Clin Endosc.  2023 Jul;56(4):510-520. 10.5946/ce.2022.142.

Diagnostic value of homogenous delayed enhancement in contrast-enhanced computed tomography images and endoscopic ultrasound-guided tissue acquisition for patients with focal autoimmune pancreatitis

• Yonamine K
• Koshita S
• Kanno Y
• Ogawa T
• Kusunose H
• Sakai T
• Miyamoto K
• Kozakai F
• Anan H
• Okano H
• Oikawa M
• Tsuchiya T
• Sawai T
• Noda Y
• Ito K

• KMID: 2544574
• DOI: http://doi.org/10.5946/ce.2022.142

Abstract

Background/Aims
We aimed to investigate (1) promising clinical findings for the recognition of focal type autoimmune pancreatitis (FAIP) and (2) the impact of endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) on the diagnosis of FAIP.
Methods
Twenty-three patients with FAIP were involved in this study, and 44 patients with resected pancreatic ductal adenocarcinoma (PDAC) were included in the control group.
Results
(1) Multivariate analysis revealed that homogeneous delayed enhancement on contrast-enhanced computed tomography was a significant factor indicative of FAIP compared to PDAC (90% vs. 7%, p=0.015). (2) For 13 of 17 FAIP patients (76.5%) who underwent EUS-TA, EUS-TA aided the diagnostic confirmation of AIPs, and only one patient (5.9%) was found to have AIP after surgery. On the other hand, of the six patients who did not undergo EUS-TA, three (50.0%) underwent surgery for pancreatic lesions.
Conclusions
Homogeneous delayed enhancement on contrast-enhanced computed tomography was the most useful clinical factor for discriminating FAIPs from PDACs. EUS-TA is mandatory for diagnostic confirmation of FAIP lesions and can contribute to a reduction in the rate of unnecessary surgery for patients with FAIP.

Keyword

Autoimmune pancreatitis; Computed tomography; Endoscopic ultrasound-guided tissue acquisition; Focal type; Pancreatic ductal adenocarcinoma

Figure

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  Fig. 1. This patient (patient no. 1 in Table 4) was referred to our hospital due to a mass lesion in the pancreatic head. Using contrast-enhanced computed tomography, a focal mass lesion in the pancreatic head (arrow) which showed hypovascularity during the arterial phase (A) and homogeneously delayed enhancement during the portal (B) and delayed phases (C) was detected.

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  Fig. 2. This patient (patient no. 12 in Table 4) was referred to our hospital due to a mass lesion in the pancreatic body. Histological findings of the specimens obtained from the mass lesion by using endoscopic ultrasound-guided fine needle biopsy: The results of hematoxylin and eosin staining for the specimens showed abundant lymphoplasmacytic infiltration and storiform fibrosis (A, ×200). Using IgG4 immunostaining for the specimen, a large number of IgG4-positive plasma cells (B, ×200) was detected. Obliterative phlebitis was detected by using Elastica-Masson staining (C, ×400).

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