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ADVANCED MRI CHARACTERISTICS FOR DIAGNOSIS OF EARLY CHRONIC PANCREATITIS: A PILOT STUDY
Shahana Gupta
*1, Yugandhar S
2, Rahul Asok
2, VIVEK LANKA
3, SURESH V
21SURGICAL GASTROENTEROLOGY, All India Institute of Medical Sciences Kalyani, Kalyani, West Bengal, India; 2All India Institute of Medical Sciences Mangalagiri, Mangalagiri, AP, India; 3AIG HYDERABAD, HYDERABAD, India
Background:Chronic pancreatitis (CP) is a progressive inflammatory condition characterized by structural changes in pancreas,often leading to chronic abdominal pain and pancreatic endocrine and exocrine insufficiency( assessed by Fecal elastaste1;FE1 in stool). EarlyCP (ECP) is particularly challenging to diagnose due to its subtle clinical and imaging manifestations that overlap with other gastrointestinal disorders.International Consensus Statement on ECP acknowledges the fact that ECP is a stage of CP with preserved pancreatic function and potentially reversible features.Early detection will help in improving the quality of life in a cost-effective manner.Of the current diagnostic tools, transabdominal Ultrasound has limited specificity in detecting ECP. EUS and histopathology, are limited by availability and invasiveness.FE-1 estimation in stool has been reported to have low sensitivity and specificity.Clinical features do not help in early diagnosis of ECP. Advanced quantitative MRI techniques,namely T1 and T2* relaxation times, apparent diffusion coefficient (ADC), and fat fraction (FF) estimation, have shown potential in differentiating ECP from advanced CP (ACP) and normal pancreatic tissue. This study aims to evaluate the utility of these MRI parameters for early detection of ECP.
ObjectivesTo compare quantitative MRI variables across groups classified as no pancreatitis, ECP, and ACP.
MethodologyThis cross-sectional study was conducted over 2years in a tertiary institute in India.Patients with clinical features indicative of CP were categorized into ECP, and ACP using clinical features,biochemical tests (FE-1), and MRI imaging.MRI parameters recorded included T1 and T2* relaxation times, apparent diffusion coefficient (ADC) values, and fat fraction estimations. Statistical analyses were performed using ANOVA.
ResultsThe study analyzed data from 53 patients(13 controls, 20ECP,20 ACP). No significant difference was noted between ECP and controls based on clinical features(p<0.01). Estimation of FE-1 by ELISA found values(in mcg/g stool) of 285.23±54.2 (p<0.01) in controls;130.49±45 and 80.46±55.04(p<0.01) in ECP and ACP respectively Significant differences in T1 relaxation times were observed among the groups (e.g., T1 mean for the head: ACP- 1192.5 ± 194.4,control- 855.5 ± 78.4, ECP- 985.7 ± 62.2;
p < 0.001).FF also showed significant variation, particularly in the body of the pancreas (ACP 10.7 ± 4.4, control 4.2 ± 3.3, ECP 5.9 ± 2.4;
p < 0.001)
.ConclusionThe findings of this study suggest that advanced MRI parameters can be used to diagnose ECP and differentiate with controls who have a normal pancreas. This could minimize the need for invasive procedures and improve patient management in regions with high prevalence of CP. Future larger-scale studies are required to define diagnostic cut-offs for broader clinical application.
Elevated FF on MRI in ECP
Increased T 1 relaxation time on MRI in ECP
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