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Comparison of diagnostic performance between CT and MRI in differentiating non-diffuse-type autoimmune pancreatitis from pancreatic ductal adenocarcinoma

 Sunyoung Lee  ;  Jin Hee Kim  ;  So Yeon Kim  ;  Jae Ho Byun  ;  Hyoung Jung Kim  ;  Myung-Hwan Kim  ;  Moon-Gyu Lee  ;  Seung Soo Lee 
 EUROPEAN RADIOLOGY, Vol.28(12) : 5267-5274, 2018 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Autoimmune Diseases/diagnosis* ; Carcinoma, Pancreatic Ductal/diagnosis* ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Pancreas/diagnostic imaging* ; Pancreatic Neoplasms/diagnosis* ; Pancreatitis/diagnosis* ; ROC Curve ; Retrospective Studies ; Tomography, X-Ray Computed/methods* ; Young Adult
Autoimmune disease ; Carcinoma, pancreatic ductal ; Magnetic resonance imaging ; Multidetector computed tomography ; Pancreatitis
OBJECTIVES: To intraindividually compare the diagnostic performance of CT and MRI in differentiating non-diffuse-type autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDA). METHODS: Sixty-one patients with non-diffuse-type AIP and 122 patients with PDA, who underwent dynamic contrast-enhanced CT and MRI with MR pancreatography, were included. Two blinded radiologists independently rated their confidence in differentiating the two diseases on a 5-point scale, and the diagnostic performances of CT and MRI were compared. The presence of key imaging features to differentiate AIP and PDA were compared between CT and MRI. RESULTS: The area under the receiver operating characteristic curve was significantly greater on MRI (0.993-0.995) than on CT (0.953-0.976) for both raters (p≤0.035). The sensitivities of MRI were higher than those of CT for the diagnosis of AIP (88.5-90.2% vs. 77-80.3%, p≤0.07) and PDA (97.5-99.2% vs. 91.8-94.3%, p≤0.031) for both raters, although the difference for AIP was statistically marginal (p=0.07) for rater 1. In AIP, multiple pancreatic masses, delayed homogeneous enhancement of the pancreatic mass, and multiple main pancreatic duct (MPD) strictures were observed significantly more frequently using MRI than CT (p≤0.008). In PDA, discrete pancreatic mass and MPD stricture were observed significantly more frequently using MRI than CT (p≤0.012). CONCLUSIONS: The diagnostic performance of MRI is better for differentiating non-diffuse-type AIP from PDA, which is due to the superiority of MRI over CT in demonstrating the key distinguishing features of both diseases. KEY POINTS: • Imaging differential diagnosis of non-diffuse-type AIP and PDA is challenging. • MRI has better diagnostic performance than CT in differentiating non-diffuse-type AIP from PDA. • MRI is superior to CT in demonstrating key distinguishing features of non-diffuse-type AIP and PDA.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Sunyoung(이선영) ORCID logo https://orcid.org/0000-0002-6893-3136
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