Recent Advances in Pancreatic MR Imaging: A Guide on How, When, and Why to Perform

Sivasubramanian Srinivasan; Argha Chatterjee

doi:10.1055/s-0040-1709080

Journal of Gastrointestinal and Abdominal Radiology, Table of Contents

CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2020; 3(01): 002-013
DOI: 10.1055/s-0040-1709080

Review Article

Recent Advances in Pancreatic MR Imaging: A Guide on How, When, and Why to Perform

Sivasubramanian Srinivasan

¹Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore

,

Argha Chatterjee

²Department of Radiology and Imaging, Tata Medical Center, Kolkata, India

› Author Affiliations

Abstract

Imaging of the pancreas is often challenging because of its retroperitoneal location and unique set of pathologies. Conventional imaging modalities, such as transabdominal and endoscopic ultrasonography (EUS), computed tomography (CT), and magnetic resonance imaging (MRI), are well described in the literature. However, with modern demand for functional and molecular information from imaging studies, newer imaging modalities and modifications of existing modalities are developed. MRI is widely used as a problem-solving tool in pancreatic pathologies. Magnetic resonance cholangiopancreatography (MRCP) is an excellent technique for the depiction of the pancreatic ductal or biliary ductal pathologies. Newer modification of MRI including secretin MRCP, advanced diffusion-weighted imaging (DWI), perfusion imaging, and tissue composition analysis (fat and fibrosis quantification) add to the arsenal of MRI of the pancreas. In this review, we discuss the evolution of MRI of the pancreas and clinical application of advanced MR sequences.

Keywords

diffusion magnetic resonance imaging - magnetic resonance imaging - pancreas - recent advance

