Korean J Radiol.  2016 Aug;17(4):509-521. 10.3348/kjr.2016.17.4.509.

Comparison of Multidetector CT and Gadobutrol-Enhanced MR Imaging for Evaluation of Small, Solid Pancreatic Lesions

• Choi TW
• Lee JM
• Kim JH
• Yu MH
• Han JK
• Choi BI

• KMID: 2455421
• DOI: http://doi.org/10.3348/kjr.2016.17.4.509

Abstract

OBJECTIVE
To compare multidetector computed tomography (MDCT) and MRI for lesion conspicuity, as well as the detection and characterization of small solid pancreatic lesions (SPLs).
MATERIALS AND METHODS
193 patients with small SPLs (< 3 cm) and 52 patients with normal pancreas who underwent both multiphasic MDCT and gadobutrol-enhanced MRI were included in our study. Two radiologists blinded to the pathologic diagnoses independently reviewed those images, and determined the detection of "SPL per se" and "SPL in consideration of secondary features", the lesion conspicuity, the probability of pancreatic ductal adenocarcinoma (PDAC), and the most likely specific diagnosis.
RESULTS
The sensitivity of MRI for "detection of SPL per se" was significantly higher than that of CT in both reviewers: 92.7% (179/193) and 97.9% (189/193), respectively, for reviewer 1 (p = 0.031) and 90.7% (175/193) and 99.5% (192/193), respectively, for reviewer 2 (p < 0.001). In addition, MRI provided better lesion conspicuity than MDCT for both reviewers (p < 0.001). However, CT and MRI did not show significant difference in sensitivity for "detection of SPL in consideration of secondary features", specificity for SPL detection, and differentiation of PDAC vs. non-PDAC (p > 0.05). The accuracies of CT and MRI for making a specific diagnosis were as follows: 85.7% (210/245) vs. 86.9% (213/245), respectively, for reviewer 1 (p = 0.736), and 91.8% (225/245) vs. 93.5% (229/245), respectively, for reviewer 2 (p = 0.454).
CONCLUSION
MRI showed better lesion conspicuity than MDCT, but did not show significantly different diagnostic performance compared with MDCT for detecting and characterizing small SPLs.

Keyword

Pancreas; CT; MRI

MeSH Terms

Adult
Aged
Aged, 80 and over
Area Under Curve
Contrast Media/*chemistry
Databases, Factual
Diagnosis, Differential
Female
Humans
Image Interpretation, Computer-Assisted
*Magnetic Resonance Imaging
Male
Middle Aged
*Multidetector Computed Tomography
Organometallic Compounds/*chemistry
Pancreas/diagnostic imaging
Pancreatic Neoplasms/*diagnosis/diagnostic imaging
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Contrast Media
Organometallic Compounds

Figure

• 

  Fig. 1 81-year-old woman with pancreatic ductal adenocarcinoma. A. Axial, post-contrast CT image obtained during hepatic venous phase shows dilatation of main pancreatic duct with abrupt narrowing (arrow) at neck portion of pancreas. However no definite focal pancreatic mass lesion obstructing main pancreatic duct is visualized on CT. Both reviewers answered that SPL per se was not detected on CT images. However, main pancreatic ductal change led both reviewers to detection of SPL in consideration of secondary features and to correct diagnosis. B. Axial, fat-suppressed, T2-weighted image demonstrates dilatation of main pancreatic duct (arrowheads) and abrupt narrowing (arrow) without definite parenchymal lesion at neck portion of pancreas. C. Axial, fat–suppressed, T1-weighted image shows approximately 1 cm sized ill-defined, subtle hypointensity lesion (arrow) in neck portion of pancreas. D. Axial, post-contrast, T1-weighted image obtained during pancreatic phase, shows no definite mass lesion in pancreas. In addition, diffusion-weighted image did not show definite focal lesion in pancreas (not shown). Both reviewers reported SPL per se as detectable on MR image with poor lesion conspicuity graded as 1, and their specific diagnosis was pancreatic ductal adenocarcinoma. SPL = solid pancreatic lesion

• 

  Fig. 2 Representative figures for each conspicuity category from six different patients with pancreatic ductal adenocarcinoma. A, B, and C demonstrate axial CT images obtained during pancreatic phase and D, E, and F show axial fat-suppressed non-enhanced T1-weighted MR images. Conspicuity of lesion (arrows) is 1, poor, i.e., faint perceptibility of lesion, on A and D; 2, good, i.e., easily recognizable, on B and E; and 3, excellent, i.e., excellent lesion perceptibility, on C and F.

• 

  Fig. 3 40-year-old woman with pancreatic neuroendocrine tumor, grade 1. A. Axial, post-contrast CT image obtained during pancreatic phase shows subtle, slightly high attenuated lesion (arrow) in tail portion of pancreas. On CT, both reviewers were not able to detect "SPL in consideration of secondary features" as well as "SPL per se". B. Axial, fat-suppressed, T2-weighted image demonstrates approximately 1.5 cm sized hyperintense lesion (arrow) at pancreatic tail. C. On axial, fat–suppressed, non-enhanced T1-weighted image, lesion (arrow) shows marked hypointensity compared to that of pancreas parenchyma. D, E. Axial, diffusion-weighted image with b value of 800 sec/mm2 (D) and apparent diffusion constant map (E) also demonstrate hyperintense lesion (arrows) with diffusion restriction. On MRI, both reviewers were able to detect SPL per se and made correct specific diagnosis. Lesion conspicuity was excellent for reviewer 1, and good for reviewer 2. SPL = solid pancreatic lesion

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