0481
Investigation of risk factors for pancreatic exocrine insufficiency using 3T multiparametric MR imaging1Radiology, Kawasaki Medical School, Kurashiki, Japan, 2Philips Japan, Tokyo, Japan
Synopsis
Retrospective study included 46 patients without pancreatic disorders including pancreatic tumor and acute pancreatitis who underwent 3T abdominal multi-parametric MRI including cine-dynamic with spatially selective inversion recovery pulse and proton density fat fraction in 3D mDIXON quant (PDFF (%)). Pancreatic exocrine function was assessed as secretion grade (SG) based on the travel distance of inflowing pancreatic juice in the main pancreatic duct on cine-dynamic MRCP. The negative correlation between PDFF of the pancreas and SG estimated by cine-dynamic MRCP with spatially selective IR pulse suggests an association between pancreatic steatosis and impaired pancreatic exocrine function.
Introduction
Assessment of exocrine pancreatic function is important for the diagnosis of chronic pancreatitis as well as for decision-making regarding appropriate treatment. Recent studies have shown that the secretory flow of pancreatic juice can be directly and noninvasively visualized as a high-signal-intensity inflow within the tagged area at frequent intervals in normal subjects by means of nonpharmacological, noncontrast-enhanced cine-dynamic MR cholangiopancreatography (MRCP) with a spatially selective inversion recovery (IR) pulse.1,2 This technique may have the potential for evaluating pancreatic exocrine function noninvasively in patients with chronic pancreatitis.3 In addition, recent study have shown that an association of pancreatic steatosis with impaired pancreatic exocrine function in a population-based setting.4Purpose
To investigate the value of multi-parametric MR imaging (mpMRI) for identifying risk factors for pancreatic exocrine insufficiency.Materials and Methods
Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent. This retrospective study included 46 patients without pancreatic disorders including pancreatic tumor and acute pancreatitis who underwent 3T abdominal mpMRI including cine-dynamic MRCP with spatially selective IR pulse (cine-dynamic MRCP) and proton density fat fraction in 3D mDIXON quant (PDFF (%)). Pancreatic exocrine function was assessed as secretion grade (SG) based on the travel distance of inflowing pancreatic juice in the main pancreatic duct on cine-dynamic MRCP. In pancreatic parenchymal measurements, the pancreas-to-muscle signal intensity ratio (SIR) on in-phase imaging (SIR-I), opposed-phase imaging (SIR-O), and T2-weighted imaging (SIR-T2), apparent diffusion coefficient (ADC (×10-3 mm2/s)) on diffusion-weighted imaging, and PDFF were calculated. Patients were classified into two groups according to pancreatic fat content: group 1, PDFF < 10%; group 2, PDFF ≥ 10%.Results
Overall, SG, SIR-I and SIR-O, SIR-T2, ADC and PDFF was 1.2±0.88, 1.6±0.31, 1.5±0.44, 1.9±0.42, 1.5±0.28 and 8.2±6.69, respectively (mean±SD). PDFF showed a significant negative correlation with SG (ρ = −0.317, P = 0.032). There was no significant correlation between SG and SIR-I, SIR-O, or SIR-T2 or between SG and ADC (ρ = 0.43; P = 0.778, ρ = 0.13; P = 0.131, ρ = –0.43; P = 0.778, and ρ = 0.06; P = 0.715 respectively). SG was significantly lower in group 2 than in group 1 (1.3±0.90, 0.7±0.60, P = 0.022).Conclusion
The negative correlation between PDFF of the pancreas and SG estimated by cine-dynamic MRCP with spatially selective IR pulse suggests an association between pancreatic steatosis and impaired pancreatic exocrine function.Clinical Relevance
Increased pancreatic fat content quantified by PDFF might be a risk factor for exocrine pancreatic insufficiency.Acknowledgements
No acknowledgement found.References
1. Ito K, Torigoe T, Tamada T et al. The secretory flow of pancreatic juice in the main pancreatic duct: visualization by means of MRCP with spatially selective inversion-recovery pulse. Radiology 2011;261(2):582-6.
2. Torigoe T, Ito K, Yamamoto A et al. Age-related change of the secretory flow of pancreatic juice in the main pancreatic duct: evaluation with cine-dynamic MRCP using spatially selective inversion recovery pulse. AJR Am J Roentgenol 2014;202(5):1022-6.
3. Yasokawa K, Ito K, Tamada T et al. Noninvasive investigation of exocrine pancreatic function: Feasibility of cine dynamic MRCP with a spatially selective inversion-recovery pulse. J Magn Reson Imaging 2015;42(5):1266-71.
4. Kromrey ML, Friedrich N, Hoffmann RT et al. Pancreatic Steatosis Is Associated With Impaired Exocrine Pancreatic Function. Invest Radiol 2019;54(7):403-8.
Figures
