Diagnosis and Staging of Pancreatic Cancer: Comparison of Mangafodipir Trisodium—Enhanced MR Imaging and Contrast-Enhanced Helical Hydro-CT
Wolfgang Schima1,
Reinhold Függer2,
Ewald Schober1,
Claudia Oettl1,
Peter Wamser2,
Florian Grabenwöger1,
J. Mark Ryan3 and
Gottfried Novacek4
1 Department of Radiology, University of Vienna, Waehringer Guertel 18-20,
A-1090 Vienna, Austria.
2 Department of Surgery, University of Vienna, A-1090 Vienna, Austria.
3 Department of Vascular/Interventional Radiology, Duke University Medical
Center, DUMC 3808, Durham, NC 27710.
4 Department of Internal Medicine 4, Division of Gastroenterology, University of
Vienna, A-1090 Vienna, Austria.
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Fig. 1A. —44-year-old man with unresectable tumor of pancreatic body
and tail. Thin-section helical CT image obtained during pancreatic phase
reveals large pancreatic tumor (arrow) with tumor surrounding celiac
trunk and hepatic artery.
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Fig. 1B. —44-year-old man with unresectable tumor of pancreatic body
and tail. Unenhanced T1-weighted gradient-recalled echo MR image shows large
hypointense tumor that is not well delineated.
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Fig. 1C. —44-year-old man with unresectable tumor of pancreatic body
and tail. Mangafodipir trisodium—enhanced T1-weighted gradient-recalled
echo MR image differentiates between hypointense tumor and enhancing normal
parenchyma (solid arrow) better than B. However, extent of
vascular encasement (open arrow) is better depicted by CT scan
(A) than by MR images (B and C).
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Fig. 2A. —50-year-old woman with small pancreatic tumor that was not
revealed on CT. ERCP image shows slight narrowing of pancreatic duct
(arrow) and ductal dilatation. Sphincterotomy was performed, and
pancreatic stent was placed. Biopsy results were negative for tumor.
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Fig. 2B. —50-year-old woman with small pancreatic tumor that was not
revealed on CT. Contrast-enhanced CT scan fails to depict tumor
(arrow) around stent in dilated common bile duct.
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Fig. 2C. —50-year-old woman with small pancreatic tumor that was not
revealed on CT. Unenhanced T1-weighted gradient-recalled echo MR image shows
inhomogeneity of pancreatic head, but does not show tumor.
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Fig. 2D. —50-year-old woman with small pancreatic tumor that was not
revealed on CT. Mangafodipir trisodium—enhanced T1-weighted
gradient-recalled echo MR image shows slight dilatation of common bile duct
(long arrow) and pancreatic duct (short arrow).
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Fig. 2E. —50-year-old woman with small pancreatic tumor that was not
revealed on CT. Mangafodipir trisodium—enhanced MR image obtained at
lower level than C and D reveals small irregular hypointense
tumor (arrows) at pancreatobiliary junction. Mass was proven to be
adenocarcinoma at surgery. (x2)
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Fig. 3. —Graph shows differentiation between benign lesions and
pancreatic adenocarcinoma by receiver operating characteristic analysis. Mean
area under curve is 0.832 for CT (solid line) and 0.920 for MR
imaging (dotted line) (not significant).
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Fig. 4A. —40-year-old man with focal pancreatitis misdiagnosed as
pancreatic adenocarcinoma on MR imaging and CT. Helical CT scan shows
hypoattenuating mass (straight arrow) in pancreatic head adjacent to
venous confluence. Half (180° of circumference) of superior mesenteric
artery is surrounded by mass (curved arrows). Adjacent CT slices (not
shown) revealed no abnormalities to suggest chronic pancreatitis.
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Fig. 4B. —40-year-old man with focal pancreatitis misdiagnosed as
pancreatic adenocarcinoma on MR imaging and CT. Mangafodipir
trisodium—enhanced T1-weighted gradient-recalled echo MR image reveals
unenhancing mass (curved arrow) in pancreatic head around superior
mesenteric artery. Remainder of pancreatic head (straight arrow)
shows normal enhancement of parenchyma.
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Fig. 5A. —68-year-old woman with focal fatty infiltration that was
misdiagnosed as tumor on CT. Thin-section CT scan obtained during pancreatic
phase shows small hypodense lesion (arrow) in pancreatic head
adjacent to superior mesenteric vein.
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Fig. 5B. —68-year-old woman with focal fatty infiltration that was
misdiagnosed as tumor on CT. Unenhanced T1-weighted gradient-recalled echo MR
image shows that pancreatic head is homogenous.
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Fig. 5C. —68-year-old woman with focal fatty infiltration that was
misdiagnosed as tumor on CT. Mangafodipir trisodium—enhanced MR image
reveals homogenous uptake of mangafodipir trisodium (arrows); this
finding ruled out tumor. Findings on contiguous slices (not shown) were
similar. Diagnosis of focal fatty infiltration is most likely. Presence of
tumor was ruled out by follow-up of patient over 2 years.
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Fig. 6A. —68-year-old woman with cancer of pancreatic head and solitary
liver metastasis that was missed on CT. Thin-section helical CT scan obtained
during pancreatic phase shows contiguity of tumor (arrow) to lateral
wall of venous confluence.
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Fig. 6B. —68-year-old woman with cancer of pancreatic head and solitary
liver metastasis that was missed on CT. CT image obtained during portal venous
phase fails to show focal liver lesion. Contiguous slices (not shown) also
failed to reveal lesion.
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Fig. 6C. —68-year-old woman with cancer of pancreatic head and solitary
liver metastasis that was missed on CT. Mangafodipir trisodium—enhanced
T1-weighted fat-suppressed gradient-recalled echo MR image reveals hypointense
mass (arrow) in pancreatic head. Ductal dilatation and atrophy of
pancreatic body and tail are visible. Enhancement of atrophic parenchyma is
minimal.
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Fig. 6D. —68-year-old woman with cancer of pancreatic head and solitary
liver metastasis that was missed on CT. Mangafodipir trisodium—enhanced
gradient-recalled echo MR image reveals small subcapsular focal liver lesion
(arrow). Lesion was not seen on T2-weighted MR images (not shown),
which ruled out presence of cyst. All other more centrally located hypointense
structures seen could be identified as portal or hepatic venous branches by
reviewing contiguous slices (not shown).
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Copyright © 2002 by the American Roentgen Ray Society.