Full Text

References

References
1 Sandrasegaran K, Lin C, Akisik FM, Tann M. State-of-the-art pancreatic MRI. AJR Am J Roentgenol 2010; 195 (01) 42-53
2 Tscholakoff D, Hricak H, Thoeni R, Winkler ML, Margulis AR. MR imaging in the diagnosis of pancreatic disease. AJR Am J Roentgenol 1987; 148 (04) 703-709
3 Fölsing C, Helmberger T, Sittek H, Reiser M. [Caroli syndrome: diagnostic possibilities of magnetic resonance tomography and MR cholangiopancreaticography] (in German).. Rontgenpraxis 1996; 49 (09) 226-228
4 Siddiqui N, Vendrami CL, Chatterjee A, Miller FH, Advanced MR. Advanced MR imaging techniques for pancreas imaging. Magn Reson Imaging Clin N Am 2018; 26 (03) 323-344
5 Tirkes T, Menias CO, Sandrasegaran K. MR imaging techniques for pancreas. Radiol Clin North Am 2012; 50 (03) 379-393
6 Patel BN. Routine MR Imaging for pancreas. Magn Reson Imaging Clin N Am 2018; 26 (03) 315-322
7 Maccioni F, Martinelli M, Al Ansari N. et al. Magnetic resonance cholangiography: past, present and future: a review. Eur Rev Med Pharmacol Sci 2010; 14 (08) 721-725
8 Coppens E, Metens T, Winant C, Matos C. Pineapple juice labeled with gadolinium: a convenient oral contrast for magnetic resonance cholangiopancreatography. Eur Radiol 2005; 15 (10) 2122-2129
9 Papanikolaou N, Karantanas A, Maris T, Gourtsoyiannis N. MR cholangiopancreatography before and after oral blueberry juice administration. J Comput Assist Tomogr 2000; 24 (02) 229-234
10 Riordan RD, Khonsari M, Jeffries J, Maskell GF, Cook PG. Pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography: a preliminary evaluation. Br J Radiol 2004; 77 (924) 991-999
11 Pamuklar Sr E, Semelka RC. MR imaging of the pancreas. Magn Reson Imaging Clin N Am 2005; 13 (02) 313-330
12 Winston CB, Mitchell DG, Outwater EK, Ehrlich SM. Pancreatic signal intensity on T1-weighted fat saturation MR images: clinical correlation. J Magn Reson Imaging 1995; 5 (03) 267-271
13 Kim BS, Kim JH, Choi GM. et al. Comparison of three free-breathing T2-weighted MRI sequences in the evaluation of focal liver lesions. AJR Am J Roentgenol 2008; 190 (01) W19-W27
14 Bosmans H, Van Hoe L, Gryspeerdt S. et al. Single-shot T2-weighted MR imaging of the upper abdomen: preliminary experience with double-echo HASTE technique. AJR Am J Roentgenol 1997; 169 (05) 1291-1293
15 Semelka RC, Kelekis NL, Thomasson D, Brown MA, Laub GA. HASTE MR imaging: description of technique and preliminary results in the abdomen. J Magn Reson Imaging 1996; 6 (04) 698-699
16 Lee SS, Byun JH, Hong HS. et al. Image quality and focal lesion detection on T2-weighted MR imaging of the liver: comparison of two high-resolution free-breathing imaging techniques with two breath-hold imaging techniques. J Magn Reson Imaging 2007; 26 (02) 323-330
17 Delfaut EM, Beltran J, Johnson G, Rousseau J, Marchandise X, Cotten A. Fat suppression in MR imaging: techniques and pitfalls. Radiographics 1999; 19 (02) 373-382
18 Vitellas KM, Keogan MT, Spritzer CE, Nelson RC. MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. Radiographics 2000; 20 (04) 939-957, quiz 1107–1108, 1112
19 Sodickson A, Mortele KJ, Barish MA, Zou KH, Thibodeau S, Tempany CM. Three-dimensional fast-recovery fast spin-echo MRCP: comparison with two-dimensional single-shot fast spin-echo techniques. Radiology 2006; 238 (02) 549-559
20 Yoon LS, Catalano OA, Fritz S, Ferrone CR, Hahn PF, Sahani DV. Another dimension in magnetic resonance cholangiopancreatography: comparison of 2- and 3-dimensional magnetic resonance cholangiopancreatography for the evaluation of intraductal papillary mucinous neoplasm of the pancreas. J Comput Assist Tomogr 2009; 33 (03) 363-368
21 Soto JA, Barish MA, Yucel EK, Ferrucci JT. MR cholangiopancreatography: findings on 3D fast spin-echo imaging. AJR Am J Roentgenol 1995; 165 (06) 1397-1401
22 Chouhan MD, Firmin L, Read S, Amin Z, Taylor SA. Quantitative pancreatic MRI: a pathology-based review. Br J Radiol 2019; 92 (1099) 20180941
23 Trout AT, Wallihan DB, Serai S, Abu-El-Haija M. Secretin-enhanced magnetic resonance cholangiopancreatography for assessing pancreatic secretory function in children. J Pediatr 2017; 188: 186-191
24 Tirkes T, Sandrasegaran K, Sanyal R. et al. Secretin-enhanced MR cholangiopancreatography: spectrum of findings. Radiographics 2013; 33 (07) 1889-1906
25 Akisik MF, Sandrasegaran K, Aisen AA, Maglinte DD, Sherman S, Lehman GA. Dynamic secretin-enhanced MR cholangiopancreatography. Radiographics 2006; 26 (03) 665-677
26 Monill J, Pernas J, Clavero J. et al. Pancreatic duct after pancreatoduodenectomy: morphologic and functional evaluation with secretin-stimulated MR pancreatography. AJR Am J Roentgenol 2004; 183 (05) 1267-1274
27 Schraml C, Schwenzer NF, Martirosian P, Claussen CD, Schick F. Perfusion imaging of the pancreas using an arterial spin labeling technique. J Magn Reson Imaging 2008; 28 (06) 1459-1465
28 Kim JH, Lee JM, Park JH. et al. Solid pancreatic lesions: characterization by using timing bolus dynamic contrast-enhanced MR imaging assessment–a preliminary study. Radiology 2013; 266 (01) 185-196
29 Ma W, Li N, Zhao W. et al. Apparent diffusion coefficient and dynamic contrast-enhanced magnetic resonance imaging in pancreatic cancer: characteristics and correlation with histopathologic parameters. J Comput Assist Tomogr 2016; 40 (05) 709-716
30 Barral M, Taouli B, Guiu B. et al. Diffusion-weighted MR imaging of the pancreas: current status and recommendations. Radiology 2015; 274 (01) 45-63
31 Virostko J, Williams J, Hilmes M. et al. Pancreas volume declines during the first year after diagnosis of Type 1 diabetes and exhibits altered diffusion at disease onset. Diabetes Care 2019; 42 (02) 248-257
