (2015) Pancreatic duct “Icicle sign” on MRI for distinguishing autoimmune pancreatitis from pancreatic ductal adenocarcinoma in proximal pancreas. Eur Radiol 25:1551–1560. https://doi.org/10.1007/s00330-014-3548-4

    Article  PubMed  Google Scholar 

  19. Sun GF, Zuo CJ, Shao CW, Wang JH, Zhang J (2013) Focal autoimmune pancreatitis: radiological characteristics help to distinguish from pancreatic cancer. World J Gastroenterol 19:3634–3641. https://doi.org/10.3748/wjg.v19.i23.3634

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A, Kamata N (2003) Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma. Am J Gastroenterol 98(12):2694–2699. https://doi.org/10.1111/j.1572-0241.2003.08775.x

    Article  PubMed  Google Scholar 

  21. Tirkes T (2018) Chronic pancreatitis. What the clinician wants to know from MR imaging. Magn Reson Imaging Clin N Am 26:451–461. https://doi.org/10.1016/j.mric.2018.03.012

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ly JN, Miller FH (2002) MR imaging of the pancreas. A practical approach. Radiol Clin N Am 40:1289–1306

    Article  Google Scholar 

  23. Tamura R, Ishibashi T, Takahashi S (2006) Chronic pancreatitis: MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation. Radiology 238:920–928. https://doi.org/10.1148/radiol.2382041527

    Article  PubMed  Google Scholar 

  24. Miller FH, Keppke AL, Wadhwa A, Ly JN, Dalal K, Kamler VA (2004) MRI of pancreatitis and its complications: part 2, chronic pancreatitis. AJR Am J Roentgenol 183(6):1645–1652. https://doi.org/10.2214/ajr.183.6.01831645

    Article  PubMed  Google Scholar 

  25. Leyendecker JR, Elsayes KM, Gratz BI, Brown JJ (2002) MR cholangiopancreatography: spectrum of pancreatic duct abnormality. AJR Am J Roentgenol 179:1465–1471. https://doi.org/10.2214/ajr.179.6.1791465

    Article  PubMed  Google Scholar 

  26. Lu DSK, Vedantham S, Krasny RM, Kadell B, Berger WL, Reber HA (1996) Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas and vascular structures. Radiology 199:607–701. https://doi.org/10.1148/radiology.199.3.8637990

    Article  Google Scholar 

  27. Li H, Zeng MS, Zhou KR, Jin DY, Lou WH (2005) Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion. J Comput Assist Tomogr 29:170–175. https://doi.org/10.1097/01.rct.0000155060.73107.83

    Article  PubMed  Google Scholar 

  28. Montejo Gañán I, Ángel Ríos LF, Sarría Octavio de Toledo L, Martínez Mombila ME, Ros Mendoza LH (2018) Staging pancreatic carcinoma by computed tomography. Radiología (English Edition) 60(1):10. https://doi.org/10.1016/j.rxeng.2017.08.003

    Article  Google Scholar 

  29. Megibow AJ, Bosniak MA, Ambos MA, Beranbaum ER (1981) Thickening of celiac axis and/or superior mesenteric artery: a sign of pancreatic carcinoma on computed tomography. Radiology 141:449–453. https://doi.org/10.1148/radiology.141.2.7291572

    Article  CAS  PubMed  Google Scholar 

  30. Baker ME, Cohan RH, Nadel SN, Leder RA, Dunnick NR (1990) Obliteration of the fat surrounding the celiac axis and superior mesenteric artery is not a specific CT finding of carcinoma of pancreas. AJR 155:991–996. https://doi.org/10.2214/ajr.155.5.2120970

    Article  CAS  PubMed  Google Scholar 

  31. Perez-Johnston R, Sainani NI, Sahani DV (2012) Imaging of chronic pancreatitis (including groove and autoimmune pancreatitis). Radiol Clin N Am 50(3):447–466. https://doi.org/10.1016/j.rcl.2012.03.005

