ISMRM 24th Annual Meeting & Exhibition • 07-13 May 2016 • Singapore

Scientific Session: Hepatobiliary 2: Pancreasbiliary

Tuesday, May 10, 2016
Summit 2
16:00 - 18:00
Moderators: Masoom Haider, Diego Hernando

Magnetic Resonance Imaging of the Pancreas in a Transgenic Mouse Model of Pancreatic Carcinogenesis
Conny F. Waschkies1,2, Theresia F. Reding1, Gitta Maria Seleznik1, Udo Ungethuem1, and Rolf Graf1
1Division of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland, 2Institute for Biomedical Engineering, ETH and University Zurich, Zurich, Switzerland
Few preclinical studies rely on MRI to monitor pancreatic tissue changes in commensurate animal models, mostly due to inherently low conspicuity of the rodent pancreas. Pancreatic inflammation is a risk factor for pancreatic ductal adenocarcinoma development, and its initiation is linked to activating mutations in KRAS oncogene, known as the KPC mouse model. In the present study we demonstrate the potential of preclinical MRI to visualize the murine pancreas and its changes associated with cellular transformations in this mouse model of pancreatic carcinogenesis.

Pilot Study of Rapid MR Pancreas Screening for Patients with BRCA Mutation Undergoing Screening Breast MRI – Preliminary Data
Mitchell C Raeside1, Andrea Agostini1, Richard K.G. Do1, Amita Shukla-Dave1,2, David Aramburu-Nunez2, Ramesh Paudyal2, Olga Smelianskaia1, Monika Khan1, David Kelsen3, and Lorenzo Mannelli1
1Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, 2Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, 3Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
The purpose of this study was to develop and optimize a rapid MR pancreas screening protocol to be performed in conjunction with breast MRI screening in BRCA-positive individuals. 15 patients underwent a rapid pancreatic screening at the conclusion of their breast MRI examination.  Images were acquired with the patient in the prone position, with the breast coil still in place, but using the built-in body coil on a 3T magnet, and evaluated for image quality (including SNR and CNR), and detection of pancreatic lesions. Rapid MR protocol for pancreatic cancer screening is feasible and provides diagnostic quality images.

Contrast Agent Uptake Analysis at 3T for Pancreatic Cancer
Douglas Arthur Charles Kelley1, Eric Collisson2, Benjamin M Yeh3, Michael Ohliger3, and Zhen Wang3
1Neuro Applications and Workflow, GE Healthcare, Corte Madera, CA, United States, 2Medicine, University of California, San Francisco, San Francisco, CA, United States, 3Radiology, University of California, San Francisco, San Francisco, CA, United States
Pancreatic cancer is highly desmoplastic and slowly takes up extracellular gadolinium based contrast agents during MR imaging. Quantitative estimation of gadolinium based contrast uptake in pancreas cancers may help assess the tumor stroma, which is implicated in tumor aggressiveness and treatment response. However, tissue motion and sensitivity inhomogeneity on abdominal MR scans present complications for quantitative analysis of contrast uptake. A new MR PET system with higher performance gradient and RF capabilities coupled with data-driven analysis methods allow robust estimation of contrast agent concentration in pancreatic cancer patients. 

Differentiating Pancreatic Cancer from Mass-Forming Focal Pancreatitis with a Novel Inhomogeneity Index Based on ADC Map Analysis
Chao Ma1, Li Liu1, Jing Li1, Li Wang1, Xu Fang1, Jianxun Qu2, Shi-yue Chen1, and Jianping Lu1
1Department of Radiology, Changhai Hospital of Shanghai, Shanghai, China, People's Republic of, 2MR Research China, GE Healthcare, Beijing, China, People's Republic of
Differentiating mass-forming focal pancreatitis (FP) and pancreatic ductal adenocarcinoma (PDAC) is of great importance and yet remains a challenge in clinical practice. In this work, we propose a novel method to address the challenge with a new parameter (inhomogeneity index) based on the ADC map analysis with different region of interest (ROI) size.

Prediction of response by DCE-MRI and DW-MRI for intrahepatic cholangiocarcinomas treated with locoregional and systemic chemotherapy: a preliminary analysis
Kristen L Zakian1, Richard K Do2, Taryn Boucher2, Mithat Gonen3, Andrea Cercek4, William R Jarnagin5, and Nancy Kemeny4
1Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, 2Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, 3Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, 4Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, 5Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy and has few treatment options. A previous study suggested that MRI may help identify patients likely to benefit from hepatic arterial infusion pump therapy with floxuridine (HAI-FUDR). The purpose of this prospective study was to investigate the ability of pre-treatment and early-in-treatment DCE and DW-MRI to predict ICC response to combined HAI-FUDR and systemic chemotherapy given in a Phase 2 clinical trial. Our preliminary analysis suggests that DW-MRI may predict response of unresectable ICC using data acquired at baseline or at 1 month after treatment start.

