Diagnostic performance of contrast-enhanced MRI with secretin-stimulated mrcp for non-calcific chronic pancreatitis

A comparison with histopathology

Guru Trikudanathan, Sidney P. Walker, Satish Munigala, Ben Spilseth, Ahmad Malli, Yusheng Han, Melena Bellin, Srinath Chinnakotla, Ty Dunn, Timothy L. Pruett, Gregory J. Beilman, Jose Vega Peralta, Mustafa A. Arain, Stuart K. Amateau, Sarah J. Schwarzenberg, Shawn Mallery, Rajeev Attam, Martin L. Freeman

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Abstract

OBJECTIVES:Diagnosis of non-calcific chronic pancreatitis (NCCP) in patients presenting with chronic abdominal pain is challenging and controversial. Contrast-enhanced magnetic resonance imaging (MRI) with secretin-stimulated MRCP (sMRCP) offers a safe and noninvasive modality to diagnose mild CP, but its findings have not been correlated with histopathology. We aimed to assess the correlation of a spectrum of MRI/sMRCP findings with surgical histopathology in a cohort of NCCP patients undergoing total pancreatectomy with islet autotransplantation (TPIAT).METHODS:Adult patients undergoing TPIAT for NCCP between 2008 and 2013 were identified from our institution's surgery database and were included if they had MRI/sMRCP within a year before surgery. Histology was obtained from resected pancreas at the time of TPIAT by wedge biopsy of head, body, and tail, and was graded by a gastrointestinal pathologist who was blinded to the imaging features. A fibrosis score (FS) of 2 or more was considered as abnormal, with FS ≥6 as severe fibrosis. A multivariate regression analysis was performed for MRI features predicting fibrosis, after taking age, sex, smoking, alcohol, and body mass index (BMI) into consideration. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation coefficient (r) was calculated.RESULTS:Fifty-seven patients (females=49, males=8) with NCCP and MRI/sMRCP were identified. ROC curve analysis showed that two or more MRI/sMRCP features provided the best balance of sensitivity (65%), specificity (89%), and accuracy (68%) to differentiate abnormal (FS≥2) from normal pancreatic tissue. Two or more features provided the best cutoff (sensitivity 88%, specificity 78%) for predicting severe fibrosis (FS≥6). There was a significant correlation between the number of features and severity of fibrosis (r=0.6, P<0.0001). A linear regression after taking age, smoking, and BMI into consideration showed that main pancreatic duct irregularity, T1-weighted signal intensity ratio between pancreas and paraspinal muscle, and duodenal filling after secretin injection to be significant independent predictors of fibrosis.CONCLUSIONS:A strong correlation exists between MRI/sMRCP findings and histopathology of NCCP.

Original languageEnglish (US)
Pages (from-to)1598-1606
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume110
Issue number11
DOIs
StatePublished - Nov 1 2015

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Secretin
Chronic Pancreatitis
Fibrosis
Magnetic Resonance Imaging
Pancreatectomy
Autologous Transplantation
ROC Curve
Pancreas
Body Mass Index
Smoking
Paraspinal Muscles
Sensitivity and Specificity
Pancreatic Ducts
Nonparametric Statistics
Chronic Pain
Abdominal Pain
Linear Models
Histology
Multivariate Analysis
Head

Cite this

@article{0627d1a5a5a54d2dbeb22c1d680a694d,
title = "Diagnostic performance of contrast-enhanced MRI with secretin-stimulated mrcp for non-calcific chronic pancreatitis: A comparison with histopathology",
abstract = "OBJECTIVES:Diagnosis of non-calcific chronic pancreatitis (NCCP) in patients presenting with chronic abdominal pain is challenging and controversial. Contrast-enhanced magnetic resonance imaging (MRI) with secretin-stimulated MRCP (sMRCP) offers a safe and noninvasive modality to diagnose mild CP, but its findings have not been correlated with histopathology. We aimed to assess the correlation of a spectrum of MRI/sMRCP findings with surgical histopathology in a cohort of NCCP patients undergoing total pancreatectomy with islet autotransplantation (TPIAT).METHODS:Adult patients undergoing TPIAT for NCCP between 2008 and 2013 were identified from our institution's surgery database and were included if they had MRI/sMRCP within a year before surgery. Histology was obtained from resected pancreas at the time of TPIAT by wedge biopsy of head, body, and tail, and was graded by a gastrointestinal pathologist who was blinded to the imaging features. A fibrosis score (FS) of 2 or more was considered as abnormal, with FS ≥6 as severe fibrosis. A multivariate regression analysis was performed for MRI features predicting fibrosis, after taking age, sex, smoking, alcohol, and body mass index (BMI) into consideration. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation coefficient (r) was calculated.RESULTS:Fifty-seven patients (females=49, males=8) with NCCP and MRI/sMRCP were identified. ROC curve analysis showed that two or more MRI/sMRCP features provided the best balance of sensitivity (65{\%}), specificity (89{\%}), and accuracy (68{\%}) to differentiate abnormal (FS≥2) from normal pancreatic tissue. Two or more features provided the best cutoff (sensitivity 88{\%}, specificity 78{\%}) for predicting severe fibrosis (FS≥6). There was a significant correlation between the number of features and severity of fibrosis (r=0.6, P<0.0001). A linear regression after taking age, smoking, and BMI into consideration showed that main pancreatic duct irregularity, T1-weighted signal intensity ratio between pancreas and paraspinal muscle, and duodenal filling after secretin injection to be significant independent predictors of fibrosis.CONCLUSIONS:A strong correlation exists between MRI/sMRCP findings and histopathology of NCCP.",
author = "Guru Trikudanathan and Walker, {Sidney P.} and Satish Munigala and Ben Spilseth and Ahmad Malli and Yusheng Han and Melena Bellin and Srinath Chinnakotla and Ty Dunn and Pruett, {Timothy L.} and Beilman, {Gregory J.} and {Vega Peralta}, Jose and Arain, {Mustafa A.} and Amateau, {Stuart K.} and Schwarzenberg, {Sarah J.} and Shawn Mallery and Rajeev Attam and Freeman, {Martin L.}",
year = "2015",
month = "11",
day = "1",
doi = "10.1038/ajg.2015.297",
language = "English (US)",
volume = "110",
pages = "1598--1606",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "11",

}

TY - JOUR

T1 - Diagnostic performance of contrast-enhanced MRI with secretin-stimulated mrcp for non-calcific chronic pancreatitis

T2 - A comparison with histopathology

AU - Trikudanathan, Guru

AU - Walker, Sidney P.

