Conny F. Waschkies^1,2, Theresia F. Reding¹, Gitta Maria Seleznik¹, Udo Ungethuem¹, and Rolf Graf^1
1Division of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland, ²Institute for Biomedical Engineering, ETH and University Zurich, Zurich, Switzerland

Few preclinical studies rely on MRI to monitor pancreatic tissue changes in commensurate animal models, mostly due to inherently low conspicuity of the rodent pancreas. Pancreatic inflammation is a risk factor for pancreatic ductal adenocarcinoma development, and its initiation is linked to activating mutations in KRAS oncogene, known as the KPC mouse model. In the present study we demonstrate the potential of preclinical MRI to visualize the murine pancreas and its changes associated with cellular transformations in this mouse model of pancreatic carcinogenesis.

Mitchell C Raeside¹, Andrea Agostini¹, Richard K.G. Do¹, Amita Shukla-Dave^1,2, David Aramburu-Nunez², Ramesh Paudyal², Olga Smelianskaia¹, Monika Khan¹, David Kelsen³, and Lorenzo Mannelli^1
1Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, ²Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, ³Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States

The purpose of this study was to develop and optimize a rapid MR pancreas screening protocol to be performed in conjunction with breast MRI screening in BRCA-positive individuals. 15 patients underwent a rapid pancreatic screening at the conclusion of their breast MRI examination.  Images were acquired with the patient in the prone position, with the breast coil still in place, but using the built-in body coil on a 3T magnet, and evaluated for image quality (including SNR and CNR), and detection of pancreatic lesions. Rapid MR protocol for pancreatic cancer screening is feasible and provides diagnostic quality images.

Douglas Arthur Charles Kelley¹, Eric Collisson², Benjamin M Yeh³, Michael Ohliger³, and Zhen Wang^3
1Neuro Applications and Workflow, GE Healthcare, Corte Madera, CA, United States, ²Medicine, University of California, San Francisco, San Francisco, CA, United States, ³Radiology, University of California, San Francisco, San Francisco, CA, United States

Pancreatic cancer is highly desmoplastic and slowly takes up extracellular gadolinium based contrast agents during MR imaging. Quantitative estimation of gadolinium based contrast uptake in pancreas cancers may help assess the tumor stroma, which is implicated in tumor aggressiveness and treatment response. However, tissue motion and sensitivity inhomogeneity on abdominal MR scans present complications for quantitative analysis of contrast uptake. A new MR PET system with higher performance gradient and RF capabilities coupled with data-driven analysis methods allow robust estimation of contrast agent concentration in pancreatic cancer patients. 

Chao Ma¹, Li Liu¹, Jing Li¹, Li Wang¹, Xu Fang¹, Jianxun Qu², Shi-yue Chen¹, and Jianping Lu^1
1Department of Radiology, Changhai Hospital of Shanghai, Shanghai, China, People's Republic of, ²MR Research China, GE Healthcare, Beijing, China, People's Republic of

Differentiating mass-forming focal pancreatitis (FP) and pancreatic ductal adenocarcinoma (PDAC) is of great importance and yet remains a challenge in clinical practice. In this work, we propose a novel method to address the challenge with a new parameter (inhomogeneity index) based on the ADC map analysis with different region of interest (ROI) size.

Kristen L Zakian¹, Richard K Do², Taryn Boucher², Mithat Gonen³, Andrea Cercek⁴, William R Jarnagin⁵, and Nancy Kemeny^4
1Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, ²Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, ³Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, ⁴Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States, ⁵Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy and has few treatment options. A previous study suggested that MRI may help identify patients likely to benefit from hepatic arterial infusion pump therapy with floxuridine (HAI-FUDR). The purpose of this prospective study was to investigate the ability of pre-treatment and early-in-treatment DCE and DW-MRI to predict ICC response to combined HAI-FUDR and systemic chemotherapy given in a Phase 2 clinical trial. Our preliminary analysis suggests that DW-MRI may predict response of unresectable ICC using data acquired at baseline or at 1 month after treatment start.

Scott B. King¹, Jarod Matwiy¹, Calvin Bewsky¹, Hung-Yu Lin¹, and Masoom A. Haider^2,3
1Medical Devices, National Research Council Canada, Winnipeg, MB, Canada, ²Dept of Medical Imaging, Sunnybrook Health Sciences Center, Toronto, ON, Canada, ³Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

The pancreas is difficult to image because of its central location deep in the abdomen, often with overlapping artifact in parallel MRI reconstruction through the mid abdomen and drop off of signal.   In this new concept for improved SNR and parallel MRI in pancreas MRI, a surface array is pushed/indented into the abdomen, bringing smaller array elements closer to the pancreas. Compared to the benchmark array, the Indenting Array demonstrated >2x SNR and 40% improved R=3 A-P parallel MRI with g-factor = 1 within the pancreas.  This new “indenting” array design could have a significant impact on pancreas diagnostic MRI.

