Diffusion-weighted MR Imaging of Solid and Cystic Lesions of the Pancreas

Published Online:https://doi.org/10.1148/rg.313105174

The MR imaging features of common solid and cystic pancreatic neoplasms are reviewed, with emphasis on diffusion-weighted imaging and the associated histopathologic characteristics of these neoplasms.

Diffusion-weighted magnetic resonance (MR) imaging is increasingly used in the detection and characterization of pancreatic lesions. Diffusion-weighted imaging may provide additional information to radiologists evaluating patients who have cystic or solid neoplasms of the pancreas. Because of greater freedom of motion of water molecules in fluid-rich environments, simple cysts in the pancreas have higher signal intensity on diffusion-weighted images with a b value of 0 sec/mm2 and lower signal intensity on high-b-value images. High apparent diffusion coefficient (ADC) values can be obtained on ADC maps because of the T2 “shine-through” effect. In contrast, solid neoplasms of the pancreas show increased signal intensity relative to the pancreas on diffusion-weighted images with a b value of 0 sec/mm2 and relatively high signal intensity on high-b-value images. Diffusion-weighted imaging can help detect solid pancreatic neoplasms with extremely dense cellularity or extracellular fibrosis by demonstrating significantly low ADC values, and these neoplasms may be better detected on diffusion-weighted MR images because of better contrast, although the resolution is generally worse. However, diffusion-weighted imaging may not be capable of helping definitively characterize solid lesions as inflammatory or neoplastic because of an overlap in ADC values between the two types. For example, it is difficult to distinguish poorly differentiated pancreatic adenocarcinoma from mass-forming pancreatitis at diffusion-weighted imaging because of similarly low ADC values attributed to dense fibrosis.

