TY - JOUR
T1 - Diagnostic performance of contrast-enhanced MRI with secretin-stimulated mrcp for non-calcific chronic pancreatitis
T2 - A comparison with histopathology
AU - Trikudanathan, Guru
AU - Walker, Sidney P.
AU - Munigala, Satish
AU - Spilseth, Ben
AU - Malli, Ahmad
AU - Han, Yusheng
AU - Bellin, Melena
AU - Chinnakotla, Srinath
AU - Dunn, Ty
AU - Pruett, Timothy L.
AU - Beilman, Gregory J.
AU - Vega Peralta, Jose
AU - Arain, Mustafa A.
AU - Amateau, Stuart K.
AU - Schwarzenberg, Sarah J.
AU - Mallery, Shawn
AU - Attam, Rajeev
AU - Freeman, Martin L.
N1 - Publisher Copyright:
© 2015 by the American College of Gastroenterology.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - OBJECTIVES:Diagnosis of non-calcific chronic pancreatitis (NCCP) in patients presenting with chronic abdominal pain is challenging and controversial. Contrast-enhanced magnetic resonance imaging (MRI) with secretin-stimulated MRCP (sMRCP) offers a safe and noninvasive modality to diagnose mild CP, but its findings have not been correlated with histopathology. We aimed to assess the correlation of a spectrum of MRI/sMRCP findings with surgical histopathology in a cohort of NCCP patients undergoing total pancreatectomy with islet autotransplantation (TPIAT).METHODS:Adult patients undergoing TPIAT for NCCP between 2008 and 2013 were identified from our institution's surgery database and were included if they had MRI/sMRCP within a year before surgery. Histology was obtained from resected pancreas at the time of TPIAT by wedge biopsy of head, body, and tail, and was graded by a gastrointestinal pathologist who was blinded to the imaging features. A fibrosis score (FS) of 2 or more was considered as abnormal, with FS ≥6 as severe fibrosis. A multivariate regression analysis was performed for MRI features predicting fibrosis, after taking age, sex, smoking, alcohol, and body mass index (BMI) into consideration. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation coefficient (r) was calculated.RESULTS:Fifty-seven patients (females=49, males=8) with NCCP and MRI/sMRCP were identified. ROC curve analysis showed that two or more MRI/sMRCP features provided the best balance of sensitivity (65%), specificity (89%), and accuracy (68%) to differentiate abnormal (FS≥2) from normal pancreatic tissue. Two or more features provided the best cutoff (sensitivity 88%, specificity 78%) for predicting severe fibrosis (FS≥6). There was a significant correlation between the number of features and severity of fibrosis (r=0.6, P<0.0001). A linear regression after taking age, smoking, and BMI into consideration showed that main pancreatic duct irregularity, T1-weighted signal intensity ratio between pancreas and paraspinal muscle, and duodenal filling after secretin injection to be significant independent predictors of fibrosis.CONCLUSIONS:A strong correlation exists between MRI/sMRCP findings and histopathology of NCCP.
AB - OBJECTIVES:Diagnosis of non-calcific chronic pancreatitis (NCCP) in patients presenting with chronic abdominal pain is challenging and controversial. Contrast-enhanced magnetic resonance imaging (MRI) with secretin-stimulated MRCP (sMRCP) offers a safe and noninvasive modality to diagnose mild CP, but its findings have not been correlated with histopathology. We aimed to assess the correlation of a spectrum of MRI/sMRCP findings with surgical histopathology in a cohort of NCCP patients undergoing total pancreatectomy with islet autotransplantation (TPIAT).METHODS:Adult patients undergoing TPIAT for NCCP between 2008 and 2013 were identified from our institution's surgery database and were included if they had MRI/sMRCP within a year before surgery. Histology was obtained from resected pancreas at the time of TPIAT by wedge biopsy of head, body, and tail, and was graded by a gastrointestinal pathologist who was blinded to the imaging features. A fibrosis score (FS) of 2 or more was considered as abnormal, with FS ≥6 as severe fibrosis. A multivariate regression analysis was performed for MRI features predicting fibrosis, after taking age, sex, smoking, alcohol, and body mass index (BMI) into consideration. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation coefficient (r) was calculated.RESULTS:Fifty-seven patients (females=49, males=8) with NCCP and MRI/sMRCP were identified. ROC curve analysis showed that two or more MRI/sMRCP features provided the best balance of sensitivity (65%), specificity (89%), and accuracy (68%) to differentiate abnormal (FS≥2) from normal pancreatic tissue. Two or more features provided the best cutoff (sensitivity 88%, specificity 78%) for predicting severe fibrosis (FS≥6). There was a significant correlation between the number of features and severity of fibrosis (r=0.6, P<0.0001). A linear regression after taking age, smoking, and BMI into consideration showed that main pancreatic duct irregularity, T1-weighted signal intensity ratio between pancreas and paraspinal muscle, and duodenal filling after secretin injection to be significant independent predictors of fibrosis.CONCLUSIONS:A strong correlation exists between MRI/sMRCP findings and histopathology of NCCP.
UR - http://www.scopus.com/inward/record.url?scp=84949091070&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84949091070&partnerID=8YFLogxK
U2 - 10.1038/ajg.2015.297
DO - 10.1038/ajg.2015.297
M3 - Article
C2 - 26372506
AN - SCOPUS:84949091070
SN - 0002-9270
VL - 110
SP - 1598
EP - 1606
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 11
ER -