Dual-phase CT of autoimmune pancreatitis

A multireader study

Naoki Takahashi, Joel Garland Fletcher, Jeff L. Fidler, David M. Hough, Akira Kawashima, Suresh T Chari

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to identify findings that aid in differentiating autoimmune pancreatitis from pancreatic carcinoma using dual-phase CT. MATERIALS AND METHODS. Dual-phase CT scans of 74 patients (25 with autoimmune pancreatitis, 33 with pancreatic carcinoma, and 16 with a normal pancreas) were independently evaluated by three radiologists for enhancement of the pancreas; the presence of a capsule-like rim, peripancreatic strands, and pancreatic calcifications; pancreatic duct or bile duct changes; and renal involvement. The frequency of CT characteristics was compared between autoimmune pancreatitis and carcinoma. Interobserver agreement for the three reviewers for the assessment of CT characteristics was evaluated using kappa statistics. RESULTS. Diffusely decreased enhancement of the pancreas (autoimmune pancreatitis vs carcinoma: 28% vs 3%; p = 0.02, κ = 0.33-0.75), capsule-like rim (40% vs 9%; p = 0.009, κ = 0.42-0.66), peripancreatic strands (60% vs 27%; p = 0.02, κ = 0.45-0.54), pancreatic calcifications (32% vs 9%; p = 0.04, κ = 0.14-0.47), bile duct wall enhancement (52% vs 6%; p = 0.0001, κ = 0.28-0.47), and renal involvement (28% vs 0%; p = 0.002, κ = 0.32-0.74) were more frequent in patients with autoimmune pancreatitis. Pancreatic duct dilation (24% vs 67%; p = 0.001, κ = 0.65-0.73) and abrupt cutoff (16% vs 55%; p = 0.003, κ = 0.60-0.65) were more frequent in patients with carcinoma. CONCLUSION. Diffusely decreased enhancement of the pancreas, a capsule-like rim, bile duct enhancement, and renal involvement are useful signs of autoimmune pancreatitis.

Original languageEnglish (US)
Pages (from-to)280-286
Number of pages7
JournalAmerican Journal of Roentgenology
Volume190
Issue number2
DOIs
StatePublished - Feb 2008

Fingerprint

Pancreatitis
Pancreas
Bile Ducts
Capsules
Pancreatic Ducts
Carcinoma
Kidney
Dilatation
Pancreatic Carcinoma

Keywords

  • Autoimmune pancreatitis
  • CT
  • Gastrointestinal tract
  • Pancreas
  • Pancreatic carcinoma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Dual-phase CT of autoimmune pancreatitis : A multireader study. / Takahashi, Naoki; Fletcher, Joel Garland; Fidler, Jeff L.; Hough, David M.; Kawashima, Akira; Chari, Suresh T.

