November 12, 2014
Notes: Jin, Yin
Research Support, Non-U.S. Gov’t
World J Gastroenterol. 2013 Jul 7;19(25):4066-71. doi: 10.3748/wjg.v19.i25.4066.
Author Address: Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang Province, China.
Reference Type: Journal Article
Record Number: 5104Author: Kalb, B., Martin, D. R., Sarmiento, J. M., Erickson, S. H., Gober, D., Tapper, E. B., Chen, Z. and Adsay, N. V.
Title: Paraduodenal pancreatitis: clinical performance of MR imaging in distinguishing from carcinoma
Short Title: Paraduodenal pancreatitis: clinical performance of MR imaging in distinguishing from carcinoma
Alternate Journal: Radiology
ISSN: 1527-1315 (Electronic)
Accession Number: 23847255
Carcinoma, Pancreatic Ductal/diagnosis
Contrast Media/diagnostic use
Magnetic Resonance Imaging/*methods
Meglumine/analogs & derivatives/diagnostic use
Organometallic Compounds/diagnostic use
Predictive Value of Tests
Sensitivity and Specificity
Abstract: PURPOSE: To evaluate the diagnostic performance of contrast material-enhanced magnetic resonance (MR) imaging for distinguishing paraduodenal pancreatitis (PDP) from pancreatic head duct adenocarcinoma (CA) in patients with diagnoses confirmed by histopathologic analysis. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board and is HIPAA compliant. Between July 2007 and July 2010, 47 patients who underwent Whipple procedure and MR imaging less than 60 days before surgery were identified retrospectively. Two relatively inexperienced fellowship trainees with 9 months of body fellowship training were asked to record the presence or absence of three MR imaging features: focal thickening of the second portion of the duodenum; abnormal enhancement of the second portion of the duodenum; and cystic focus in the expected region of the accessory pancreatic duct. Strict criteria for diagnosis of PDP included presence of all three imaging features. Any case that did not fulfill the criteria was classified as CA. Sensitivity, specificity, positive predictive value, and negative predictive value for characterization of PDP was calculated for each reader with 95% confidence intervals. A kappa test assessed level of agreement between readers. RESULTS: Each reader correctly categorized 15 of 17 (88.2%) PDP cases when all three imaging criteria were met. Alternatively, 26 of 30 (86.7%) pancreatic duct CA were correctly categorized as inconsistent with PDP. Four patients with histopathologic diagnosis of CA were incorrectly classified as PDP by each reader. Agreement between the two readers showed substantial kappa agreement for the diagnosis of PDP and differentiation from pancreatic duct CA. CONCLUSION: Contrast-enhanced MR imaging may help accurately identify PDP and distinguish it from CA when strict diagnostic criteria are followed. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13112056/-/DC1.