3D MR elastography of the pancreas in children
Early diagnosis of chronic pancreatitis (CP) remains elusive. Preliminary data suggest that MR elastography (MRE) may have diagnostic value in the identification of CP. We sought to measure pancreas stiffness by MRE in healthy children and to compare measured values to stiffness values in pediatric patients with acute recurrent pancreatitis (ARP) or CP.
Under IRB approval, 49 healthy controls volunteered to be included, and 14 patients with ARP or CP that underwent 3D MRE on a 1.5T MR scanner were included in the study. A soft passive driver was utilized and vibrated at 40 Hz. Regions of interest for measurement of pancreatic stiffness were drawn by two blinded readers and statistical analysis were performed for comparisons between the two groups.
Mean age of the healthy controls was 11 ± 2.7 years and mean pancreas stiffness was 1.7 ± 0.3 (Reader 1) and 1.7 ± 0.3 (Reader 2) kPa. For patients with ARP or CP, mean age was 12.6 ± 4.4 years and mean pancreas stiffness was 0.9 ± 0.2 (Reader 1) and 1.1 ± 0.3 (Reader 2) kPa. Pancreas stiffness was significantly lower in patients with ARP and CP as compared to healthy controls (p < 0.001). Between readers, there was a strong and statistically significant agreement on measured pancreas stiffness (r = 0.81; p < 0.001). Bland–Altman difference analysis showed a mean bias of only 0.05 kPa (95% limits of agreement: − 0.49 to + 0.58)
MRE of the pancreas can be performed in pediatric patients. Through this study, we have defined normal pancreas stiffness for children and have shown decreases in measured stiffness in patients with ARP or CP compared to healthy controls.
3D MRE of the pancreas offers a novel approach for detecting pancreatic disease based on changes in tissue mechanical properties.
KeywordsMagnetic resonance imaging MR elastography Pancreas MRE 3D MRE Pancreas MRE Pancreas stiffness MR elastography of pancreas Pediatric Children adolescents
We thank Rebecca Imbus for her efforts recruiting the healthy control participants. We thank Richard L. Ehman, MD, PhD, Scott Kruse, BS, and Kevin Glaser, PhD, of Mayo Clinic (Rochester, MN) for their support and technical assistance related to 3D MRE. We also thank Shi Yu, MS, of Shengjing Hospital (China) and Sudha A. Anupindi, MD, of Children's Hospital of Philadelphia (Philadelphia, PA) for their helpful discussions and feedback related to our results.
Imaging of the healthy control participants was funded by a grant from The National Pancreas Foundation.
- 4.Yin, M., et al., Distinguishing between Hepatic Inflammation and Fibrosis with MR Elastography. Radiology, 2017: p. 160622.Google Scholar
- 8.Wang, M., et al., Magnetic resonance elastography and T1 mapping for early diagnosis and classification of chronic pancreatitis. J Magn Reson Imaging, 2018.Google Scholar
- 13.Uc, A., et al., INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE Cohort Study: Design and Rationale for INSPPIRE 2 From the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Pancreas, 2018. 47(10): p. 1222-1228.Google Scholar
- 15.Serai, S.D., et al., Repeatability of MR Elastography of Liver: A Meta-Analysis. Radiology, 2017: p. 161398.Google Scholar