AU - Munigala, Satish

AU - Spilseth, Ben

AU - Malli, Ahmad

AU - Han, Yusheng

AU - Bellin, Melena

AU - Chinnakotla, Srinath

AU - Dunn, Ty

AU - Pruett, Timothy L.

AU - Beilman, Gregory J.

AU - Vega Peralta, Jose

AU - Arain, Mustafa A.

AU - Amateau, Stuart K.

AU - Schwarzenberg, Sarah J.

AU - Mallery, Shawn

AU - Attam, Rajeev

AU - Freeman, Martin L.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - OBJECTIVES:Diagnosis of non-calcific chronic pancreatitis (NCCP) in patients presenting with chronic abdominal pain is challenging and controversial. Contrast-enhanced magnetic resonance imaging (MRI) with secretin-stimulated MRCP (sMRCP) offers a safe and noninvasive modality to diagnose mild CP, but its findings have not been correlated with histopathology. We aimed to assess the correlation of a spectrum of MRI/sMRCP findings with surgical histopathology in a cohort of NCCP patients undergoing total pancreatectomy with islet autotransplantation (TPIAT).METHODS:Adult patients undergoing TPIAT for NCCP between 2008 and 2013 were identified from our institution's surgery database and were included if they had MRI/sMRCP within a year before surgery. Histology was obtained from resected pancreas at the time of TPIAT by wedge biopsy of head, body, and tail, and was graded by a gastrointestinal pathologist who was blinded to the imaging features. A fibrosis score (FS) of 2 or more was considered as abnormal, with FS ≥6 as severe fibrosis. A multivariate regression analysis was performed for MRI features predicting fibrosis, after taking age, sex, smoking, alcohol, and body mass index (BMI) into consideration. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation coefficient (r) was calculated.RESULTS:Fifty-seven patients (females=49, males=8) with NCCP and MRI/sMRCP were identified. ROC curve analysis showed that two or more MRI/sMRCP features provided the best balance of sensitivity (65%), specificity (89%), and accuracy (68%) to differentiate abnormal (FS≥2) from normal pancreatic tissue. Two or more features provided the best cutoff (sensitivity 88%, specificity 78%) for predicting severe fibrosis (FS≥6). There was a significant correlation between the number of features and severity of fibrosis (r=0.6, P<0.0001). A linear regression after taking age, smoking, and BMI into consideration showed that main pancreatic duct irregularity, T1-weighted signal intensity ratio between pancreas and paraspinal muscle, and duodenal filling after secretin injection to be significant independent predictors of fibrosis.CONCLUSIONS:A strong correlation exists between MRI/sMRCP findings and histopathology of NCCP.

AB - OBJECTIVES:Diagnosis of non-calcific chronic pancreatitis (NCCP) in patients presenting with chronic abdominal pain is challenging and controversial. Contrast-enhanced magnetic resonance imaging (MRI) with secretin-stimulated MRCP (sMRCP) offers a safe and noninvasive modality to diagnose mild CP, but its findings have not been correlated with histopathology. We aimed to assess the correlation of a spectrum of MRI/sMRCP findings with surgical histopathology in a cohort of NCCP patients undergoing total pancreatectomy with islet autotransplantation (TPIAT).METHODS:Adult patients undergoing TPIAT for NCCP between 2008 and 2013 were identified from our institution's surgery database and were included if they had MRI/sMRCP within a year before surgery. Histology was obtained from resected pancreas at the time of TPIAT by wedge biopsy of head, body, and tail, and was graded by a gastrointestinal pathologist who was blinded to the imaging features. A fibrosis score (FS) of 2 or more was considered as abnormal, with FS ≥6 as severe fibrosis. A multivariate regression analysis was performed for MRI features predicting fibrosis, after taking age, sex, smoking, alcohol, and body mass index (BMI) into consideration. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation coefficient (r) was calculated.RESULTS:Fifty-seven patients (females=49, males=8) with NCCP and MRI/sMRCP were identified. ROC curve analysis showed that two or more MRI/sMRCP features provided the best balance of sensitivity (65%), specificity (89%), and accuracy (68%) to differentiate abnormal (FS≥2) from normal pancreatic tissue. Two or more features provided the best cutoff (sensitivity 88%, specificity 78%) for predicting severe fibrosis (FS≥6). There was a significant correlation between the number of features and severity of fibrosis (r=0.6, P<0.0001). A linear regression after taking age, smoking, and BMI into consideration showed that main pancreatic duct irregularity, T1-weighted signal intensity ratio between pancreas and paraspinal muscle, and duodenal filling after secretin injection to be significant independent predictors of fibrosis.CONCLUSIONS:A strong correlation exists between MRI/sMRCP findings and histopathology of NCCP.

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U2 - 10.1038/ajg.2015.297

DO - 10.1038/ajg.2015.297

M3 - Article

VL - 110

SP - 1598

EP - 1606

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 11

ER -