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Diffusion-weighted magnetic resonance imaging in autoimmune pancreatitis
Takao Taniguchi1, Hisato Kobayashi, Koji Nishikawa
1Department of Internal Medicine, Ohtsu Red Cross Hospital, 1-1-35 Nagara, Ohtsu, 520-8511, Japan. ttng8511@yahoo.co.jp
Purpose:
The aim of this study was to investigate the usefulness of diffusion-weighted magnetic resonance imaging (DWI MRI) for the diagnosis and evaluation of autoimmune pancreatitis (AIP).
Materials And Methods:
A total of 4 consecutive patients with AIP, 5 patients with chronic alcoholic pancreatitis (CP), and 13 patients without pancreatic disease (controls) were studied. DWI was performed in the axial plane with spin-echo echo-planar imaging single-shot sequence. Apparent diffusion coefficients (ADCs) were measured in circular regions of interest in the pancreas. In AIP patients, abdominal MRI was performed before, and 2-4 weeks after steroid treatment. Follow-up study was performed chronologically for up to 11 months in two patients. The correlation between ADCs of the pancreas and the immunoglobulin G4 (IgG4) index (serum IgG4 value/serum IgG4 value before steroid treatment) was evaluated.
Results:
In the AIP patients, DWI of the pancreas showed high signal intensity, and the ADCs of the pancreas (mean +/- SD: 0.97 +/- 0.18 x 10(-3) mm(2)/s) were significantly lower than those in patients with CP (1.45 +/- 0.10 x 10(-3) mm(2)/s) or the controls (1.45 +/- 0.16 x 10(-3) mm(2)/s) (Mann-Whitney U-test, P < 0.05). In one AIP patient with focal swelling of the pancreas head that appeared to be a mass, DWI showed high signal intensity throughout the pancreas, indicating diffuse involvement. The ADCs of the pancreas and IgG4 index were significantly inversely correlated (Spearman's rank correlation coefficient, r (s) = -0.80, P < 0.05).
Conclusion:
Autoimmune pancreatitis showed high signal intensity on DWI, which improved after steroid treatment. ADCs reflected disease activity. Thus, diffusion-weighted MRI might be useful for diagnosing AIP, determining the affected area, and evaluating the effect of treatment.
Insights
Diffusion-weighted MRI (DWI MRI) shows high signal intensity in autoimmune pancreatitis (AIP), with lower apparent diffusion coefficients (ADCs) compared to other conditions. DWI MRI may aid in diagnosing AIP and assessing treatment response.
Area of Science:
- Radiology
- Gastroenterology
- Immunology
Background:
- Autoimmune pancreatitis (AIP) is a chronic inflammatory condition requiring accurate diagnosis.
- Distinguishing AIP from other pancreatic diseases can be challenging.
- Magnetic resonance imaging (MRI) techniques are evolving for pancreatic disease evaluation.
Purpose of the Study:
- To assess the diagnostic utility of diffusion-weighted magnetic resonance imaging (DWI MRI) for autoimmune pancreatitis (AIP).
- To evaluate the effectiveness of DWI MRI in characterizing AIP lesions and monitoring treatment response.
Main Methods:
- Diffusion-weighted imaging (DWI) was performed on patients with AIP, chronic alcoholic pancreatitis (CP), and healthy controls.
- Apparent diffusion coefficients (ADCs) of the pancreas were measured.
- Correlations between ADCs and the immunoglobulin G4 (IgG4) index were analyzed.
- Serial MRI scans were obtained for AIP patients before and after steroid treatment.
Main Results:
- AIP patients exhibited high signal intensity on DWI and significantly lower pancreatic ADCs compared to CP patients and controls (P < 0.05).
- DWI revealed diffuse pancreatic involvement in an AIP patient with a suspected focal mass.
- A significant inverse correlation was found between pancreatic ADCs and the IgG4 index (r(s) = -0.80, P < 0.05).
Conclusions:
- Autoimmune pancreatitis demonstrates characteristic high signal intensity on DWI, which resolves with steroid treatment.
- ADCs measured by DWI MRI correlate with disease activity in AIP.
- DWI MRI shows promise for diagnosing AIP, defining the extent of disease, and evaluating therapeutic efficacy.
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