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Native T1 mapping of autoimmune pancreatitis as a quantitative outcome surrogate

  • Liang Zhu
  • Yamin Lai
  • Marcus Makowski
  • Wen Zhang
  • Zhaoyong Sun
  • Tianyi Qian
  • Dominik Nickel
  • Bernd Hamm
  • Patrick Asbach
  • Matthius Duebgen
  • Huadan Xue
  • Zhengyu JinEmail author
Hepatobiliary-Pancreas
  • 19 Downloads

Abstract

Objectives

To investigate the ability of T1 mapping to visualize and quantify the short-term and mid-term response of autoimmune pancreatitis (AIP) to corticosteroid treatment (CST) and to correlate T1 relaxation time of the pancreas with clinical status and serum IgG4 level.

Methods

The institutional review board approved this prospective study, and all patients provided written informed consent. Pancreatic MRI including native T1 mapping was performed in 39 AIP patients before and during CST, and 40 patients without pancreatic diseases served as control. T1 relaxation time of the pancreatic head, body, and tail was measured in each patient. Clinical symptoms and serum IgG4 level of the patients were recorded.

Results

The native T1 relaxation time of AIP was significantly elongated compared to normal pancreatic tissue (1124.5 ms ± 95.7 ms vs 784.3 ms ± 41.8 ms, p < 0.001). After short-term CST (4 weeks), T1 relaxation time of AIP already shortened significantly (957.2 ms ± 97.3 ms, p < 0.001). After mid-term CST (12 weeks), the T1 relaxation time further shortened towards normalization (844.2 ms ± 71.6 ms, p < 0.001). In 33 AIP patients with elevated serum IgG4 at baseline, T1 relaxation time demonstrated a significant positive correlation with serum IgG4 level (r = 0.329, p = 0.011). In six AIP patients with normal serum IgG4 level at baseline, T1 relaxation time shortening preceded or was in accordance with symptom relief.

Conclusions

Native T1 mapping can be used to assess parenchymal inflammation of AIP and to quantify response to treatment. It provides a quantitative outcome surrogate for AIP.

Key Points

Parenchymal inflammation in autoimmune pancreatitis results in T1 relaxation time elongation, which shortens after effective treatment.

T1 relaxation time of the pancreas correlates with serum IgG4 level, and in serum IgG4-negative AIP patients, T1 relaxation time shortening predicts clinical improvement.

T1 mapping provides a quantitative outcome surrogate for AIP.

Keywords

Pancreatitis IgG4 Inflammation Treatment Magnetic resonance imaging 

Abbreviations

ADC

Apparent diffusion coefficient

AIP

Autoimmune pancreatitis

ANOVA

Analysis of variance

CST

Corticosteroid treatment

ICC

Intraclass correlation coefficient

ICDC

International consensus diagnostic criteria

IgG4

Immunoglobulin G4

MRCP

MR cholangiopancreatography

ROC

Receiver operating characteristic

ROI

Region of interest

SI

Signal intensity

T1WI

T1-weighted image

Notes

Acknowledgements

The authors sincerely acknowledge Dr. Zhong Wang, Ms. Jing An, and Ms. Xinzhi Zhao from Siemens Healthcare for their MR technical support.

Funding

This study has received funding from the National Public Welfare Basic Scientific Research Project (2017PT32004) and Chinese Academy of Medical Sciences Initiative for Innovative Medicine (2017-I2M-1-001).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Professor Zheng-yu Jin, the department chair of radiology, Peking Union Medical College Hospital.

Conflict of interest

Tian-yi Qian and Marcel Dominik Nickel are employees from Siemens Healthcare Company, who provided technical support with the T1 mapping prototype sequence and were not involved in the data collection and analysis. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

