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Magnetic resonance imaging as a non-invasive method for the assessment of pancreatic fibrosis (MINIMAP): a comprehensive study design from the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer

  • Temel TirkesEmail author
  • Dhiraj Yadav
  • Darwin L. Conwell
  • Paul R. Territo
  • Xuandong Zhao
  • Sudhakar K. Venkatesh
  • Arunark Kolipaka
  • Liang Li
  • Joseph R. Pisegna
  • Stephen J. Pandol
  • Walter G. Park
  • Mark Topazian
  • Jose Serrano
  • Evan L. Fogel
  • the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer
Pancreas
  • 68 Downloads

Abstract

Characteristic features of chronic pancreatitis (CP) may be absent on standard imaging studies. Quantitative Magnetic Resonance Imaging (MRI) techniques such as T1 mapping, extracellular volume (ECV) fraction, diffusion-weighted imaging (DWI) with apparent diffusion coefficient map (ADC), MR elastography (MRE), and T1-weighted signal intensity ratio (SIR) have shown promise for the diagnosis and grading severity of CP. However, radiologists still use the Cambridge classification which is based on traditional ductal imaging alone. There is an urgent need to develop new diagnostic criteria that incorporate both parenchymal and ductal features of CP seen by MRI/MRCP. Designed to fulfill this clinical need, we present the MINIMAP study, which was funded in September 2018 by the National Institutes of Health. This is a comprehensive quantitative MR imaging study which will be performed at multiple institutions in well-phenotyped CP patient cohorts. We hypothesize that quantitative MRI/MRCP features can serve as valuable non-invasive imaging biomarkers to detect and grade CP. We will evaluate the role of T1 relaxometry, ECV, T1-weighted gradient echo SIR, MRE, arteriovenous enhancement ratio, ADC, pancreas volume/atrophy, pancreatic fat fraction, ductal features, and pancreatic exocrine output following secretin stimulation in the assessment of CP. We will attempt to generate a multi-parametric pancreatic tissue fibrosis (PTF) scoring system. We anticipate that a quantitative scoring system may serve as a biomarker of pancreatic fibrosis; hence this imaging technique can be used in clinical practice as well as clinical trials to evaluate the efficacy of agents which may slow the progression or reverse measures of CP.

Keywords

Chronic pancreatitis MRI MRCP T1 mapping Extracellular volume Diffusion-weighted imaging MR elastography 

Abbreviations

ADC

Apparent diffusion coefficient

CP

Chronic pancreatitis

CPDPC

Chronic pancreatitis, diabetes, and pancreatic cancer consortium

DWI

Diffusion-weighted imaging

ECV

Extracellular Volume

ERCP

Endoscopic retrograde cholangiopancreatography

MINIMAP

Magnetic resonance imaging as a non-invasive method for the assessment of pancreatic fibrosis

MRCP

Magnetic resonance cholangiopancreatography

MRI

Magnetic resonance imaging

MRE

Magnetic resonance elastography

PROCEED

Prospective evaluation of chronic pancreatitis for epidemiologic and translational studies

SIR

Signal intensity ratio

Notes

Acknowledgements

We acknowledge Anil Dasyam, MD; Ely Felker, MD; Zarine Shah, MD; Naoki Takahashi, MD; Shreyas Vasanawala, MD; and Ashley Wachsman, MD (in alphabetical order) for their participation in this study. We acknowledge the support of ChiRhoClin Inc. (Burtonsville, MD, USA) for supplying the Secretin (ChiRhoStim).

Funding

Research reported in this publication was supported by National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award numbers R01DK116963 (MINIMAP), U01DK108323 (IU), U01DK108306 (UPMC), U01DK108327 (OSU), U01DK108314 (CSMC), DKP3041301 (UCLA), U01DK108300 (Stanford), and U01DK108288 (Mayo). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Conflict of interest

All authors declared that they have no competing interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Temel Tirkes
    • 1
    Email author
  • Dhiraj Yadav
    • 2
  • Darwin L. Conwell
    • 3
  • Paul R. Territo
    • 4
  • Xuandong Zhao
    • 4
  • Sudhakar K. Venkatesh
    • 5
  • Arunark Kolipaka
    • 6
  • Liang Li
    • 7
  • Joseph R. Pisegna
    • 8
  • Stephen J. Pandol
    • 9
  • Walter G. Park
    • 10
  • Mark Topazian
    • 11
  • Jose Serrano
    • 12
  • Evan L. Fogel
    • 13
  • the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer
  1. 1.Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisUSA
  2. 2.Division of Gastroenterology, Hepatology & Nutrition, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  3. 3.Department of Medicine, Division of Gastroenterology, Hepatology & NutritionOhio State University Wexner Medical CenterColumbusUSA
  4. 4.Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisUSA
  5. 5.Department of RadiologyMayo ClinicRochesterUSA
  6. 6.The Ohio State University Wexner Medical CenterColumbusUSA
  7. 7.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  8. 8.Division of Gastroenterology and Hepatology, Departments of Medicine and Human GeneticsVA Greater Los Angeles HCSLos AngelesUSA
  9. 9.Division of Digestive and Liver DiseasesCedars-Sinai Medical CenterLos AngelesUSA
  10. 10.Division of Gastroenterology and Hepatology, Department of MedicineStanford University Medical CenterStanfordUSA
  11. 11.Division of Gastroenterology and Hepatology, Department of MedicineMayo Clinic CampusRochesterUSA
  12. 12.CAPT, Medical Corps US Public Health Service, Division of Digestive Diseases and NutritionNational Institute of Diabetes and Digestive and Kidney DiseasesBethesdaUSA
  13. 13.Lehman, Bucksot and Sherman Section of Pancreatobiliary EndoscopyIndiana University School of MedicineIndianapolisUSA

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