Multiparametric MRI Scoring System of the Pancreas for the Diagnosis of Chronic Pancreatitis

Temel Tirkes; Dhiraj Yadav; Darwin L Conwell; Xuandong Zhao; Anil K Dasyam; Vivek Gowdra Halappa; Aashish Patel; Zarine K Shah; Jordan Swensson; Naoki Takahashi; Sudhakar Venkatesh; Ashley Wachsman; Liang Li; Kristofer Jennings; Yunlong Yang; Phil A Hart; Stephen J Pandol; Walter G Park; Santhi Swaroop Vege; Mark Topazian; Paul R Territo; Scott A Persohn; Dana K Andersen; Evan L Fogel; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC)

doi:10.1002/jmri.29594

Multiparametric MRI Scoring System of the Pancreas for the Diagnosis of Chronic Pancreatitis

J Magn Reson Imaging. 2024 Sep 3. doi: 10.1002/jmri.29594. Online ahead of print.

Authors

Temel Tirkes¹, Dhiraj Yadav², Darwin L Conwell³, Xuandong Zhao¹, Anil K Dasyam⁴, Vivek Gowdra Halappa¹, Aashish Patel¹, Zarine K Shah⁵, Jordan Swensson¹, Naoki Takahashi⁶, Sudhakar Venkatesh⁶, Ashley Wachsman⁷, Liang Li⁸, Kristofer Jennings⁸, Yunlong Yang⁸, Phil A Hart⁹, Stephen J Pandol¹⁰, Walter G Park¹¹, Santhi Swaroop Vege¹², Mark Topazian¹³, Paul R Territo¹⁴, Scott A Persohn¹⁵, Dana K Andersen¹⁶, Evan L Fogel¹⁷; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC)

Affiliations

¹ Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA.
² Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
³ Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
⁴ Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
⁵ Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
⁶ Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
⁷ Department of Imaging, Cedars-Sinai Medical Center, University of California in Los Angeles, Los Angeles, California, USA.
⁸ Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁹ Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹⁰ Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California, USA.
¹¹ Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, California, USA.
¹² Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹³ Mayo Clinic, Rochester, Minnesota, USA.
¹⁴ Division of Clinical Pharmacology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹⁵ Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹⁶ Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
¹⁷ Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, Indiana, USA.

PMID: 39225586
DOI: 10.1002/jmri.29594

Abstract

Background: Ductal features alone may not offer high diagnostic sensitivity or most accurate disease severity of chronic pancreatitis (CP).

Purpose: Diagnose CP based on multiparametric MRI and MRCP features.

Study type: Prospective.

Population: Between February 2019 and May 2021, 46 control (23 males, 49.3 ± 14.1 years), 45 suspected (20 males, 48.7 ± 12.5 years), and 46 definite (20 males, 53.7 ± 14.6 years) CP patients were enrolled at seven hospitals enrolled in the MINIMAP study. CP classification was based on imaging findings and clinical presentation.

Field strength and sequences: 1.5 T. T₁-weighted (T₁W) spoiled gradient echo, T1 map with variable flip angle, dual-echo Dixon, secretin-enhanced MRCP before and after secretin infusion.

Assessment: Dual-echo fat fraction (FF), T₁ relaxation time, extracellular volume (ECV), T₁ signal intensity ratio of the pancreas to the spleen (T₁ score), arterial-to-venous enhancement ratio (AVR), pancreatic tail diameter (PTD), pancreas volume, late gadolinium enhancement, pancreatic ductal elasticity (PDE), and duodenal filling grade of secretin-enhanced MRCP were measured.

Statistical tests: Logistic regression analysis generated CP-MRI and secretin-enhanced CP-SMRI scores. Receiver operating characteristics analysis was used to differentiate definite CP from control. Interobserver agreement was assessed using Lin's concordance correlation coefficient.

Results: Compared to control, definite CP cohort showed significantly higher dual-echo FF (7% vs. 11%), lower AVR (1.35 vs. 0.85), smaller PTD (2.5 cm vs. 1.95 cm), higher ECV (28% vs. 38%), and higher incidence of PDE loss (6.5% vs. 50%). With the cut-off of >2.5 CP-MRI score (dual-echo FF, AVR, and PTD) and CP-SMRI score (dual-echo FF, AVR, PTD, and PDE) had cross-validated area under the curves of 0.84 (sensitivity 87%, specificity 68%) and 0.86 (sensitivity 89%, specificity 67%), respectively. Interobserver agreement for both CP-MRI and CP-SMRI scores was 0.74.

Conclusion: The CP-MRI and CP-SMRI scores yielded acceptable performance and interobserver agreement for the diagnosis of CP.

Evidence level: 1 TECHNICAL EFFICACY: Stage 2.

Keywords: MRCP; MRI; chronic pancreatitis; enhancement ratio; secretin.

Abstract

Grants and funding