References

  1. 1.
    Finkelberg DL, Sahani D, Deshpande V, Brugge WR (2006) Autoimmune pancreatitis. N Engl J Med 355(25):2670–2676CrossRefGoogle Scholar
  2. 2.
    Nishimori I, Tamakoshi A, Otsuki M, Research Committee on Intractable Diseases of the Pancreas, Ministry of Health, Labour, and Welfare of Japan (2007) Prevalence of autoimmune pancreatitis in Japan from a nationwide survey in 2002. J Gastroenterol 42(Suppl 18):6–8Google Scholar
  3. 3.
    Kanno A, Nishimori I, Masamune A et al (2012) Nationwide epidemiological survey of autoimmune pancreatitis in Japan. Pancreas 41(6):835–839CrossRefGoogle Scholar
  4. 4.
    Moon SH, Kim MH, Park DH et al (2008) Is a 2-week steroid trial after initial negative investigation for malignancy useful in differentiating autoimmune pancreatitis from pancreatic cancer? A prospective outcome study. Gut 57(12):1704–1712CrossRefGoogle Scholar
  5. 5.
    Shimosegawa T, Chari ST, Frulloni L et al (2011) International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 40(3):352–358CrossRefGoogle Scholar
  6. 6.
    Kamisawa T, Shimosegawa T, Okazaki K et al (2009) Standard steroid treatment for autoimmune pancreatitis. Gut 58(11):1504–1507CrossRefGoogle Scholar
  7. 7.
    Kubota K, Kamisawa T, Okazaki K et al (2017) Low-dose maintenance steroid treatment could reduce the relapse rate in patients with type 1 autoimmune pancreatitis: a long-term Japanese multicenter analysis of 510 patients. J Gastroenterol 52(8):955–964CrossRefGoogle Scholar
  8. 8.
    Hart PA, Chari ST (2017) Preventing disease relapses in autoimmune pancreatitis with maintenance steroids: are we there yet? Gut 66(3):394–396CrossRefGoogle Scholar
  9. 9.
    Hart PA, Kamisawa T, Brugge WR et al (2013) Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. Gut 62(12):1771–1776CrossRefGoogle Scholar
  10. 10.
    Hart PA, Topazian MD, Witzig TE et al (2013) Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience. Gut 62(11):1607–1615CrossRefGoogle Scholar
  11. 11.
    Morselli-Labate AM, Pezzilli R (2009) Usefulness of serum IgG4 in the diagnosis and follow up of autoimmune pancreatitis: a systematic literature review and meta-analysis. J Gastroenterol Hepatol 24(1):15–36CrossRefGoogle Scholar
  12. 12.
    Chari ST, Smyrk TC, Levy MJ et al (2006) Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol 4(8):1010–1016 quiz 934CrossRefGoogle Scholar
  13. 13.
    Sahani DV, Kalva SP, Farrell J et al (2004) Autoimmune pancreatitis: imaging features. Radiology 233(2):345–352CrossRefGoogle Scholar
  14. 14.
    Sahani DV, Sainani NI, Deshpande V, Shaikh MS, Frinkelberg DL, Fernandez-del Castillo C (2009) Autoimmune pancreatitis: disease evolution, staging, response assessment, and CT features that predict response to corticosteroid therapy. Radiology 250(1):118–129CrossRefGoogle Scholar
  15. 15.
    Manfredi R, Graziani R, Cicero C et al (2008) Autoimmune pancreatitis: CT patterns and their changes after steroid treatment. Radiology 247(2):435–443CrossRefGoogle Scholar
  16. 16.
    Manfredi R, Frulloni L, Mantovani W, Bonatti M, Graziani R, Pozzi Mucelli R (2011) Autoimmune pancreatitis: pancreatic and extrapancreatic MR imaging-MR cholangiopancreatography findings at diagnosis, after steroid therapy, and at recurrence. Radiology 260(2):428–436CrossRefGoogle Scholar
  17. 17.
    Frulloni L, Scattolini C, Falconi M et al (2009) Autoimmune pancreatitis: differences between the focal and diffuse forms in 87 patients. Am J Gastroenterol 104(9):2288–2294CrossRefGoogle Scholar
  18. 18.
    Liang W, Xu S (2012) Radiologic evaluation of autoimmune pancreatitis. Radiology 262(2):731–732 author reply 732Google Scholar
  19. 19.
    Oki H, Hayashida Y, Oki H et al (2015) DWI findings of autoimmune pancreatitis: comparison between symptomatic and asymptomatic patients. J Magn Reson Imaging 41(1):125–131Google Scholar
  20. 20.
    Braithwaite AC, Dale BM, Boll DT, Merkle EM (2009) Short- and midterm reproducibility of apparent diffusion coefficient measurements at 3.0-T diffusion-weighted imaging of the abdomen. Radiology 250(2):459–465CrossRefGoogle Scholar
  21. 21.
    Winston CB, Mitchell DG, Outwater EK, Ehrlich SM (1995) Pancreatic signal intensity on T1-weighted fat saturation MR images: clinical correlation. JMRI 5(3):267–271CrossRefGoogle Scholar
  22. 22.
    Schelbert EB, Messroghli DR (2016) State of the art: clinical applications of cardiac T1 mapping. Radiology 278(3):658–676CrossRefGoogle Scholar
  23. 23.
    Yoon JH, Lee JM, Kim E, Okuaki T, Han JK (2017) Quantitative liver function analysis: volumetric T1 mapping with fast multisection B1 inhomogeneity correction in hepatocyte-specific contrast-enhanced liver MR imaging. Radiology 282(2):408–417CrossRefGoogle Scholar
  24. 24.
    Youssef N, Petitjean B, Bonte H, Terris B, de Saint Maur PP, Fléjou JF (2004) Non-alcoholic duct destructive chronic pancreatitis: a histological, immunohistochemical and in-situ apoptosis study of 18 cases. Histopathology 44(5):453–461Google Scholar
  25. 25.
    Wreesmann V, van Eijck CH, Naus DC, van Velthuysen ML, Jeekel J, Mooi WJ (2001) Inflammatory pseudotumour (inflammatory myofibroblastic tumour) of the pancreas: a report of six cases associated with obliterative phlebitis. Histopathology 38(2):105–110CrossRefGoogle Scholar
  26. 26.
    Wakabayashi T, Kawaura Y, Satomura Y et al (2002) Clinical study of chronic pancreatitis with focal irregular narrowing of the main pancreatic duct and mass formation: comparison with chronic pancreatitis showing diffuse irregular narrowing of the main pancreatic duct. Pancreas 25(3):283–289CrossRefGoogle Scholar
  27. 27.
    Kawa S, Ito T, Watanabe T et al (2012) The utility of serum IgG4 concentrations as a biomarker. Int J Rheumatol 2012:198314CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Liang Zhu
    • 1
  • Yamin Lai
    • 2
  • Marcus Makowski
    • 3
  • Wen Zhang
    • 4
  • Zhaoyong Sun
    • 1
  • Tianyi Qian
    • 5
  • Dominik Nickel
    • 6
  • Bernd Hamm
    • 3
  • Patrick Asbach
    • 3
  • Matthius Duebgen
    • 3
  • Huadan Xue
    • 1
  • Zhengyu Jin
    • 1
    Email author
  1. 1.Department of RadiologyPeking Union Medical College HospitalBeijingChina
  2. 2.Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
  3. 3.Department of RadiologyCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  4. 4.Department of RheumatologyPeking Union Medical College HospitalBeijingChina
  5. 5.MR Collaboration NE AsiaSiemens HealthcareBeijingChina
  6. 6.Siemens Healthcare GmbHErlangenGermany

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