Multitasking dynamic contrast enhanced magnetic resonance imaging can accurately differentiate chronic pancreatitis from pancreatic ductal adenocarcinoma

Nan Wang; Srinivas Gaddam; Yibin Xie; Anthony G Christodoulou; Chaowei Wu; Sen Ma; Zhaoyang Fan; Lixia Wang; Simon Lo; Andrew E Hendifar; Stephen J Pandol; Debiao Li

doi:10.3389/fonc.2022.1007134

Multitasking dynamic contrast enhanced magnetic resonance imaging can accurately differentiate chronic pancreatitis from pancreatic ductal adenocarcinoma

Front Oncol. 2023 Jan 6:12:1007134. doi: 10.3389/fonc.2022.1007134. eCollection 2022.

Authors

Nan Wang¹, Srinivas Gaddam², Yibin Xie¹, Anthony G Christodoulou^{1

3}, Chaowei Wu^{1

3}, Sen Ma¹, Zhaoyang Fan^{1

4}, Lixia Wang¹, Simon Lo², Andrew E Hendifar⁵, Stephen J Pandol², Debiao Li^{1

3}

Affiliations

¹ Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
² The Karsh Division of Gastroenterology and Hepatology, Cedars Sinai Medical Center, Los Angeles, CA, United States.
³ Bioengineering Department, University of California, Los Angeles, Los Angeles, CA, United States.
⁴ Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Los Angeles, CA, United States.
⁵ Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, United States.

Abstract

Background and aims: Accurate differentiation of chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDAC) is an area of unmet clinical need. In this study, a novel Multitasking dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) technique was used to quantitatively evaluate the microcirculation properties of pancreas in CP and PDAC and differentiate between them.

Methods: The Multitasking DCE technique was able to acquire one 3D image per second during the passage of MRI contrast agent, allowing the quantitative estimation of microcirculation properties of tissue, including blood flow F_p, plasma volume fraction v_p, transfer constant K^trans, and extravascular extracellular volume fraction v_e. Receiver operating characteristic (ROC) analysis was performed to differentiate the CP pancreas, PDAC pancreas, normal control pancreas, PDAC tumor, PDAC upstream, and PDAC downstream. ROCs from quantitative analysis and conventional analysis were compared.

Results: Fourteen PDAC patients, 8 CP patients and 20 healthy subjects were prospectively recruited. The combination of F_p, v_p, K^trans, and v_e can differentiate CP versus PDAC pancreas with good AUC (AUC [95% CI] = 0.821 [0.654 - 0.988]), CP versus normal pancreas with excellent AUC (1.000 [1.000 - 1.000]), PDAC pancreas versus normal pancreas with excellent AUC (1.000 [1.000 - 1.000]), CP versus PDAC tumor with excellent AUC (1.000 [1.000 - 1.000]), CP versus PDAC downstream with excellent AUC (0.917 [0.795 - 1.000]), and CP versus PDAC upstream with fair AUC (0.722 [0.465 - 0.980]). This quantitative analysis outperformed conventional analysis in differentiation of each pair.

Conclusion: Multitasking DCE MRI is a promising clinical tool that is capable of unbiased quantitative differentiation between CP from PDAC.

Keywords: Multitasking DCE; differential diagnosis of chronic pancreatitis and pancreatic ductal adenocarcinoma; dynamic contrast enhanced magnetic resonance imaging; microcirculation properties; quantitative imaging.

Abstract

Grants and funding