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Duct-penetrating Sign at MRCP: Usefulness for Differentiating Inflammatory Pancreatic Mass from Pancreatic Carcinomas¹

¹ From the Department of Radiology, Yamanashi Medical University, 1110 Shimokato, Tamaho, Nakakoma, Yamanashi 409-3815, Japan (T.I., H.S., T.A., A.S.A., T.Y., K.I.); and Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan (H.H., J.H.). Received June 30, 2000; revision requested August 8; final revision received and accepted April 17, 2001. Address correspondence to T.I. (e-mail: ichikawa@res.yamanashi-med.ac.jp).

PURPOSE: To define the duct-penetrating sign at magnetic resonance (MR) cholangiopancreatography (MRCP) and to assess the usefulness of this sign for distinguishing an inflammatory pancreatic mass (IPM) from a conventional pancreatic carcinoma (CPC) compared with arterial phase computed tomography (hereafter, CT) and arterial phase MR imaging (hereafter, MR imaging).

MATERIALS AND METHODS: MRCP, CT, and MR images were compared by means of receiver operating characteristic (ROC) analysis for 11 IPMs and 43 CPCs. With the MRCP images, a morphologic classification of the main pancreatic duct (MPD) was attempted for all lesions. On the basis of this classification and the enhancement patterns of a lesion, all readers graded the presence of IPM or CPC on a five-point scale for all images.

RESULTS: On the MRCP images, the morphologic characteristics of the MPD were nonobstruction for IPM (28 of 33, 85%) and obstruction or irregular stenosis for CPC (124 of 129, 96%). At ROC analysis among all the techniques, MRCP images had the highest value (0.98) for significant areas under the ROC curve (CT, 0.84; MR, 0.76) (P < .001). For the duct-penetrating sign in the broad sense (nonobstructed MPD) and the sign in the narrow sense (only normal MPD), the sensitivity, specificity, and accuracy for diagnosis of IPM were 85%, 96%, and 94%, respectively, and 36%, 100%, and 87%, respectively.

CONCLUSION: The duct-penetrating sign on MRCP images was more helpful to distinguish IPM from CPC than were the enhancement patterns on CT and MR images.

Index terms: Pancreas, CT, 770.12113, 770.12115 • Pancreas, MR, 770.121411, 770.121412, 77.121415, 770.12143 • Pancreas, neoplasms, 774.321 • Pancreatitis, 770.291

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