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Differentiation of focal-type autoimmune pancreatitis from pancreatic carcinoma: assessment by multiphase contrast-enhanced CT

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the utility of multiphase contrast-enhanced computed tomography (CT) findings alone and in combination for differentiating focal-type autoimmune pancreatitis (f-AIP) from pancreatic carcinoma (PC).

Methods

The study group comprised 22 f-AIP lesions and 61 PC lesions. Two radiologists independently evaluated CT findings. Frequencies of findings were compared between f-AIP and PC. Statistical, univariate and multivariate analyses were performed.

Results

Homogeneous enhancement during the portal phase (AIP, 59 % vs. PC, 3 %; P < 0.001), dotted enhancement during the pancreatic phase (50 % vs. 7 %; P < 0.001), duct-penetrating sign (46 % vs. 2 %; P < 0.001), enhanced duct sign (36 % vs. 2 %; P < 0.001) and capsule-like rim (46 % vs. 3 %; P < 0.001) were more frequently observed in AIP. Ring-like enhancement during the delayed phase (5 % vs. 46 %; P < 0.001) and peripancreatic strands with a length of at least 10 mm (5 % vs. 39 %; P = 0.001) were more frequently observed in PC. AIP was identified with 82 % sensitivity and 98 % specificity using four of these seven findings. Multivariate analysis revealed significant differences in dotted enhancement (P = 0.004), duct-penetrating sign (P < 0.001) and capsule-like rim (P = 0.007).

Conclusions

The combination of CT findings may allow improvements in differentiating f-AIP from PC.

Key Points

• f-AIP can mimic PC on imaging findings.

• The differentiation of f-AIP from PC is important in patient management.

• Some CT findings can be used to identify AIP.

• The combination of CT findings will improve differentiation from PC.

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Abbreviations

AIP:

Autoimmune pancreatitis

CBD:

Common bile duct

CT:

Computed tomography

f-AIP:

Focal-type autoimmune pancreatitis

MPD:

Main pancreatic duct

MRI:

Magnetic resonance imaging

PC:

Pancreatic carcinoma

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Acknowledgements

The scientific guarantor of this publication is Shinji Naganawa (Department of Radiology, Nagoya University Graduate School of Medicine). The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Some study subjects or cohorts have been previously reported in 2012; Kawai Y, Suzuki K, Itoh S, et al. Autoimmune pancreatitis: assessment of the enhanced duct sign on multiphase contrast-enhanced computed tomography. Eur J Radiol 81:3055–3060. Specifically, ten focal-type autoimmune pancreatitis patients overlapped with the published study. In the previous study, only an enhancement of the main pancreatic duct wall of each patient was minutely evaluated, whereas in this study, other CT findings were additionally evaluated and regarding an enhancement of the main pancreatic duct wall, only whether present or absent was evaluated. Methodology: retrospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Naohiro Furuhashi, Kojiro Suzuki, Yusuke Sakurai & Shinji Naganawa

  2. Department of Radiological Technology, Nagoya University Graduate School of Medicine, 1-20 Daikominami 1-chome, Higashi-ku, Nagoya, 461-8673, Japan

    Mitsuru Ikeda

  3. Department of Diagnostic Radiology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8551, Japan

    Yuichi Kawai

Authors
  1. Naohiro Furuhashi
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  2. Kojiro Suzuki
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  3. Yusuke Sakurai
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  4. Mitsuru Ikeda
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  5. Yuichi Kawai
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  6. Shinji Naganawa
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Correspondence to Naohiro Furuhashi.

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Furuhashi, N., Suzuki, K., Sakurai, Y. et al. Differentiation of focal-type autoimmune pancreatitis from pancreatic carcinoma: assessment by multiphase contrast-enhanced CT. Eur Radiol 25, 1366–1374 (2015). https://doi.org/10.1007/s00330-014-3512-3

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  • DOI: https://doi.org/10.1007/s00330-014-3512-3

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