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Preoperative Evaluation of Pancreatic Fibrosis and Lipomatosis

Correlation of Magnetic Resonance Findings With Histology Using Magnetization Transfer Imaging and Multigradient Echo Magnetic Resonance Imaging

Schawkat, Khoschy, MD*; Eshmuminov, Dilmurodjon, MD; Lenggenhager, Daniela, MD; Endhardt, Katharina, MD; Vrugt, Bart, MD; Boss, Andreas, MD, PhD*; Petrowsky, Henrik, MD; Clavien, Pierre-Alain, MD, PhD; Reiner, Caecilia S., MD*

doi: 10.1097/RLI.0000000000000496
Original Articles

Objectives The purpose of this study was to evaluate the diagnostic performance of magnetization transfer (MT) imaging and multigradient echo magnetic resonance imaging (MRI) to quantify pancreatic fibrosis and lipomatosis in patients before pancreatoduodenectomy for postoperative risk stratification with histopathology as the reference standard.

Materials and Methods Twenty-four patients (age, 68 ± 8 years, 16 males) prospectively underwent quantitative MT imaging using a 2-dimensional gradient echo sequence with and without MT prepulse and multigradient echo imaging on a 3 T MRI 1 day before pancreatoduodenectomy due to adenocarcinoma of the pancreatic head region (n = 20), neuroendocrine tumor (n = 3), or intraductal papillary mucinous neoplasm (n = 1). Magnetization transfer ratio (MTR) and proton density fat fraction (PDFF) were measured in pancreatic tail (PT) and at the resection margin (RM). Histopathologically, pancreatic fibrosis was graded as mild, moderate, or severe (F1–F3), lipomatosis was graded as 0% to 10%, 11% to 30%, and greater than 30% fat deposition (L1–L3). In addition, MTR and histopathologic fibrosis was assessed in pancreatic adenocarcinoma. Mann-Whitney U test and Spearman correlation were used.

Results Patients with advanced pancreatic fibrosis (F3) showed a significantly higher MTR compared with the F1 group at the RM and PT (38 ± 4 vs 32.3 ± 1.6, P = 0.018 and 39.7 ± 5.5 vs 31.2 ± 1.7, P = 0.001). Spearman correlation coefficient of MTR and fibrosis grade was r = 0.532 (P = 0.011) and 0.554 (P = 0.008), respectively. Pancreatic parenchyma with advanced fat deposition (L2–L3) showed significantly higher PDFF compared with lipomatosis grade L1 (RM: P = 0.002 and PT: P = 0.001). Proton density fat fraction of pancreatic parenchyma exhibited a moderate and significant correlation with histopathologic lipomatosis grade (RM: r = 0.668 and PT: r = 0.707, P < 0.001). Magnetization transfer ratio was significantly higher in pancreatic adenocarcinoma compared with pancreatic parenchyma (44 ± 5.5 vs 36.0 ± 4.4 and 37.4 ± 5.4, P = 0.004).

Conclusions Multiparametric MRI of the pancreas including MTR and PDFF maps may provide quantitative and noninvasive information on pancreatic fibrosis and lipomatosis before surgery.

From the *Institute of Diagnostic and Interventional Radiology,

Department of Surgery and Transplantation, and

Institute of Pathology and Molecular Pathology, University Hospital Zurich, University Zurich, Switzerland.

Received for publication April 14, 2018; and accepted for publication, after revision, May 23, 2018.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Caecilia S. Reiner, MD, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100 8091 Zurich, Switzerland. E-mail:

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.