An Indenting Abdominal Array for 2-Fold SNR Improvement in Pancreatic MRI
Scott B. King1, Jarod Matwiy1, Calvin Bewsky1, Hung-Yu Lin1, and Masoom A. Haider2,3
1Medical Devices, National Research Council Canada, Winnipeg, MB, Canada, 2Dept of Medical Imaging, Sunnybrook Health Sciences Center, Toronto, ON, Canada, 3Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
The pancreas is difficult to image because of its central location deep in the abdomen, often with overlapping artifact in parallel MRI reconstruction through the mid abdomen and drop off of signal.   In this new concept for improved SNR and parallel MRI in pancreas MRI, a surface array is pushed/indented into the abdomen, bringing smaller array elements closer to the pancreas. Compared to the benchmark array, the Indenting Array demonstrated >2x SNR and 40% improved R=3 A-P parallel MRI with g-factor = 1 within the pancreas.  This new “indenting” array design could have a significant impact on pancreas diagnostic MRI.

Repeatability of MRI and MRS pancreatic proton density fat fraction (PDFF) quantification methods
Alexandra N Schlein1, Yesenia Covarrubias1, Adrija Mamidipalli1, Jonathan Hooker1, Michael S Middleton1, Rohit Loomba2, Tanya Wolfson3, Claude B Sirlin1, and Gavin Hamilton1
1Radiology, UCSD, San Diego, CA, United States, 2Hepatology, UCSD, San Diego, CA, United States, 3Computational and Applied Statistics Laboratory UCSD, San Diego, CA, United States
Advanced MR techniques have been developed to estimate proton density fat fraction (PDFF) of pancreatic fat. The purpose of this study is to assess intra- and inter-examination repeatability of 1H MRS and multi-echo MRI to estimate pancreatic PDFF. Subjects were scanned with both MRI and MRS three times: twice without subject repositioning and then once more after having subjects get off and back on the table. The results suggest that MRI is more repeatable than MRS, especially when subjects are repositioned between acquisitions, which more closely simulates the conditions in which these techniques might be applied clinically and in research.

Quantitative analysis of diagnosing pancreatic fibrosis using Magnetic resonance elastography
Yu Shi1, qiyong guo1, He An1, Kevin J Glaser2, and Ehman L Richard3
1Department of radiology, Shengjing hospital of China medical university, shenyang, China, People's Republic of, 2Rochester, MN, United States, 3Department of radiology, Mayo Clinic, Rochester, MN, United States
An accurate diagnosis of pancreatic fibrosis is important in clinical work. MR elastography (MRE) can be used for staging the degrees of pancreatic fibrosis that reflects the severity of chronic pancreatitis. Our work proved that both fibrosis (P< 0.001) and inflammation (P= 0.014) contribute to higher stiffness of pancreatic parenchyma, excluding fat deposition (P= 0.082).  The sensitivity and specificity was 100% and 86% for diagnosing ≥F2, and 100% and 100% for diagnosing =F3 fibrosis stage, respectively.

Impact of Inter-lobular Fat on the Repeatability of Pancreatic Fat Fraction Measurement by MRI.
Adam Jaster1, Ivan Pedrosa1,2, Robert E. Lenkinski1,2, Ildiko Lingvay3,4, and Takeshi Yokoo1,2
1Radiology, UT Southwestern Medical Center, Dallas, TX, United States, 2Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, United States, 3Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States, 4Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, United States
In pancreatic steatosis, fat accumulates within intra-lobular (parenchyma) and inter-lobular (adipose) tissue. Regions of interest (ROIs) placed in pancreas include heterogeneous population of pixels of lower-fat intra-lobular tissue, higher-fat inter-lobular tissue, and admixture of the two by partial volume effects. In this study of 21 subjects with insulin-dependent type 2 diabetes, we investigated the impact of inter-lobular fat on the repeatability of pancreatic fat fraction (FF) measurement by multiecho gradient-echo MRI.  We found that the mean FF measurement within segmented pancreatic ROI is highly repeatable with intraclass correlation of 0.965 after exclusion of high-fat (FF≥50%) pixels contaminated by inter-lobular fat. 

Longitudinal change of pancreatic proton density fat fraction (PDFF) and its correlates during weight loss in initially obese adults
Yesenia Covarrubias1, Alexandra N Schlein1, William M Haufe1, Catherine A Hooker1, Adrija Mamidipalli1, Tanya Wolfson2, Garth Jacobson3, Santiago Horgan3, Jeffrey B Schwimmer4, Scott B Reeder5, and Claude B Sirlin1
1Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, CA, United States, 2Computational and Applied Statistics Laboratory (CASL), SDSC, University of California, San Diego, La Jolla, CA, United States, 3Department of Surgery, University of California, San Diego, La Jolla, CA, United States, 4Division of Gastroenterology, Hepatology, and Nutrition & Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, CA, United States, 5Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, Emergency Medicine, University of Wisconsin, Madison, WI, United States
This pilot, prospective, longitudinal study in 9 obese adults explored the relationship between weight loss and longitudinal change in MRI-determined pancreatic proton density fat fraction (PDFF), as well as the relationships between rates of change in pancreatic PDFF, hepatic PDFF, and anthropometric measures. Pancreatic PDFF decreased in every subject from a mean of 15.5% at the first study visit to a mean of 8.6% at the last study visit (p=0.006). Further research in larger cohorts is needed to confirm our findings and to understand the clinical and biological relevance of pancreatic PDFF reduction.

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