Share this content in WeChat
Advances in imaging differential diagnosis of autoimmune pancreatitis and pancreatic cancer
ZHONG Shuting  HUANG Xiaohua  QIN Shize  CHEN Yuwei  LIU Zhuoyu  JIANG Yu 

ZHONG S T, HUANG X H, QIN S Z, et al. Advances in imaging differential diagnosis of autoimmune pancreatitis and pancreatic cancer[J]. Chin J Magn Reson Imaging, 2023, 14(8): 165-170. DOI:10.12015/issn.1674-8034.2023.08.029.

[Abstract] Autoimmune pancreatitis (AIP) is a benign, autoimmune-mediated, fibroinflammatory chronic pancreatitis. In clinical diagnosis, it is easy to be confused with pancreatic cancer (PC), lymphoma and other malignant tumors and unnecessary surgical treatment. Imaging examination plays an important role in the diagnosis and differential diagnosis of AIP. There are many studies on various imaging techniques of AIP, but imaging techniques have their own advantages and disadvantages. Therefore, this article mainly reviews the research progress of various imaging methods in the differential diagnosis of AIP and PC, in order to provide reference for the diagnosis of AIP.
[Keywords] autoimmune pancreatitis;pancreatic cancer;endosonography;magnetic resonance imaging;positron emission tomography computed tomography;tomography, X-ray computed;differential diagnosis

ZHONG Shuting   HUANG Xiaohua*   QIN Shize   CHEN Yuwei   LIU Zhuoyu   JIANG Yu  

Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China

Corresponding author: Huang XH, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS Strategic Cooperation of Science and Technology in Nanchong City (No. 20SXQT0303).
Received  2022-12-28
Accepted  2023-06-25
DOI: 10.12015/issn.1674-8034.2023.08.029
ZHONG S T, HUANG X H, QIN S Z, et al. Advances in imaging differential diagnosis of autoimmune pancreatitis and pancreatic cancer[J]. Chin J Magn Reson Imaging, 2023, 14(8): 165-170. DOI:10.12015/issn.1674-8034.2023.08.029.

