Pancreatic Adenocarcinoma: Variability of Diffusion-weighted MR Imaging Findings

Purpose: To compare the apparent diffusion coefficients (ADCs) of pancreatic adenocarcinomas that appear hyperintense with clearly defined borders (clear hyperintense) with those that do not show clear hyperintense borders on diffusion-weighted magnetic resonance (MR) images. Materials and Methods: Institutional review board approval was obtained and informed consent was waived. Eighty patients with histologically confirmed pancreatic adenocarcinoma (mean tumor size, 32 mm) underwent fat-suppressed single-shot echo-planar 3.0-T diffusion-weighted MR imaging with diffusion gradients (b = 1000 sec/mm(2)). ADC values of the pancreatic adenocarcinomas (n = 80) and proximal (n = 51) and distal (n = 70) pancreas were compared by using the Friedman test, followed by the Wilcoxon signed-rank test, and the difference in serum amylase levels between pancreatic adenocarcinomas with and without clear hyperintensity was evaluated by using the chi(2) test. Results: In 38 of 80 patients, pancreatic adenocarcinomas showed clear hyperintensity relative to the surrounding pancreas; 26 were hyperintense with unclear distal borders; 12, isointense; and four, hypointense. In all patients, the mean ADC (+/- standard deviation) of the tumors (1.16 x 10(-3) mm(2)/sec +/- 0.22) was significantly lower than those of the proximal pancreas (1.33 x 10(-3) mm(2)/sec +/- 0.16, P < .001) and the distal pancreatic parenchyma (1.24 x 10(-3) mm(2)/sec +/- 0.23, P = .004). No significant difference in ADC was seen between the pancreatic adenocarcinomas without clear hyperintensity and the distal pancreas. The frequency of serum amylase levels greater than 120 U/L (2.00 mu kat/L) was significantly higher than in those with clear hyperintense pancreatic adenocarcinomas (P < .001). Conclusion: Diffusion-weighted MR imaging was not useful for delineating 47% of pancreatic adenocarcinomas, because of hyperintensity of the pancreatic parenchyma distal to the cancer. (c) RSNA, 2012