A retrospective preliminary study of intrapancreatic late enhancement as a noteworthy imaging finding in the early stages of pancreatic adenocarcinoma

Yoshihiro Konno; Yasuhiro Sugai; Masafumi Kanoto; Keisuke Suzuki; Toshitada Hiraka; Yuki Toyoguchi; Kazuho Niino

doi:10.1007/s00330-022-09388-w

A retrospective preliminary study of intrapancreatic late enhancement as a noteworthy imaging finding in the early stages of pancreatic adenocarcinoma

Eur Radiol. 2023 Jul;33(7):5131-5141. doi: 10.1007/s00330-022-09388-w. Epub 2023 Jan 17.

Authors

Yoshihiro Konno¹, Yasuhiro Sugai², Masafumi Kanoto², Keisuke Suzuki², Toshitada Hiraka², Yuki Toyoguchi², Kazuho Niino³

Affiliations

¹ Department of Diagnostic Radiology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata-Shi, Yamagata, 990-9585, Japan. hiro.konno@med.id.yamagata-u.ac.jp.
² Department of Diagnostic Radiology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata-Shi, Yamagata, 990-9585, Japan.
³ Department of Radiology, Nihonkai General Hospital, 30 Akiho, Sakata-Shi, Yamagata, 998-8501, Japan.

PMID: 36648551
DOI: 10.1007/s00330-022-09388-w

Abstract

Objective: To characterize intrapancreatic late enhancement (ILE) observed in the early stages of pancreatic adenocarcinoma (PAC).

Methods: Among 203 patients pathologically diagnosed with PAC between October 2011 and February 2021, 32 patients with pre-diagnostic abdominal contrast-enhanced CT performed from 6 months to 5 years before the diagnosis were enrolled in this study. Indirect findings (IFs) on pre-diagnostic CT, including ILE, were evaluated and examined for various clinical data and time intervals to diagnosis (TIDs). The detected ILE was quantitatively evaluated, and the effect of ILE awareness on lesion detection by two radiologists and their interobserver agreement were assessed.

Results: Among the 32 patients, 23 showed IFs. ILE was observed in 14 patients (63%), with a median TID of 17 months (interquartile ratio [IQR]: 9.3-42.3). ILE alone was observed in eight patients (35%), ILE with focal pancreatic parenchymal atrophy (FPPA) was observed in five patients (22%), and ILE with main pancreatic duct abnormalities (MPDA) was observed in one patient (4%). Pancreatic head lesions were significantly more frequent in patients with ILE alone than in patients with FPPA or MPDA (p = 0.026). The median long-axis diameters of the region with ILE and ILE-to-pancreas contrast were 10 (IQR: 5-11) mm and 24 (IQR: 17-33) HU, respectively. Awareness of ILE led observers to detect two or three more pancreatic head lesions, and interobserver agreement increased from poor agreement (k = 0.17) to moderate agreement (k = 0.55).

Conclusion: ILE is a significant IF for early PAC detection.

Key points: • Intrapancreatic late enhancement (ILE) is a significant indirect finding in the early detection of pancreatic adenocarcinoma. • ILE without other indirect findings is expected to help detect pancreatic head lesions. • Image evaluation focusing on ILE can increase lesion detection and improve the interobserver agreement.

Keywords: Adenocarcinoma; Diagnostic imaging; Early diagnosis; Pancreas.

MeSH terms

Adenocarcinoma* / diagnostic imaging
Humans
Pancreatic Neoplasms* / diagnosis
Retrospective Studies
Tomography, X-Ray Computed / methods

Substances

3-(2'-pyridyldithio)benzyldiazoacetate