Focal pancreatic mass: Distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo MRI†

Purpose To determine the accuracy of MRI including T1-weighted gadolinium (Gd)-enhanced three-dimensional-gradient-echo (3D-GE) sequences to distinguish pancreatic cancer from chronic pancreatitis in patients with pancreatic mass or focal enlargement. Materials and Methods The study included 22 patients (15 males and seven females; mean age ± SD, 56.2 ± 11.5 years) with pancreatic mass or focal enlargement. Fourteen had pancreatic carcinoma and eight had chronic pancreatitis based on the histopathological and clinical findings. MRI examinations of all patients were retrospectively evaluated by two independent reviewers for the predetermined imaging findings of carcinoma and chronic pancreatitis. The accuracy of MRI for differentiating pancreatic carcinoma from chronic pancreatitis was determined. MRI findings of both entities were compared using t-tests, chi-squared tests, and logistic regression analyses for the differentiation of these two entities. The extent of agreement between two reviewers was determined with Kappa statistics. Results The sensitivity and specificity of MRI including T1-weighted 3D-GE sequences for differentiating pancreatic carcinoma from chronic pancreatitis were 93% (13/14) and 75% (6/8), respectively. The most discriminative finding for pancreatic carcinoma was relative demarcation of the mass compared to background pancreas in contrast to chronic pancreatitis on post-Gd 3D-GRE sequences (P < 0.05). Conclusion MRI including Gd-enhanced T1-weighted 3D-GE sequences can differentiate pancreatic carcinoma from chronic pancreatitis successfully in most cases. J. Magn. Reson. Imaging 2007. © 2007 Wiley-Liss, Inc.