LANZILLOTTA M, TACELLI M, FALCONI M, et al. Incidence of endocrine and exocrine insufficiency in patients with autoimmune pancreatitis at diagnosis and after treatment: a systematic review and meta-analysis[J]. Eur J Intern Med, 2022, 100: 83-93. DOI: 10.1016/j.ejim.2022.03.014.
SHIMOSEGAWA T, CHARI S T, FRULLONI L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology[J]. Pancreas, 2011, 40(3): 352-358. DOI: 10.1097/MPA.0b013e3182142fd2.
NISTA E C, DE LUCIA S S, MANILLA V, et al. Autoimmune pancreatitis: from pathogenesis to treatment[J/OL]. Int J Mol Sci, 2022, 23(20): 12667 [2022-12-01]. DOI: 10.3390/ijms232012667.
MASAMUNE A, KIKUTA K, HAMADA S, et al. Nationwide epidemiological survey of autoimmune pancreatitis in Japan in 2016[J]. J Gastroenterol, 2020, 55(4): 462-470. DOI: 10.1007/s00535-019-01658-7.
QURESHI A, GHOBRIAL Y, DE CASTRO J, et al. Autoimmune pancreatitis-what we know and what do we have to know?[J/OL]. Autoimmun Rev, 2021, 20(10): 102912 [2022-11-23]. DOI: 10.1016/j.autrev.2021.102912.
HA J, CHOI S H, BYUN J H, et al. Meta-analysis of CT and MRI for differentiation of autoimmune pancreatitis from pancreatic adenocarcinoma[J]. Eur Radiol, 2021, 31(5): 3427-3438. DOI: 10.1007/s00330-020-07416-1.
LIU Z, XIE F, WANG C, et al. Diagnosis and treatment of autoimmune pancreatitis[J]. Chin J Gen Surg, 2021, 36(2): 93-97. DOI: 10.3760/cma.j.cn113855-20200218-00094.
SUN Y S, ZHOU X H, FAN X B. Evaluation on the value of CT in differential diagnosis of AIP and PC[J]. China Med Equip, 2019, 16(11): 62-66. DOI: 10.3969/J.ISSN.1672-8270.2019.11.018.
LOPES VENDRAMI C, SHIN J S, HAMMOND N A, et al. Differentiation of focal autoimmune pancreatitis from pancreatic ductal adenocarcinoma[J]. Abdom Radiol (NY), 2020, 45(5): 1371-1386. DOI: 10.1007/s00261-019-02210-0.
LEE-FELKER S A, FELKER E R, KADELL B, et al. Use of MDCT to differentiate autoimmune pancreatitis from ductal adenocarcinoma and interstitial pancreatitis[J]. AJR Am J Roentgenol, 2015, 205(1): 2-9. DOI: 10.2214/AJR.14.14059.
LEE S, KIM J H, KIM S Y, et al. Comparison of diagnostic performance between CT and MRI in differentiating non-diffuse-type autoimmune pancreatitis from pancreatic ductal adenocarcinoma[J]. Eur Radiol, 2018, 28(12): 5267-5274. DOI: 10.1007/s00330-018-5565-1.
MASOOD M. Autoimmune pancreatitis: what we know so far[J]. JGH Open, 2022, 6(1): 3-10. DOI: 10.1002/jgh3.12688.
HICKETHIER T, WENNING J, BRATKE G, et al. Evaluation of soft-plaque stenoses in coronary artery stents using conventional and monoenergetic images: first in-vitro experience and comparison of two different dual-energy techniques[J]. Quant Imaging Med Surg, 2020, 10(3): 612-623. DOI: 10.21037/qims.2020.02.11.
WANG Y D, HU X F, SHI S Y, et al. Utility of quantitative metrics from dual-layer spectral-detector CT for differentiation of pancreatic neuroendocrine tumor and neuroendocrine carcinoma[J]. AJR Am J Roentgenol, 2022, 218(6): 999-1009. DOI: 10.2214/AJR.21.27017.
MA X, WANG Y R, ZHUO L Y, et al. Retrospective analysis of the value of enhanced CT radiomics analysis in the differential diagnosis between pancreatic cancer and chronic pancreatitis[J]. Int J Gen Med, 2022, 15: 233-241. DOI: 10.2147/IJGM.S337455.
DU F C, LIU H, ZHANG C F, et al. Comparison of the diagnostic value between CT and MRI in distinguishing non-diffuse-type autoimmune pancreatitis and pancreatic ductal adenocarcinoma[J]. Chin J Gastroenterol Hepatol, 2020, 29(4): 416-419. DOI: 10.3969/j.issn.1006-5709.2020.04.012.
LI D, ZHOU X M, BAO L N, et al. Pancreatic and extra-pancreatic imaging features in autoimmune pancreatitis[J]. Chongqing Med, 2020, 49(8): 1331-1335. DOI: 10.3969/j.issn.1671-8348.2020.08.028.
LI L, CHEN W C, LIU B, et al. CT and MRI features of type I autoimmune pancreatitis[J]. Chin J Med Imaging, 2021, 29(1): 65-68, 72. DOI: 10.3969/j.issn.1005-5185.2021.01.016.
