Case Study | Body Imaging
High-Resolution Pancreas Imaging
with Turbo LAVA
By Marc Zins, MD, Chief Radiologist, Fondation Hôpital Saint-Joseph, Paris, France
Introduction
Autoimmune pancreatitis is a type of chronic pancreatitis that has two distinct
Discovery™ MR750 3.0T
profiles: Type 1, which is a manifestation of IgG4-related disease associated with
a tendency to mass-forming, issue-destructive lesions in multiple sites, that
typically affects older patients and has a higher relapse rate; and Type 2, which is
not associated with IgG4, typically presents in younger patients, and is frequently
associated with inflammatory bowel disease.1,2
In many cases, it can be difficult to distinguish autoimmune pancreatitis from
pancreatic carcinoma. This distinction is important for patient management
because autoimmune pancreatitis can be treated with corticosteroids,
particularly prednisone.
To assess chronic pancreatitis, an MR examination utilizing T1, T2 and MRCP is
Parameters
Turbo LAVA
TR:
Min
TE:
Min
Slice:
2 mm
FOV:
40 x 32
Freq:
320
Phase:
288
BW:
111kHz
typically employed. In this case, we utilized Turbo LAVA for the abdominal exam.
B
Figure 1. (A) LAVA late enhancement.
(B) Communication between nodular
formation and dilatation of the
pancreatic duct.
A
GEHEALTHCARE.COM/MR
58
AUTUMN 2016
Figure 2. FOCUS with
increased spatial resolution
allows a clear depiction
of the pancreas from the
nodular lesion.
FOCUS b50
Figure 3. (A) CT revealed an
enlarged corporeo-caudal
portion of the pancreas,
with a nodular lesion of
17 mm in the long axis.
(B) The MRCP reveals a
discrete dilatation of the
Wirsung canal upstream
the nodular lesion.
B
Patient history
Discussion
A 41-year-old patient has severe abdominal pain with no
With the LAVA Turbo Mode option, we are able to increase the
specific history. CT revealed an enlarged corporeo-caudal
spatial resolution from 1.33 x 1.56 x 2.4 mm3 (matrix 300 x 256)
portion of the pancreas, with a nodular lesion of 17 mm in
to 1.25 x 1.38 x 2 mm3 (matrix 320 x 288) on the arterial
the long axis. Referred for an MR exam of the pancreas to
phase while reducing the breath-hold time from 28 seconds
rule out pancreatitis.
to 23-24 seconds for dynamics. With this sequence, we were
able to obtain CT-quality images with the added benefit of MR
Results
contrast, enabling a confident diagnosis of pancreatitis.
The hyposignal of the tail of the pancreas on the LAVA series
References
is in favor of a pancreatitis. The MRCP reveals a discrete
1. Kamisawa T, Chari ST, Lerch MM, Kim MH, Gress TM, Shimosegawa T. Recent advances in
autoimmune pancreatitis: Type 1 and Type 2. Gut, 2013 Sep;62(9):1373-80. doi: 10.1136/
gutjnl-2012-304224. Epub 2013 Jun 8.
dilatation of the Wirsung canal upstream the nodular lesion.
2. Sugumar A, Chari A. Autoimmune Pancreatitis: An Update. Available at:
http://www.medscape.com/viewarticle/708921_3
Marc Zins, MD, is Chief Radiologist at the Fondation Hôpital Saint-Joseph in Paris, France.
Saint Joseph Hospital is a 746-bed, private, non-profit public service hospital. In January 2006, Saint Michel Hospital and Notre Dame de Bon Secours
Hospital joined Saint-Joseph to form the Paris Saint-Joseph Hospital Group. Today, the three hospitals provide a full range of heath services for patients
south of Paris.
GESIGNAPULSE.COM
59
AUTUMN 2016
Case Studies
A
FOCUS b500