Differentiating mass-forming autoimmune pancreatitis from pancreatic ductal adenocarcinoma on the basis of contrast-enhanced MRI and DWI findings

OBJECTIVE. The purpose of this study was to assess value of contrast-enhanced MRI, MRCP, and DWI for differentiating mass-forming autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS. This study included 15 patients with mass-forming AIP and 79 with PDAC who underwent gadoxetic acid-enhanced MRI with DWI and MRCP. Two radiologists evaluated the MRI findings in consensus. Statistically significant imaging findings were identified through univariate and multivariate analyses, and their diagnostic performance for predicting mass-forming AIP was analyzed. RESULTS. In the univariate analysis, multiplicity, similar or high signal intensity on portal phase and 3- and 20-minute delayed phase images, homogeneous enhancement, no peripancreatic fat infiltration, no internal cystic or necrotic portion, capsulelike rim, no upstream pancreatitis, no vascular invasion, and duct penetrating sign were more frequently observed (p < 0.05) in mass-forming AIP. The apparent diffusion coefficient (ADC) value was also significantly lower for mass-forming AIP than for PDAC (0.96 ± 0.14 versus 1.13 ± 0.23 × 10-3 mm2/s; p < 0.001). The optimal cutoff value of ADC for differentiating mass-forming AIP from PDAC was 0.9407 × 10-3 mm2/s. In multivariate analysis, homogeneous enhancement (p = 0.001), duct penetrating sign (p < 0.001), and ADC value less than 0.9407 × 10-3 mm2/s (p < 0.001) were significant for differentiating mass-forming AIP from PDAC. When two of these three criteria were combined, 80% (12/15) of mass-forming AIPs were identified with specificity of 98.7%. When all three criteria were satisfied, specificity was 100%. CONCLUSION. Contrast-enhanced MRI with MRCP and DWI may be helpful for differentiating mass-forming AIP from PDAC.