Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography

Background Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used for the diagnosis of pancreatic cancer. Because autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer and can be tested for by FDG-PET analysis based on the presence of suspected pancr...

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Veröffentlicht in:Journal of gastroenterology 2008-02, Vol.43 (2), p.144-151
Hauptverfasser: Ozaki, Yayoi, Oguchi, Kazuhiro, Hamano, Hideaki, Arakura, Norikazu, Muraki, Takashi, Kiyosawa, Kendo, Momose, Mitsuhiro, Kadoya, Masumi, Miyata, Kazunobu, Aizawa, Takao, Kawa, Shigeyuki
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container_end_page 151
container_issue 2
container_start_page 144
container_title Journal of gastroenterology
container_volume 43
creator Ozaki, Yayoi
Oguchi, Kazuhiro
Hamano, Hideaki
Arakura, Norikazu
Muraki, Takashi
Kiyosawa, Kendo
Momose, Mitsuhiro
Kadoya, Masumi
Miyata, Kazunobu
Aizawa, Takao
Kawa, Shigeyuki
description Background Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used for the diagnosis of pancreatic cancer. Because autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer and can be tested for by FDG-PET analysis based on the presence of suspected pancreatic cancer, we attempted to clarify the differences in FDG-PET findings between the two conditions. Methods We compared FDG-PET findings between 15 patients with autoimmune pancreatitis and 26 patients with pancreatic cancer. The findings were evaluated visually or semiquantitatively using the maximum standardized uptake value and the accumulation pattern of FDG. Results FDG uptake was found in all 15 patients with autoimmune pancreatitis, whereas it was found in 19 of 26 patients (73.1%) with pancreatic cancer. An accumulation pattern characterized by nodular shapes was significantly more frequent in pancreatic cancer, whereas a longitudinal shape indicated autoimmune pancreatitis. Heterogeneous accumulation was found in almost all cases of autoimmune pancreatitis, whereas homogeneous accumulation was found in pancreatic cancer. Significantly more cases of pancreatic cancer showed solitary localization, whereas multiple localization in the pancreas favored the presence of autoimmune pancreatitis. FDG uptake by the hilar lymph node was significantly more frequent in autoimmune pancreatitis than in pancreatic cancer, and uptake by the lachrymal gland, salivary gland, biliary duct, retroperitoneal space, and prostate were seen only in autoimmune pancreatitis. Conclusions FDG-PET is a useful tool for differentiating autoimmune pancreatitis from suspected pancreatic cancer, if the accumulation pattern and extrapancreatic involvement are considered. IgG4 measurement and other current image tests can further confirm the diagnosis.
doi_str_mv 10.1007/s00535-007-2132-y
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Because autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer and can be tested for by FDG-PET analysis based on the presence of suspected pancreatic cancer, we attempted to clarify the differences in FDG-PET findings between the two conditions. Methods We compared FDG-PET findings between 15 patients with autoimmune pancreatitis and 26 patients with pancreatic cancer. The findings were evaluated visually or semiquantitatively using the maximum standardized uptake value and the accumulation pattern of FDG. Results FDG uptake was found in all 15 patients with autoimmune pancreatitis, whereas it was found in 19 of 26 patients (73.1%) with pancreatic cancer. An accumulation pattern characterized by nodular shapes was significantly more frequent in pancreatic cancer, whereas a longitudinal shape indicated autoimmune pancreatitis. Heterogeneous accumulation was found in almost all cases of autoimmune pancreatitis, whereas homogeneous accumulation was found in pancreatic cancer. Significantly more cases of pancreatic cancer showed solitary localization, whereas multiple localization in the pancreas favored the presence of autoimmune pancreatitis. FDG uptake by the hilar lymph node was significantly more frequent in autoimmune pancreatitis than in pancreatic cancer, and uptake by the lachrymal gland, salivary gland, biliary duct, retroperitoneal space, and prostate were seen only in autoimmune pancreatitis. Conclusions FDG-PET is a useful tool for differentiating autoimmune pancreatitis from suspected pancreatic cancer, if the accumulation pattern and extrapancreatic involvement are considered. IgG4 measurement and other current image tests can further confirm the diagnosis.</description><identifier>ISSN: 0944-1174</identifier><identifier>EISSN: 1435-5922</identifier><identifier>DOI: 10.1007/s00535-007-2132-y</identifier><identifier>PMID: 18306988</identifier><language>eng</language><publisher>Japan: Springer Japan</publisher><subject>Abdominal Surgery ; Adenocarcinoma - diagnostic imaging ; Adult ; Aged ; Autoimmune Diseases - diagnosis ; Biliary Tract ; Colorectal Surgery ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18 ; Gastroenterology ; Hepatology ; Humans ; Liver ; Male ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Pancreas ; Pancreatic cancer ; Pancreatic Neoplasms - diagnostic imaging ; Pancreatitis - diagnostic imaging ; Pancreatitis - immunology ; Positron-Emission Tomography ; Radiopharmaceuticals ; Surgical Oncology</subject><ispartof>Journal of gastroenterology, 2008-02, Vol.43 (2), p.144-151</ispartof><rights>Springer Japan 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c532t-7a351463e9bd91987ba9c84b5f725d5e39f66ecdd83803ff35160918c5dfce373</citedby><cites>FETCH-LOGICAL-c532t-7a351463e9bd91987ba9c84b5f725d5e39f66ecdd83803ff35160918c5dfce373</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00535-007-2132-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00535-007-2132-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18306988$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ozaki, Yayoi</creatorcontrib><creatorcontrib>Oguchi, Kazuhiro</creatorcontrib><creatorcontrib>Hamano, Hideaki</creatorcontrib><creatorcontrib>Arakura, Norikazu</creatorcontrib><creatorcontrib>Muraki, Takashi</creatorcontrib><creatorcontrib>Kiyosawa, Kendo</creatorcontrib><creatorcontrib>Momose, Mitsuhiro</creatorcontrib><creatorcontrib>Kadoya, Masumi</creatorcontrib><creatorcontrib>Miyata, Kazunobu</creatorcontrib><creatorcontrib>Aizawa, Takao</creatorcontrib><creatorcontrib>Kawa, Shigeyuki</creatorcontrib><title>Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography</title><title>Journal of gastroenterology</title><addtitle>J Gastroenterol</addtitle><addtitle>J Gastroenterol</addtitle><description>Background Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used for the diagnosis of pancreatic cancer. Because autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer and can be tested for by FDG-PET analysis based on the presence of suspected pancreatic cancer, we attempted to clarify the differences in FDG-PET findings between the two conditions. Methods We compared FDG-PET findings between 15 patients with autoimmune pancreatitis and 26 patients with pancreatic cancer. The findings were evaluated visually or semiquantitatively using the maximum standardized uptake value and the accumulation pattern of FDG. Results FDG uptake was found in all 15 patients with autoimmune pancreatitis, whereas it was found in 19 of 26 patients (73.1%) with pancreatic cancer. An accumulation pattern characterized by nodular shapes was significantly more frequent in pancreatic cancer, whereas a longitudinal shape indicated autoimmune pancreatitis. Heterogeneous accumulation was found in almost all cases of autoimmune pancreatitis, whereas homogeneous accumulation was found in pancreatic cancer. Significantly more cases of pancreatic cancer showed solitary localization, whereas multiple localization in the pancreas favored the presence of autoimmune pancreatitis. FDG uptake by the hilar lymph node was significantly more frequent in autoimmune pancreatitis than in pancreatic cancer, and uptake by the lachrymal gland, salivary gland, biliary duct, retroperitoneal space, and prostate were seen only in autoimmune pancreatitis. Conclusions FDG-PET is a useful tool for differentiating autoimmune pancreatitis from suspected pancreatic cancer, if the accumulation pattern and extrapancreatic involvement are considered. 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Because autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer and can be tested for by FDG-PET analysis based on the presence of suspected pancreatic cancer, we attempted to clarify the differences in FDG-PET findings between the two conditions. Methods We compared FDG-PET findings between 15 patients with autoimmune pancreatitis and 26 patients with pancreatic cancer. The findings were evaluated visually or semiquantitatively using the maximum standardized uptake value and the accumulation pattern of FDG. Results FDG uptake was found in all 15 patients with autoimmune pancreatitis, whereas it was found in 19 of 26 patients (73.1%) with pancreatic cancer. An accumulation pattern characterized by nodular shapes was significantly more frequent in pancreatic cancer, whereas a longitudinal shape indicated autoimmune pancreatitis. Heterogeneous accumulation was found in almost all cases of autoimmune pancreatitis, whereas homogeneous accumulation was found in pancreatic cancer. Significantly more cases of pancreatic cancer showed solitary localization, whereas multiple localization in the pancreas favored the presence of autoimmune pancreatitis. FDG uptake by the hilar lymph node was significantly more frequent in autoimmune pancreatitis than in pancreatic cancer, and uptake by the lachrymal gland, salivary gland, biliary duct, retroperitoneal space, and prostate were seen only in autoimmune pancreatitis. Conclusions FDG-PET is a useful tool for differentiating autoimmune pancreatitis from suspected pancreatic cancer, if the accumulation pattern and extrapancreatic involvement are considered. IgG4 measurement and other current image tests can further confirm the diagnosis.</abstract><cop>Japan</cop><pub>Springer Japan</pub><pmid>18306988</pmid><doi>10.1007/s00535-007-2132-y</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Abdominal Surgery
Adenocarcinoma - diagnostic imaging
Adult
Aged
Autoimmune Diseases - diagnosis
Biliary Tract
Colorectal Surgery
Diagnosis, Differential
Female
Fluorodeoxyglucose F18
Gastroenterology
Hepatology
Humans
Liver
Male
Medicine
Medicine & Public Health
Middle Aged
Pancreas
Pancreatic cancer
Pancreatic Neoplasms - diagnostic imaging
Pancreatitis - diagnostic imaging
Pancreatitis - immunology
Positron-Emission Tomography
Radiopharmaceuticals
Surgical Oncology
title Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography
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