Alexandra N Schlein¹, Yesenia Covarrubias¹, Adrija Mamidipalli¹, Jonathan Hooker¹, Michael S Middleton¹, Rohit Loomba², Tanya Wolfson³, Claude B Sirlin¹, and Gavin Hamilton^1
1Radiology, UCSD, San Diego, CA, United States, ²Hepatology, UCSD, San Diego, CA, United States, ³Computational and Applied Statistics Laboratory UCSD, San Diego, CA, United States

Advanced MR techniques have been developed to estimate proton density fat fraction (PDFF) of pancreatic fat. The purpose of this study is to assess intra- and inter-examination repeatability of 1H MRS and multi-echo MRI to estimate pancreatic PDFF. Subjects were scanned with both MRI and MRS three times: twice without subject repositioning and then once more after having subjects get off and back on the table. The results suggest that MRI is more repeatable than MRS, especially when subjects are repositioned between acquisitions, which more closely simulates the conditions in which these techniques might be applied clinically and in research.

Yu Shi¹, qiyong guo¹, He An¹, Kevin J Glaser², and Ehman L Richard^3
1Department of radiology, Shengjing hospital of China medical university, shenyang, China, People's Republic of, ²Rochester, MN, United States, ³Department of radiology, Mayo Clinic, Rochester, MN, United States

An accurate diagnosis of pancreatic fibrosis is important in clinical work. MR elastography (MRE) can be used for staging the degrees of pancreatic fibrosis that reflects the severity of chronic pancreatitis. Our work proved that both fibrosis (P< 0.001) and inflammation (P= 0.014) contribute to higher stiffness of pancreatic parenchyma, excluding fat deposition (P= 0.082).  The sensitivity and specificity was 100% and 86% for diagnosing ≥F2, and 100% and 100% for diagnosing =F3 fibrosis stage, respectively.

Adam Jaster¹, Ivan Pedrosa^1,2, Robert E. Lenkinski^1,2, Ildiko Lingvay^3,4, and Takeshi Yokoo^1,2
1Radiology, UT Southwestern Medical Center, Dallas, TX, United States, ²Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, United States, ³Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States, ⁴Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, United States

In pancreatic steatosis, fat accumulates within intra-lobular (parenchyma) and inter-lobular (adipose) tissue. Regions of interest (ROIs) placed in pancreas include heterogeneous population of pixels of lower-fat intra-lobular tissue, higher-fat inter-lobular tissue, and admixture of the two by partial volume effects. In this study of 21 subjects with insulin-dependent type 2 diabetes, we investigated the impact of inter-lobular fat on the repeatability of pancreatic fat fraction (FF) measurement by multiecho gradient-echo MRI.  We found that the mean FF measurement within segmented pancreatic ROI is highly repeatable with intraclass correlation of 0.965 after exclusion of high-fat (FF≥50%) pixels contaminated by inter-lobular fat. 

Yesenia Covarrubias¹, Alexandra N Schlein¹, William M Haufe¹, Catherine A Hooker¹, Adrija Mamidipalli¹, Tanya Wolfson², Garth Jacobson³, Santiago Horgan³, Jeffrey B Schwimmer⁴, Scott B Reeder⁵, and Claude B Sirlin^1
1Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, CA, United States, ²Computational and Applied Statistics Laboratory (CASL), SDSC, University of California, San Diego, La Jolla, CA, United States, ³Department of Surgery, University of California, San Diego, La Jolla, CA, United States, ⁴Division of Gastroenterology, Hepatology, and Nutrition & Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, CA, United States, ⁵Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, Emergency Medicine, University of Wisconsin, Madison, WI, United States

This pilot, prospective, longitudinal study in 9 obese adults explored the relationship between weight loss and longitudinal change in MRI-determined pancreatic proton density fat fraction (PDFF), as well as the relationships between rates of change in pancreatic PDFF, hepatic PDFF, and anthropometric measures. Pancreatic PDFF decreased in every subject from a mean of 15.5% at the first study visit to a mean of 8.6% at the last study visit (p=0.006). Further research in larger cohorts is needed to confirm our findings and to understand the clinical and biological relevance of pancreatic PDFF reduction.