Kumaresan Sandrasegaran MD, Presenter: Research grant, Siemens AG Consultant, Repligen Corporation

Bilal Tahir MD, Abstract Co-Author: Nothing to Disclose

Kavitha Nuttaki MD, Abstract Co-Author: Nothing to Disclose

Mark Tann MD, Abstract Co-Author: Nothing to Disclose

Temel Tirkes MD, Abstract Co-Author: Nothing to Disclose

Thomas J. Howard, Abstract Co-Author: Nothing to Disclose

Many patients with mass-like chronic pancreatitis, particularly in the pancreatic head, undergo radical surgery since it is not possible to preoperatively differentiate this entity from ductal adenocarcinoma. We wanted to investigate if DWI may help in this situation.  

Retrospective review of radiology database revealed 36 patients with Whipple procedure, who also had preoperative MRI with DWI. Two reviewers (R1 and R2) blindly and independently assessed the DWI images for signal intensity on DWI, ADC of mass-like region and ADC of rest of pancreas. Four weeks later, they reviewed the remaining MRI sequences for size of mass, double duct sign (DD), pancreatic duct cut off (CO), and perivascular soft tissue cuffing (VC). Univariate and multivariate analysis was performed, using surgical pathology as gold standard.

There was no difference in age or gender between the cancer (group A, n=13) and chronic pancreatitis (group B, n=23) groups. On univariate analysis (table 1) the only finding that differentiated the two groups was size of mass (Table 1). On logistic regression, no conventional or DWI parameter was found to be differentiate the two groups. There was no significant lowering of ADC in both mass-like chronic pancreatitis and cancer, compared to rest of pancreas. Findings such as DD, CO and VC, which are typically associated with cancer, were not useful in differentiating the two groups.

Conventional MRI and DWI are not useful in separating cancer from chronic inflammation. Neither entity causes substantial lowering of ADC.

Prior studies have suggested that ADC measurements can reliably help differentiate these groups. It is probable that surgery will NOT be obviated by DWI findings.

Sandrasegaran, K, Tahir, B, Nuttaki, K, Tann, M, Tirkes, T, Howard, T, Does Diffusion-weighted Imaging Help in the Differentiation of Mass-like Chronic Pancreatitis and Pancreatic Cancer?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034368.html