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Distinguishing pancreatic cancer and autoimmune pancreatitis with in vivo tomoelastography

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To prospectively investigate the stiffness and fluidity of pancreatic ductal adenocarcinoma (PDAC) and autoimmune pancreatitis (AIP) with tomoelastography, and to evaluate its diagnostic performance in distinguishing the two entities.

Methods

Tomoelastography provided high-resolution maps of shear wave speed (c in m/s) and phase angle (φ in rad), allowing mechanical characterization of the stiffness and fluidity properties of the pancreas. Forty patients with untreated PDAC and 33 patients with untreated AIP who underwent diagnostic pancreatic MRI at 3-T together with multifrequency MR elastography and tomoelastography data processing were prospectively enrolled. Ten healthy volunteers served as controls. Two radiologists and a technician measured pancreatic stiffness and fluidity independently. The two radiologists also independently evaluated the patients’ conventional MR sequences using the following diagnostic score: 1, definitely PDAC; 2, probably PDAC; 3, indeterminate; 4, probably AIP; and 5, definitely AIP. Interobserver agreement was assessed. Stiffness and fluidity of PDAC, AIP, and healthy pancreas, as well as diagnostic performance of tomoelastography and conventional MRI, were compared.

Results

AIP showed significantly lower stiffness and fluidity than PDAC and significantly higher stiffness and fluidity than healthy pancreas. Pancreatic fluidity was not influenced by secondary obstructive changes. The intraclass correlation coefficient for pancreatic stiffness and fluidity by the 3 readers was near-perfect (0.951–0.979, all p < 0.001). Both stiffness and fluidity allowed distinguishing PDAC from AIP. AUCs were 0.906 for stiffness, 0.872 for fluidity, and 0.842 for conventional MRI.

Conclusions

Pancreatic stiffness and fluidity both allow differentiation of PDAC and AIP with high accuracy.

Key Points

• AIP showed significantly lower stiffness and fluidity than PDAC and significantly higher stiffness and fluidity than healthy pancreas.

• Both stiffness and fluidity allowed distinguishing PDAC from AIP.

• Pancreatic fluidity could distinguish malignancy from non-malignant secondary obstructive changes.

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Abbreviations

AIP:

Autoimmune pancreatitis

AUC:

Area under the curve

CI:

Confidence interval

ICC:

Intraclass correlation coefficient

MRE:

Magnetic resonance elastography

PDAC:

Pancreatic ductal adenocarcinoma

ROC:

Receiver operating characteristics

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Acknowledgments

The authors sincerely acknowledge Dr.Yi Sun and Ms. Jinxia Zhu from Siemens Healthcare for the MR technical support, and Ms. Bettina Herwig from Department of Radiology, Charité-universitätsmedizin Berlin for the linguistic revision.

Funding

This study was funded by the National Natural Science Foundation of China (81901716 to L. Zhu and 81871512 to H. Xue), National Public Welfare, Basic Scientific Research Program of Chinese Academy of Medical Sciences (2019PT32008 to Z. Jin), and German Research Foundation (SFB 1340 “Matrix in Vision, GRK 2260 BIOQIC to I. Sack, J. Guo, P. Asbach, and B. Hamm).

Author information

Author notes

  1. Liang Zhu and Jing Guo contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Peking Union Medical College Hospital, Beijing, China

    Liang Zhu, Zhengyu Jin, Huadan Xue, Zhaoyong Sun & Jia Xu

  2. Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

    Jing Guo, Stephan R. Marticorena Garcia, Patrick Asbach, Bernd Hamm & Ingolf Sack

  3. Department of General Surgery, Peking Union Medical College Hospital, Beijing, China

    Menghua Dai

  4. Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China

    Wen Zhang

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  1. Liang Zhu
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Corresponding author

Correspondence to Zhengyu Jin.

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Guarantor

The scientific guarantor of this publication is Professor Ingolf Sack from the Department of Radiology, Charité-universitätsmedizin Berlin.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• Performed at one institution

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Zhu, L., Guo, J., Jin, Z. et al. Distinguishing pancreatic cancer and autoimmune pancreatitis with in vivo tomoelastography. Eur Radiol 31, 3366–3374 (2021). https://doi.org/10.1007/s00330-020-07420-5

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  • DOI: https://doi.org/10.1007/s00330-020-07420-5

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