In: American Journal of Roentgenology, Vol. 190, No. 2, 02.2008, p. 280-286.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE. The purpose of this study was to identify findings that aid in differentiating autoimmune pancreatitis from pancreatic carcinoma using dual-phase CT. MATERIALS AND METHODS. Dual-phase CT scans of 74 patients (25 with autoimmune pancreatitis, 33 with pancreatic carcinoma, and 16 with a normal pancreas) were independently evaluated by three radiologists for enhancement of the pancreas; the presence of a capsule-like rim, peripancreatic strands, and pancreatic calcifications; pancreatic duct or bile duct changes; and renal involvement. The frequency of CT characteristics was compared between autoimmune pancreatitis and carcinoma. Interobserver agreement for the three reviewers for the assessment of CT characteristics was evaluated using kappa statistics. RESULTS. Diffusely decreased enhancement of the pancreas (autoimmune pancreatitis vs carcinoma: 28{\%} vs 3{\%}; p = 0.02, κ = 0.33-0.75), capsule-like rim (40{\%} vs 9{\%}; p = 0.009, κ = 0.42-0.66), peripancreatic strands (60{\%} vs 27{\%}; p = 0.02, κ = 0.45-0.54), pancreatic calcifications (32{\%} vs 9{\%}; p = 0.04, κ = 0.14-0.47), bile duct wall enhancement (52{\%} vs 6{\%}; p = 0.0001, κ = 0.28-0.47), and renal involvement (28{\%} vs 0{\%}; p = 0.002, κ = 0.32-0.74) were more frequent in patients with autoimmune pancreatitis. Pancreatic duct dilation (24{\%} vs 67{\%}; p = 0.001, κ = 0.65-0.73) and abrupt cutoff (16{\%} vs 55{\%}; p = 0.003, κ = 0.60-0.65) were more frequent in patients with carcinoma. CONCLUSION. Diffusely decreased enhancement of the pancreas, a capsule-like rim, bile duct enhancement, and renal involvement are useful signs of autoimmune pancreatitis.",
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N2 - OBJECTIVE. The purpose of this study was to identify findings that aid in differentiating autoimmune pancreatitis from pancreatic carcinoma using dual-phase CT. MATERIALS AND METHODS. Dual-phase CT scans of 74 patients (25 with autoimmune pancreatitis, 33 with pancreatic carcinoma, and 16 with a normal pancreas) were independently evaluated by three radiologists for enhancement of the pancreas; the presence of a capsule-like rim, peripancreatic strands, and pancreatic calcifications; pancreatic duct or bile duct changes; and renal involvement. The frequency of CT characteristics was compared between autoimmune pancreatitis and carcinoma. Interobserver agreement for the three reviewers for the assessment of CT characteristics was evaluated using kappa statistics. RESULTS. Diffusely decreased enhancement of the pancreas (autoimmune pancreatitis vs carcinoma: 28% vs 3%; p = 0.02, κ = 0.33-0.75), capsule-like rim (40% vs 9%; p = 0.009, κ = 0.42-0.66), peripancreatic strands (60% vs 27%; p = 0.02, κ = 0.45-0.54), pancreatic calcifications (32% vs 9%; p = 0.04, κ = 0.14-0.47), bile duct wall enhancement (52% vs 6%; p = 0.0001, κ = 0.28-0.47), and renal involvement (28% vs 0%; p = 0.002, κ = 0.32-0.74) were more frequent in patients with autoimmune pancreatitis. Pancreatic duct dilation (24% vs 67%; p = 0.001, κ = 0.65-0.73) and abrupt cutoff (16% vs 55%; p = 0.003, κ = 0.60-0.65) were more frequent in patients with carcinoma. CONCLUSION. Diffusely decreased enhancement of the pancreas, a capsule-like rim, bile duct enhancement, and renal involvement are useful signs of autoimmune pancreatitis.

AB - OBJECTIVE. The purpose of this study was to identify findings that aid in differentiating autoimmune pancreatitis from pancreatic carcinoma using dual-phase CT. MATERIALS AND METHODS. Dual-phase CT scans of 74 patients (25 with autoimmune pancreatitis, 33 with pancreatic carcinoma, and 16 with a normal pancreas) were independently evaluated by three radiologists for enhancement of the pancreas; the presence of a capsule-like rim, peripancreatic strands, and pancreatic calcifications; pancreatic duct or bile duct changes; and renal involvement. The frequency of CT characteristics was compared between autoimmune pancreatitis and carcinoma. Interobserver agreement for the three reviewers for the assessment of CT characteristics was evaluated using kappa statistics. RESULTS. Diffusely decreased enhancement of the pancreas (autoimmune pancreatitis vs carcinoma: 28% vs 3%; p = 0.02, κ = 0.33-0.75), capsule-like rim (40% vs 9%; p = 0.009, κ = 0.42-0.66), peripancreatic strands (60% vs 27%; p = 0.02, κ = 0.45-0.54), pancreatic calcifications (32% vs 9%; p = 0.04, κ = 0.14-0.47), bile duct wall enhancement (52% vs 6%; p = 0.0001, κ = 0.28-0.47), and renal involvement (28% vs 0%; p = 0.002, κ = 0.32-0.74) were more frequent in patients with autoimmune pancreatitis. Pancreatic duct dilation (24% vs 67%; p = 0.001, κ = 0.65-0.73) and abrupt cutoff (16% vs 55%; p = 0.003, κ = 0.60-0.65) were more frequent in patients with carcinoma. CONCLUSION. Diffusely decreased enhancement of the pancreas, a capsule-like rim, bile duct enhancement, and renal involvement are useful signs of autoimmune pancreatitis.

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