References

  • 1 Megibow AJ. Are we really closer to predicting the development of pancreatic cancer? Radiology 2010;254(3):642–646. LinkGoogle Scholar
  • 2 Freelove R, Walling AD. Pancreatic cancer: diagnosis and management. Am Fam Physician 2006;73(3):485–492. MedlineGoogle Scholar
  • 3 Ly JN, Miller FH. MR imaging of the pancreas: a practical approach. Radiol Clin North Am 2002;40(6):1289–1306. Crossref, MedlineGoogle Scholar
  • 4 Ku YM, Shin SS, Lee CH, Semelka RC. Magnetic resonance imaging of cystic and endocrine pancreatic neoplasms. Top Magn Reson Imaging 2009;20(1):11–18. Crossref, MedlineGoogle Scholar
  • 5 Herwick S, Miller FH, Keppke AL. MRI of islet cell tumors of the pancreas. AJR Am J Roentgenol 2006;187(5):W472–W480. Crossref, MedlineGoogle Scholar
  • 6 Kalb B, Sarmiento JM, Kooby DA, Adsay NV, Martin DR. MR imaging of cystic lesions of the pancreas. RadioGraphics 2009;29(6):1749–1765. LinkGoogle Scholar
  • 7 Park HS, Lee JM, Choi HK, Hong SH, Han JK, Choi BI. Preoperative evaluation of pancreatic cancer: comparison of gadolinium-enhanced dynamic MRI with MR cholangiopancreatography versus MDCT. J Magn Reson Imaging 2009;30(3):586–595. Crossref, MedlineGoogle Scholar
  • 8 Inan N, Arslan A, Akansel G, Anik Y, Demirci A. Diffusion-weighted imaging in the differential diagnosis of cystic lesions of the pancreas. AJR Am J Roentgenol 2008;191(4):1115–1121. Crossref, MedlineGoogle Scholar
  • 9 Lee SS, Byun JH, Park BJ, et al.. Quantitative analysis of diffusion-weighted magnetic resonance imaging of the pancreas: usefulness in characterizing solid pancreatic masses. J Magn Reson Imaging 2008;28(4):928–936. Crossref, MedlineGoogle Scholar
  • 10 Bakir B, Salmaslioğlu A, Poyanli A, Rozanes I, Acunas B. Diffusion weighted MR imaging of pancreatic islet cell tumors. Eur J Radiol 2010;74(1):214–220. Crossref, MedlineGoogle Scholar
  • 11 Fattahi R, Balci NC, Perman WH, et al.. Pancreatic diffusion-weighted imaging (DWI): comparison between mass-forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging 2009;29(2):350–356. Crossref, MedlineGoogle Scholar
  • 12 Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 1988;168(2):497–505. LinkGoogle Scholar
  • 13 Gass A, Niendorf T, Hirsch JG. Acute and chronic changes of the apparent diffusion coefficient in neurological disorders: biophysical mechanisms and possible underlying histopathology. J Neurol Sci 2001;186(suppl 1):S15–S23. Crossref, MedlineGoogle Scholar
  • 14 Squillaci E, Manenti G, Cova M, et al.. Correlation of diffusion-weighted MR imaging with cellularity of renal tumours. Anticancer Res 2004;24(6):4175–4179. MedlineGoogle Scholar
  • 15 Moffat BA, Chenevert TL, Lawrence TS, et al.. Functional diffusion map: a noninvasive MRI biomarker for early stratification of clinical brain tumor response. Proc Natl Acad Sci U S A 2005;102(15):5524–5529. Crossref, MedlineGoogle Scholar
  • 16 Padhani AR, Liu G, Koh DM, et al.. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 2009;11(2):102–125. Crossref, MedlineGoogle Scholar
  • 17 Hayashida Y, Hirai T, Morishita S, et al.. Diffusion-weighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity. AJNR Am J Neuroradiol 2006;27(7):1419–1425. MedlineGoogle Scholar
  • 18 Burdette JH, Elster AD, Ricci PE. Acute cerebral infarction: quantification of spin-density and T2 shine-through phenomena on diffusion-weighted MR images. Radiology 1999;212(2):333–339. LinkGoogle Scholar
  • 19 Taouli B, Tolia AJ, Losada M, et al.. Diffusion-weighted MRI for quantification of liver fibrosis: preliminary experience. AJR Am J Roentgenol 2007;189(4):799–806. Crossref, MedlineGoogle Scholar
  • 20 Higano S, Yun X, Kumabe T, et al.. Malignant astrocytic tumors: clinical importance of apparent diffusion coefficient in prediction of grade and prognosis. Radiology 2006;241(3):839–846. LinkGoogle Scholar
  • 21 Humphries PD, Sebire NJ, Siegel MJ, Olsen OE. Tumors in pediatric patients at diffusion-weighted MR imaging: apparent diffusion coefficient and tumor cellularity. Radiology 2007;245(3):848–854. LinkGoogle Scholar
  • 22 Bruegel M, Holzapfel K, Gaa J, et al.. Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 2008;18(3):477–485. Crossref, MedlineGoogle Scholar
  • 23 Klimstra DS, Pitman MB, Hruban RH. An algorithmic approach to the diagnosis of pancreatic neoplasms. Arch Pathol Lab Med 2009;133(3):454–464. Crossref, MedlineGoogle Scholar
  • 24 Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59(4):225–249. Crossref, MedlineGoogle Scholar
  • 25 Ichikawa T, Haradome H, Hachiya J, et al.. Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging. Radiology 1997;202(3):655–662. LinkGoogle Scholar
  • 26 Vachiranubhap B, Kim YH, Balci NC, Semelka RC. Magnetic resonance imaging of adenocarcinoma of the pancreas. Top Magn Reson Imaging 2009;20(1):3–9. Crossref, MedlineGoogle Scholar
