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Prospective Evaluation of Pancreatic Tumors: Accuracy of MR Imaging with MR Cholangiopancreatography and MR Angiography¹

¹ From the Departments of Radiology (E.L.H., H.A., N.H., J.R., R.F.), Visceral and Transplant Surgery (J.L., P.N.), and Gastroenterology and Hepatology (M.B., R.H., B.W, S.R.), Charité Medical University Center, Campus Virchow Clinic, Humboldt University, Augustenburger Platz 1, D-13353 Berlin, Germany. Received April 17, 2001; revision requested June 4; revision received August 27; accepted October 10. Address correspondence to E.L.H. (e-mail: enrique.lopez_haenninen@charite.de).

View larger version (132K): [in a new window]   Figure 1a. (a) Transverse T1-weighted fat-suppressed GRE MR image (151/1.7; flip angle, 80°) shows verified adenocarcinoma of the pancreatic head (true-positive) in a 42-year-old man. Adenocarcinoma was visible as a low-signal-intensity tumor (arrow). (b) Coronal oblique MR cholangiopancreatogram (8,000/1,000) demonstrates pancreatic duct obstruction (arrows) in the head with proximal dilatation of both pancreatic duct (PD) and common bile duct (CBD), which is referred to as the double duct sign. (c) Coronal MR angiogram (5.2/1.4; flip angle, 40°) in the venous phase shows vascular infiltration of the portal vein and venous confluens (straight arrow). Note the consecutive mesenteric collateral formation (curved arrows).

View larger version (106K): [in a new window]   Figure 1b. (a) Transverse T1-weighted fat-suppressed GRE MR image (151/1.7; flip angle, 80°) shows verified adenocarcinoma of the pancreatic head (true-positive) in a 42-year-old man. Adenocarcinoma was visible as a low-signal-intensity tumor (arrow). (b) Coronal oblique MR cholangiopancreatogram (8,000/1,000) demonstrates pancreatic duct obstruction (arrows) in the head with proximal dilatation of both pancreatic duct (PD) and common bile duct (CBD), which is referred to as the double duct sign. (c) Coronal MR angiogram (5.2/1.4; flip angle, 40°) in the venous phase shows vascular infiltration of the portal vein and venous confluens (straight arrow). Note the consecutive mesenteric collateral formation (curved arrows).

View larger version (161K): [in a new window]   Figure 1c. (a) Transverse T1-weighted fat-suppressed GRE MR image (151/1.7; flip angle, 80°) shows verified adenocarcinoma of the pancreatic head (true-positive) in a 42-year-old man. Adenocarcinoma was visible as a low-signal-intensity tumor (arrow). (b) Coronal oblique MR cholangiopancreatogram (8,000/1,000) demonstrates pancreatic duct obstruction (arrows) in the head with proximal dilatation of both pancreatic duct (PD) and common bile duct (CBD), which is referred to as the double duct sign. (c) Coronal MR angiogram (5.2/1.4; flip angle, 40°) in the venous phase shows vascular infiltration of the portal vein and venous confluens (straight arrow). Note the consecutive mesenteric collateral formation (curved arrows).

View larger version (123K): [in a new window]   Figure 2a. Images show chronic pancreatitis (false-positive) in a 49-year-old man. (a) Transverse T1-weighted fat-suppressed GRE MR image (151/1.7; flip angle, 80°) of the pancreatic head shows area of low signal intensity (arrow). (b) Coronal oblique MR cholangiopancreatogram (8,000/1,000) shows obstruction (arrows) of both common bile duct (CBD) and pancreatic duct (PD) in the head with upstream dilatation. Overall, findings at MR imaging were considered malignant; however, final diagnosis was chronic pancreatitis.

View larger version (96K): [in a new window]   Figure 2b. Images show chronic pancreatitis (false-positive) in a 49-year-old man. (a) Transverse T1-weighted fat-suppressed GRE MR image (151/1.7; flip angle, 80°) of the pancreatic head shows area of low signal intensity (arrow). (b) Coronal oblique MR cholangiopancreatogram (8,000/1,000) shows obstruction (arrows) of both common bile duct (CBD) and pancreatic duct (PD) in the head with upstream dilatation. Overall, findings at MR imaging were considered malignant; however, final diagnosis was chronic pancreatitis.

View larger version (121K): [in a new window]   Figure 4a. (a) Coronal oblique MR cholangiopancreatogram (8,000/1,000) shows common bile duct and pancreatic duct stenosis in a patient with histopathologically confirmed chronic pancreatitis (true-negative). Note the consecutive dilatation of intrahepatic bile ducts and of the pancreatic duct and side branches with the point of termination of obstruction (arrow). (b) Corresponding transverse T1-weighted GRE MR image (30/5; flip angle, 30°) demonstrates pancreatic head enlargement with no delineated lesion. Substantial duodenal wall thickening (arrow), which was consistent with confirmed inflammation, was visualized; however, this nonspecific finding may be seen in pancreatitis or pancreatic cancer.

View larger version (142K): [in a new window]   Figure 4b. (a) Coronal oblique MR cholangiopancreatogram (8,000/1,000) shows common bile duct and pancreatic duct stenosis in a patient with histopathologically confirmed chronic pancreatitis (true-negative). Note the consecutive dilatation of intrahepatic bile ducts and of the pancreatic duct and side branches with the point of termination of obstruction (arrow). (b) Corresponding transverse T1-weighted GRE MR image (30/5; flip angle, 30°) demonstrates pancreatic head enlargement with no delineated lesion. Substantial duodenal wall thickening (arrow), which was consistent with confirmed inflammation, was visualized; however, this nonspecific finding may be seen in pancreatitis or pancreatic cancer.

View larger version (104K): [in a new window]   Figure 3. Coronal oblique MR cholangiopancreatogram (8,000/1,000) shows adenocarcinoma of the pancreatic body in a 68-year-old woman. Adenocarcinoma was poorly delineated on transverse MR sections. At MRCP, visualization of tapering pancreatic duct stenosis (solid arrow) with proximal duct dilatation (arrowheads) was facilitated, and findings were consistent with a diagnosis of pancreatic adenocarcinoma (true-positive). Note the side branch ectasia (open arrows) in the dilated portion of the pancreatic duct. Tumor was proved at surgery.