    Article  PubMed  Google Scholar 

  32. Kim JK, Altun E, Elias J, Pamuklar E, Rivero H, Semelka RC (2007) Focal pancreatic mass: distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo. MRI J Magn Resonance Imaging 26:313–322. https://doi.org/10.1002/jmri.21010

    Article  Google Scholar 

  33. Birchard KR, Semelka RC, Hyslop WB, Brown A, Armao D, Firat Z, Vaidean G (2005) Suspected pancreatic cancer: evaluation by dynamic gadolinium-enhanced 3D gradient-echo MRI. AJR Am J Roentgenol 185:700–703. https://doi.org/10.2214/ajr.185.3.01850700

    Article  PubMed  Google Scholar 

  34. Pamuklar E, Semelka RC (2005) MR imaging of the pancreas. Magn Reson Imaging Clin NAm 13:313–330. https://doi.org/10.1016/j.mric.2005.03.012

    Article  Google Scholar 

  35. Choueiri NE, Balci NC, Alkaade S, Burton FR (2010) Advanced imaging on chronic pancreatitis. Curr Gastroenterol Rep 12(2):114–120. https://doi.org/10.1007/s11894-010-0093-4

    Article  PubMed  Google Scholar 

  36. Ferrucci JT Jr, Wittenberg J, Black EB, Kirkpatrick RH, Hall DA (1979) Computed body tomography in chronic pancreatitis. Radiology 130:175–182. https://doi.org/10.1148/130.1.175

    Article  CAS  PubMed  Google Scholar 

  37. Frulloni L, Castellani C, Bovo P, Vaona B, Calore B, Liani C et al (2003) Natural history of pancreatitis associated with cystic fibrosis gene mutations. Dig Liver Dis 35:179–185. https://doi.org/10.1016/S1590-8658(03)00026-4

    Article  CAS  PubMed  Google Scholar 

  38. Lesniak RJ, Hohenwalter MD, Taylor AJ (2002) Spectrum of causes of pancreatic calcifications. AJR Am J Roentgenol 178:79–86. https://doi.org/10.2214/ajr.178.1.1780079

    Article  PubMed  Google Scholar 

  39. Tirkes T, Shah ZK, Takahashi N, Grajo JR, Chang ST, Venkatesh SK et al (2019) Reporting standards for chronic pancreatitis by using CT, MRI, and MR cholangiopancreatography: the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Radiology 290:207–215. https://doi.org/10.1148/radiol.2018181353

    Article  PubMed  Google Scholar 

  40. Niu X, Das SK, Bhetuwal A, Xiao Y, Sun F, Zeng L et al (2014) Value of diffusion-weighted imaging in distinguishing pancreatic carcinoma from mass-forming chronic pancreatitis: a meta-analysis. Chin Med J (Engl) 127(19):3477–3482. https://doi.org/10.1097/MEG.0b013e32834eff37

    Article  Google Scholar 

  41. Sandrasegaran K, Nutakki B, Tahir A, Dhanabal M, Tann GA (2013) Cote, use of diffusion-weighted MRI to differentiate chronic pancreatitis from pancreatic cancer. AJR 201:1002–1008. https://doi.org/10.2214/AJR.12.10170

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand

    Sitthipong Srisajjakul & Patcharin Prapaisilp

  2. Department of Internal Medicine, Pathum Thani Hospital, 7 Ladlumkaew-Patumthani Road, Muang District, Pathum Thani, 12000, Thailand

    Sirikan Bangchokdee

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  1. Sitthipong Srisajjakul
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Correspondence to Sitthipong Srisajjakul.

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Srisajjakul, S., Prapaisilp, P. & Bangchokdee, S. CT and MR features that can help to differentiate between focal chronic pancreatitis and pancreatic cancer. Radiol med 125, 356–364 (2020). https://doi.org/10.1007/s11547-019-01132-7

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