AJR:190, February 2008
Naoki Takahashi, Joel G. Fletcher, Jeff L Fidler, David M. Hough, Akira Kawashima, Suresh T. Chari
Objective: The purpose of our study was to assess the increase in whole-breast vascularity in patients with unilateral breast cancer and correlate that increase with prognostic factors of breast cancer.
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, K = 0.33-0.75), capsule-like rim (40% vs 9%; p = 0.009, K = 0.42-0.66), peripancreatic strands (60% vs 27%; p = 0.02, K = 0.45-0.54), pancreatic calcifications (32% vs 9%; p = 0.04, K = 0.14-0.47), bile duct wall enhancement (52% vs 6%; p = 0.0001, K = 0.28-0.47), and renal involvement (28% vs 0%; p = 0.002, K = 0.32-0.74) were more frequent in patients with autoimmune pancreatitis. Pancreatic duct dilation (24% vs 67%; p = 0.001, K = 0.65-0.73) and abrupt cutoff (16% vs 55%; p = 0.003, K = 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.