Multiparametric MRI Scoring System of the Pancreas for the Diagnosis of Chronic Pancreatitis

IF 3.3 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Magnetic Resonance Imaging Pub Date : 2024-09-03 DOI:10.1002/jmri.29594

Temel Tirkes MD, Dhiraj Yadav MD, MPH, Darwin L. Conwell MD, MSc, Xuandong Zhao PhD, Anil K. Dasyam MD, Vivek Gowdra Halappa MD, Aashish Patel MD, Zarine K. Shah MD, Jordan Swensson MD, Naoki Takahashi MD, Sudhakar Venkatesh MD, Ashley Wachsman MD, Liang Li PhD, Kristofer Jennings PhD, Yunlong Yang MS, Phil A. Hart MD, Stephen J. Pandol MD, Walter G. Park MD, Santhi Swaroop Vege MD, Mark Topazian MD, Paul R. Territo PhD, Scott A. Persohn RT, Dana K. Andersen MD, Evan L. Fogel MD, MSc, the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC)

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引用次数: 0

Abstract

Background

Ductal features alone may not offer high diagnostic sensitivity or most accurate disease severity of chronic pancreatitis (CP).

Purpose

Diagnose CP based on multiparametric MRI and MRCP features.

Study Type

Prospective.

Population

Between February 2019 and May 2021, 46 control (23 males, 49.3 ± 14.1 years), 45 suspected (20 males, 48.7 ± 12.5 years), and 46 definite (20 males, 53.7 ± 14.6 years) CP patients were enrolled at seven hospitals enrolled in the MINIMAP study. CP classification was based on imaging findings and clinical presentation.

Field Strength and Sequences

1.5 T. T₁-weighted (T₁W) spoiled gradient echo, T1 map with variable flip angle, dual-echo Dixon, secretin-enhanced MRCP before and after secretin infusion.

Assessment

Dual-echo fat fraction (FF), T₁ relaxation time, extracellular volume (ECV), T₁ signal intensity ratio of the pancreas to the spleen (T₁ score), arterial-to-venous enhancement ratio (AVR), pancreatic tail diameter (PTD), pancreas volume, late gadolinium enhancement, pancreatic ductal elasticity (PDE), and duodenal filling grade of secretin-enhanced MRCP were measured.

Statistical Tests

Logistic regression analysis generated CP-MRI and secretin-enhanced CP-SMRI scores. Receiver operating characteristics analysis was used to differentiate definite CP from control. Interobserver agreement was assessed using Lin's concordance correlation coefficient.

Results

Compared to control, definite CP cohort showed significantly higher dual-echo FF (7% vs. 11%), lower AVR (1.35 vs. 0.85), smaller PTD (2.5 cm vs. 1.95 cm), higher ECV (28% vs. 38%), and higher incidence of PDE loss (6.5% vs. 50%). With the cut-off of >2.5 CP-MRI score (dual-echo FF, AVR, and PTD) and CP-SMRI score (dual-echo FF, AVR, PTD, and PDE) had cross-validated area under the curves of 0.84 (sensitivity 87%, specificity 68%) and 0.86 (sensitivity 89%, specificity 67%), respectively. Interobserver agreement for both CP-MRI and CP-SMRI scores was 0.74.

Conclusion

The CP-MRI and CP-SMRI scores yielded acceptable performance and interobserver agreement for the diagnosis of CP.

Evidence Level

Technical Efficacy

Stage 2

Abstract Image

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用于诊断慢性胰腺炎的胰腺多参数磁共振成像评分系统

背景：目的：根据多参数 MRI 和 MRCP 特征诊断慢性胰腺炎：研究类型：前瞻性：2019年2月至2021年5月期间，MINIMAP研究的7家医院共招募了46名对照组（23名男性，49.3±14.1岁）、45名疑似组（20名男性，48.7±12.5岁）和46名确诊组（20名男性，53.7±14.6岁）CP患者。CP 分类基于成像结果和临床表现：1.5 T.T1加权（T1W）破坏梯度回波、带可变翻转角的T1图、双回波Dixon、胰岛素注射前后的胰岛素增强MRCP：双回波脂肪分数（FF）、T1弛豫时间、细胞外容积（ECV）、胰腺与脾脏的 T1 信号强度比（T1 评分）、动静脉增强比（AVR）、胰腺尾部直径（PTD）、胰腺容积、晚期钆增强、胰管弹性（PDE）和分泌素增强 MRCP 的十二指肠充盈等级：逻辑回归分析得出 CP-MRI 和胰泌素增强 CP-SMRI 评分。接收器操作特征分析用于区分明确的 CP 和对照组。使用林氏一致性相关系数评估观察者之间的一致性：结果：与对照组相比，确诊 CP 队列显示出明显更高的双回波 FF（7% 对 11%）、更低的 AVR（1.35 对 0.85）、更小的 PTD（2.5 厘米对 1.95 厘米）、更高的 ECV（28% 对 38%）以及更高的 PDE 损失发生率（6.5% 对 50%）。CP-MRI 评分（双回波 FF、AVR 和 PTD）和 CP-SMRI 评分（双回波 FF、AVR、PTD 和 PDE）的交叉验证曲线下面积分别为 0.84（灵敏度 87%，特异性 68%）和 0.86（灵敏度 89%，特异性 67%）。CP-MRI 和 CP-SMRI 评分的观察者间一致性为 0.74：CP-MRI 和 CP-SMRI 评分在诊断 CP 方面的表现和观察者间的一致性均可接受。

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来源期刊

Journal of Magnetic Resonance Imaging 医学-核医学

CiteScore

9.70

自引率

6.80%

发文量

494

审稿时长

2 months

期刊介绍： The Journal of Magnetic Resonance Imaging (JMRI) is an international journal devoted to the timely publication of basic and clinical research, educational and review articles, and other information related to the diagnostic applications of magnetic resonance.