Swensson, Jordan

BackgroundDuctal features alone may not offer high diagnostic sensitivity or most accurate disease severity of chronic pancreatitis (CP).PurposeDiagnose CP based on multiparametric MRI and MRCP features.Study TypeProspective.PopulationBetween February 2019 and May 2021, 46 control (23 males, 49.3 ± 14.1 years), 45 suspected (20 males, 48.7 ± 12.5 years), and 46 definite (20 males, 53.7 ± 14.6 years) CP patients were enrolled at seven hospitals enrolled in the MINIMAP study. CP classification was based on imaging findings and clinical presentation.Field Strength and Sequences1.5 T. T1‐weighted (T1W) spoiled gradient echo, T1 map with variable flip angle, dual‐echo Dixon, secretin‐enhanced MRCP before and after secretin infusion.AssessmentDual‐echo fat fraction (FF), T1 relaxation time, extracellular volume (ECV), T1 signal intensity ratio of the pancreas to the spleen (T1 score), arterial‐to‐venous enhancement ratio (AVR), pancreatic tail diameter (PTD), pancreas volume, late gadolinium enhancement, pancreatic ductal elasticity (PDE), and duodenal filling grade of secretin‐enhanced MRCP were measured.Statistical TestsLogistic regression analysis generated CP‐MRI and secretin‐enhanced CP‐SMRI scores. Receiver operating characteristics analysis was used to differentiate definite CP from control. Interobserver agreement was assessed using Lin's concordance correlation coefficient.ResultsCompared to control, definite CP cohort showed significantly higher dual‐echo FF (7% vs. 11%), lower AVR (1.35 vs. 0.85), smaller PTD (2.5 cm vs. 1.95 cm), higher ECV (28% vs. 38%), and higher incidence of PDE loss (6.5% vs. 50%). With the cut‐off of >2.5 CP‐MRI score (dual‐echo FF, AVR, and PTD) and CP‐SMRI score (dual‐echo FF, AVR, PTD, and PDE) had cross‐validated area under the curves of 0.84 (sensitivity 87%, specificity 68%) and 0.86 (sensitivity 89%, specificity 67%), respectively. Interobserver agreement for both CP‐MRI and CP‐SMRI scores was 0.74.ConclusionThe CP‐MRI and CP‐SMRI scores yielded acceptable performance and interobserver agreement for the diagnosis of CP.Evidence Level1Technical EfficacyStage 2

Abstract Hemangioma is the most common benign liver tumor and is frequently encountered as an incidental finding on imaging. The classic enhancement pattern of hemangioma is diagnostic on contrast-enhanced ultrasound (CEUS), and it follows the same pattern of enhancement on computed tomography and magnetic resonance imaging. However, there is a subset of hemangiomas that demonstrate atypical enhancement patterns on CEUS. The ability to recognize the different enhancement patterns and discern when additional imaging or biopsy may be necessary is essential to accurately interpret an atypical hemangioma on CEUS. This article reviews various enhancement patterns of hemangioma on CEUS to avoid pitfalls in characterization of focal liver lesions on CEUS.