32 de Freitas Tertulino F, Schraibman V, Ardengh JC. et al. Diffusion-weighted magnetic resonance imaging indicates the severity of acute pancreatitis. Abdom Imaging 2015; 40 (02) 265-271
33 Thomas S, Kayhan A, Lakadamyali H, Oto A. Diffusion MRI of acute pancreatitis and comparison with normal individuals using ADC values. Emerg Radiol 2012; 19 (01) 5-9
34 Yencilek E, Telli S, Tekesin K. et al. The efficacy of diffusion weighted Subgroups, imaging for detection of acute pancreatitis and comparison of Gastroenterol, according to Balthazar classification. Turk J Gastroenterol 2014; 25 (05) 553-557
35 Tonolini M, Di Pietro S. Diffusion-weighted MRI: new paradigm for the diagnosis of interstitial oedematous pancreatitis. Gland Surg 2019; 8 (02) 197-206
36 Shinya S, Sasaki T, Nakagawa Y, Guiquing Z, Yamamoto F, Yamashita Y. The efficacy of diffusion-weighted imaging for the detection and evaluation of acute pancreatitis. Hepatogastroenterology 2009; 56 (94-95) 1407-1410
37 Borens B, Arvanitakis M, Absil J. et al. Added value of diffusion-weighted magnetic resonance imaging for the detection of pancreatic fluid collection infection. Eur Radiol 2017; 27 (03) 1064-1073
38 Bieliuniene E, Frøkjær JB, Pockevicius A. et al. Magnetic resonance imaging as a valid noninvasive tool for the assessment of pancreatic fibrosis. Pancreas 2019; 48 (01) 85-93
39 Akisik MF, Sandrasegaran K, Jennings SG. et al. Diagnosis of chronic pancreatitis by using apparent diffusion coefficient measurements at 3.0-T MR following secretin stimulation. Radiology 2009; 252 (02) 418-425
40 Muhi A, Ichikawa T, Motosugi U. et al. Mass-forming autoimmune pancreatitis and pancreatic carcinoma: differential diagnosis on the basis of computed tomography and magnetic resonance cholangiopancreatography, and diffusion-weighted imaging findings. J Magn Reson Imaging 2012; 35 (04) 827-836
41 Oki H, Hayashida Y, Oki H. et al. DWI findings of autoimmune pancreatitis: comparison between symptomatic and asymptomatic patients. J Magn Reson Imaging 2015; 41 (01) 125-131
42 Kartalis N, Lindholm TL, Aspelin P, Permert J, Albiin N. Diffusion-weighted magnetic resonance imaging of pancreas tumours. Eur Radiol 2009; 19 (08) 1981-1990
43 Fukukura Y, Takumi K, Kamimura K. et al. Pancreatic adenocarcinoma: variability of diffusion-weighted MR imaging findings. Radiology 2012; 263 (03) 732-740
44 Wang Y, Miller FH, Chen ZE. et al. Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographics 2011; 31 (03) E47-E64
45 Lemke A, Laun FB, Klauss M. et al. Differentiation of pancreas carcinoma from healthy pancreatic tissue using multiple b-values: comparison of apparent diffusion coefficient and intravoxel incoherent motion derived parameters. Invest Radiol 2009; 44 (12) 769-775
46 Hagmann P, Jonasson L, Maeder P, Thiran JP, Wedeen VJ, Meuli R. Understanding diffusion MR imaging techniques: from scalar diffusion-weighted imaging to diffusion tensor imaging and beyond. Radiographics 2006; 26 (Suppl 1) S205-S223
47 Nissan N, Golan T, Furman-Haran E. et al. Diffusion tensor magnetic resonance imaging of the pancreas. PLoS One 2014; 9 (12) e115783
48 Li X, Zhuang L, Zhang X. et al. Preliminary study of MR diffusion tensor imaging of pancreas for the diagnosis of acute pancreatitis. PLoS One 2016; 11 (09) e0160115
49 Kartalis N, Manikis GC, Loizou L. et al. Diffusion-weighted MR imaging of pancreatic cancer: A comparison of mono-exponential, bi-exponential and non-Gaussian kurtosis models. Eur J Radiol Open 2016; 3: 79-85
50 Noda Y, Kanematsu M, Goshima S. et al. Diffusion kurtosis imaging of the pancreas for the assessment of HbA1c levels. J Magn Reson Imaging 2016; 43 (01) 159-165
51 Riffel P, Michaely HJ, Morelli JN. et al. Zoomed EPI-DWI of the pancreas using two-dimensional spatially-selective radiofrequency excitation pulses. PLoS One 2014; 9 (03) e89468
52 Kühn JP, Berthold F, Mayerle J. et al. Pancreatic steatosis demonstrated at MR imaging in the general population: clinical relevance. Radiology 2015; 276 (01) 129-136
53 Heber SD, Hetterich H, Lorbeer R. et al. Pancreatic fat content by magnetic resonance imaging in subjects with prediabetes, diabetes, and controls from a general population without cardiovascular disease. PLoS One 2017; 12 (05) e0177154
54 Nadarajah C, Fananapazir G, Cui E. et al. Association of pancreatic fat content with type II diabetes mellitus. Clin Radiol 2020; 75 (01) 51-56
55 Watanabe H, Kanematsu M, Tanaka K. et al. Fibrosis and postoperative fistula of the pancreas: correlation with MR imaging findings–preliminary results. Radiology 2014; 270 (03) 791-799
56 Tirkes T, Lin C, Fogel EL, Sherman SS, Wang Q, Sandrasegaran K. T1 mapping for diagnosis of mild chronic pancreatitis. J Magn Reson Imaging 2017; 45 (04) 1171-1176
57 Au WY, Lam WW, Chu W. et al. A T2* magnetic resonance imaging study of pancreatic iron overload in thalassemia major. Haematologica 2008; 93 (01) 116-119
58 Henninger B, Rauch S, Zoller H, Plaikner M, Jaschke W, Kremser C. R2*-relaxometry of the pancreas in patients with human hemochromatosis protein associated hereditary hemochromatosis. Eur J Radiol 2017; 89: 149-155
59 An H, Shi Y, Guo Q, Liu Y. Test-retest reliability of 3D EPI MR elastography of the pancreas. Clin Radiol 2016; 71 (10) 1068.e7-1068.e12
60 Shi Y, Cang L, Zhang X. et al. The use of magnetic resonance elastography in differentiating autoimmune pancreatitis from pancreatic ductal adenocarcinoma: A preliminary study. Eur J Radiol 2018; 108: 13-20