  • 27 Erkan M, Reiser-Erkan C, Michalski CW, et al.. Cancer-stellate cell interactions perpetuate the hypoxia-fibrosis cycle in pancreatic ductal adenocarcinoma. Neoplasia 2009;11(5):497–508. Crossref, MedlineGoogle Scholar
  • 28 Miller FH, Rini NJ, Keppke AL. MRI of adenocarcinoma of the pancreas. AJR Am J Roentgenol 2006;187(4):W365–W374. Crossref, MedlineGoogle Scholar
  • 29 Garcea G, Dennison AR, Pattenden CJ, Neal CP, Sutton CD, Berry DP. Survival following curative resection for pancreatic ductal adenocarcinoma: a systematic review of the literature. JOP 2008;9(2):99–132. MedlineGoogle Scholar
  • 30 Winter JM, Cameron JL, Campbell KA, et al.. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 2006;10(9):1199–1210; discussion 1210–1211. Crossref, MedlineGoogle Scholar
  • 31 Parikh T, Drew SJ, Lee VS, et al.. Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 2008;246(3):812–822. LinkGoogle Scholar
  • 32 Miller FH, Hammond N, Siddiqi AJ, et al.. Utility of diffusion-weighted MRI in distinguishing benign and malignant hepatic lesions. J Magn Reson Imaging 2010;32(1):138–147. Crossref, MedlineGoogle Scholar
  • 33 Kwee TC, Takahara T, Ochiai R, Nievelstein RA, Luijten PR. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology. Eur Radiol 2008;18(9):1937–1952. Crossref, MedlineGoogle Scholar
  • 34 Kim JK, Altun E, Elias J, Pamuklar E, Rivero H, Semelka RC. Focal pancreatic mass: distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo MRI. J Magn Reson Imaging 2007;26(2):313–322. Crossref, MedlineGoogle Scholar
  • 35 Neff CC, Simeone JF, Wittenberg J, Mueller PR, Ferrucci JT. Inflammatory pancreatic masses: problems in differentiating focal pancreatitis from carcinoma. Radiology 1984;150(1):35–38. LinkGoogle Scholar
  • 36 Muraoka N, Uematsu H, Kimura H, et al.. Apparent diffusion coefficient in pancreatic cancer: characterization and histopathological correlations. J Magn Reson Imaging 2008;27(6):1302–1308. Crossref, MedlineGoogle Scholar
  • 37 Ehehalt F, Saeger HD, Schmidt CM, Grützmann R. Neuroendocrine tumors of the pancreas. Oncologist 2009;14(5):456–467. Crossref, MedlineGoogle Scholar
  • 38 Plöckinger U, Couvelard A, Falconi M, et al.. Consensus guidelines for the management of patients with digestive neuroendocrine tumours: well-differentiated tumour/carcinoma of the appendix and goblet cell carcinoma. Neuroendocrinology 2008;87(1):20–30. Crossref, MedlineGoogle Scholar
  • 39 Rha SE, Jung SE, Lee KH, Ku YM, Byun JY, Lee JM. CT and MR imaging findings of endocrine tumor of the pancreas according to WHO classification. Eur J Radiol 2007;62(3):371–377. Crossref, MedlineGoogle Scholar
  • 40 Cavallini A, Falconi M, Bortesi L, Crippa S, Barugola G, Butturini G. Pancreatoblastoma in adults: a review of the literature. Pancreatology 2009;9(1–2):73–80. Crossref, MedlineGoogle Scholar
  • 41 Montemarano H, Lonergan GJ, Bulas DI, Selby DM. Pancreatoblastoma: imaging findings in 10 patients and review of the literature. Radiology 2000;214(2):476–482. LinkGoogle Scholar
  • 42 Roebuck DJ, Yuen MK, Wong YC, Shing MK, Lee CW, Li CK. Imaging features of pancreatoblastoma. Pediatr Radiol 2001;31(7):501–506. Crossref, MedlineGoogle Scholar
  • 43 Basturk O, Coban I, Adsay NV. Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med 2009;133(3):423–438. Crossref, MedlineGoogle Scholar
  • 44 Choi JY, Kim MJ, Lee JY, et al.. Typical and atypical manifestations of serous cystadenoma of the pancreas: imaging findings with pathologic correlation. AJR Am J Roentgenol 2009;193(1):136–142. Crossref, MedlineGoogle Scholar
  • 45 Cantisani V, Mortele KJ, Levy A, et al.. MR imaging features of solid pseudopapillary tumor of the pancreas in adult and pediatric patients. AJR Am J Roentgenol 2003;181(2):395–401. Crossref, MedlineGoogle Scholar
  • 46 Nakatani K, Watanabe Y, Okumura A, et al.. MR imaging features of solid-pseudopapillary tumor of the pancreas. Magn Reson Med Sci 2007;6(2):121–126. Crossref, MedlineGoogle Scholar
  • 47 Kosmahl M, Egawa N, Schröder S, Carneiro F, Lüttges J, Klöppel G. Mucinous nonneoplastic cyst of the pancreas: a novel nonneoplastic cystic change? Mod Pathol 2002;15(2):154–158. Crossref, MedlineGoogle Scholar
  • 48 Adsay NV. Cystic neoplasia of the pancreas: pathology and biology. J Gastrointest Surg 2008;12(3):401–404. Crossref, MedlineGoogle Scholar
  • 49 Cao W, Adley BP, Liao J, et al.. Mucinous nonneoplastic cyst of the pancreas: apomucin phenotype distinguishes this entity from intraductal papillary mucinous neoplasm. Hum Pathol 2010;41(4):513–521. Crossref, MedlineGoogle Scholar
  • 50 Balci NC, Semelka RC. Radiologic features of cystic, endocrine and other pancreatic neoplasms. Eur J Radiol 2001;38(2):113–119. Crossref, MedlineGoogle Scholar

Article History

Received: July 14 2010
Revision requested: Nov 4 2010
Revision received: Dec 16 2010
Accepted: Dec 20 2010
Published online: May 4 2011
Published in print: May 2011