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Ferumoxytol-enhanced MR imaging for differentiating intrapancreatic splenules from other tumors
M R Muehler1,2, V R Rendell3, L L Bergmann4
1Department of Radiology, University of Wisconsin, Madison, WI, USA. muhler@wisc.edu.
Objectives:
Ferumoxytol is an ultra-small superparamagnetic iron oxide (USPIO) agent that is taken up by splenic tissue. This study describes our initial institutional experience of ferumoxytol-enhanced MRI (feMRI) for differentiating intrapancreatic splenules (IPS) from other pancreatic lesions.
Methods:
In this retrospective study, patients with computed tomographic imaging that identified small enhancing lesions in the tail of the pancreas subsequently underwent feMRI for further characterization. The feMRI protocol included T2-weighted (T2w) imaging with and without fat suppression (FS), R2* mapping, diffusion-weighted imaging (DWI), and T1-weighted (T1w) imaging with FS, prior to contrast injection. Immediately after slow intravenous infusion with 3 mg/kg body weight ferumoxytol, T1w was repeated. Delayed imaging with all sequences were obtained 24-72 h after ferumoxytol administration.
Results:
Seven patients underwent feMRI. In two patients, the pancreatic lesions were presumed as pancreatic neuroendocrine tumor (PNET) from feMRI and in the remaining 5 IPS. One of the two patients with PNET was symptomatic for NET. In another symptomatic patient with pathologically proven duodenal NET and suspected PNET, the pancreatic lesion was proven to be an IPS on feMRI. IPS demonstrated strong negative enhancement in feMRI on T2w and increased R2* values consistent with splenic tissue, while the presumed PNETs did not enhance. T2w FS was helpful on the pre-contrast images to identify IPS, while R2* did on post-contrast images. Neither DWI nor T1w contributed to differentiating PNETs from IPS.
Conclusions:
This study demonstrates the potential utility of feMRI as a helpful adjunct diagnostic tool for differentiating IPS from other pancreatic lesions. Further studies in larger patient cohorts are needed.
Insights
Ferumoxytol-enhanced MRI (feMRI) can help distinguish intrapancreatic splenules (IPS) from pancreatic tumors. IPS show characteristic enhancement patterns on feMRI, aiding in diagnosis.
Area of Science:
- Radiology
- Medical Imaging
- Gastroenterology
Background:
- Ferumoxytol is an ultra-small superparamagnetic iron oxide (USPIO) agent known for splenic uptake.
- Differentiating intrapancreatic splenules (IPS) from other pancreatic lesions can be challenging.
Purpose of the Study:
- To evaluate the utility of ferumoxytol-enhanced MRI (feMRI) in differentiating IPS from other pancreatic lesions.
- To describe the initial institutional experience with feMRI for this diagnostic purpose.
Main Methods:
- Retrospective study of patients with pancreatic lesions identified on CT.
- Utilized a comprehensive feMRI protocol including T2w, R2* mapping, DWI, and T1w sequences before and after ferumoxytol administration.
- Analyzed imaging features to differentiate IPS from presumed pancreatic neuroendocrine tumors (PNETs).
Main Results:
- feMRI successfully differentiated IPS from presumed PNETs in seven patients.
- IPS demonstrated characteristic strong negative enhancement on T2w and increased R2* values, consistent with splenic tissue.
- Presumed PNETs did not show enhancement, and DWI and T1w sequences were not critical for differentiation.
Conclusions:
- feMRI shows potential as a valuable tool for differentiating IPS from other pancreatic lesions.
- Further research with larger patient cohorts is warranted to confirm these findings.