JIA H H, LI J L, HUANG W J, et al. Multimodel magnetic resonance imaging of mass-forming autoimmune pancreatitis: differential diagnosis with pancreatic ductal adenocarcinoma[J/OL]. BMC Med Imaging, 2021, 21(1): 149 [2023-01-23]. DOI: 10.1186/s12880-021-00679-0.
KIM M, JANG K M, KIM J H, et al. Differentiation of mass-forming focal pancreatitis from pancreatic ductal adenocarcinoma: value of characterizing dynamic enhancement patterns on contrast-enhanced MR images by adding signal intensity color mapping[J]. Eur Radiol, 2017, 27(4): 1722-1732. DOI: 10.1007/s00330-016-4522-0.
CHOI S Y, KIM S H, KANG T W, et al. Differentiating mass-forming autoimmune pancreatitis from pancreatic ductal adenocarcinoma on the basis of contrast-enhanced MRI and DWI findings[J]. AJR Am J Roentgenol, 2016, 206(2): 291-300. DOI: 10.2214/AJR.15.14974.
LI N, ZHAO Y, WANG T, et al. Imaging manifestations of focal autoimmune pancreatitis[J]. J Pract Radiol, 2021, 37(9): 1484-1487. DOI: 10.3969/j.issn.1002-1671.2021.09.020.
QIU Y J, ZHAO G C, SHI S N, et al. Application of dynamic contrast enhanced ultrasound in distinguishing focal-type autoimmune pancreatitis from pancreatic ductal adenocarcinoma[J]. Clin Hemorheol Microcirc, 2022, 81(2): 149-161. DOI: 10.3233/ch-221390.
TAKAHASHI M, FUJINAGA Y, NOTOHARA K, et al. Diagnostic imaging guide for autoimmune pancreatitis[J]. Jpn J Radiol, 2020, 38(7): 591-612. DOI: 10.1007/s11604-020-00971-z.
ZHU L, ZHANG W, JIN Z Y, et al. DWI of autoimmune pancreatitis: is it an imaging biomarker for disease activity?[J]. AJR Am J Roentgenol, 2021, 216(5): 1240-1246. DOI: 10.2214/AJR.20.23368.
REN H N, MORI N, HAMADA S, et al. Effective apparent diffusion coefficient parameters for differentiation between mass-forming autoimmune pancreatitis and pancreatic ductal adenocarcinoma[J]. Abdom Radiol (NY), 2021, 46(4): 1640-1647. DOI: 10.1007/s00261-020-02795-x.
SEKITO T, ISHII Y, SERIKAWA M, et al. The role of apparent diffusion coefficient value in the diagnosis of localized type 1 autoimmune pancreatitis: differentiation from pancreatic ductal adenocarcinoma and evaluation of response to steroids[J]. Abdom Radiol (NY), 2021, 46(5): 2014-2024. DOI: 10.1007/s00261-020-02907-7.
FEDERAU C. Measuring perfusion: intravoxel incoherent motion MR imaging[J]. Magn Reson Imaging Clin N Am, 2021, 29(2): 233-242. DOI: 10.1016/j.mric.2021.01.003.
DE ROBERTIS R, CARDOBI N, ORTOLANI S, et al. Intravoxel incoherent motion diffusion-weighted MR imaging of solid pancreatic masses: reliability and usefulness for characterization[J]. Abdom Radiol (NY), 2019, 44(1): 131-139. DOI: 10.1007/s00261-018-1684-z.
ZHU M L, ZHANG C D, YAN J X, et al. Accuracy of quantitative diffusion-weighted imaging for differentiating benign and malignant pancreatic lesions: a systematic review and meta-analysis[J]. Eur Radiol, 2021, 31(10): 7746-7759. DOI: 10.1007/s00330-021-07880-3.
SHI Y, CANG L Z, ZHANG X Y, et al. The use of magnetic resonance elastography in differentiating autoimmune pancreatitis from pancreatic ductal adenocarcinoma: a preliminary study[J]. Eur J Radiol, 2018, 108: 13-20. DOI: 10.1016/j.ejrad.2018.09.001.
ZHU L, GUO J, JIN Z Y, et al. Distinguishing pancreatic cancer and autoimmune pancreatitis with in vivo tomoelastography[J]. Eur Radiol, 2021, 31(5): 3366-3374. DOI: 10.1007/s00330-020-07420-5.
LI X M. The concept of infinite space boundless-MR imaging new technology review[J]. J Pract Radiol, 2019, 34(10): 1061-1062. DOI: 10.13609/j.cnki.1000-0313.2019.10.001.
DENG Y, MING B, ZHOU T, et al. Radiomics model based on MR images to discriminate pancreatic ductal adenocarcinoma and mass-forming chronic pancreatitis lesions[J/OL]. Front Oncol, 2021, 11: 620981 [2022-10-15]. DOI: 10.3389/fonc.2021.620981.
MAZZA S, ELVO B, CONTI C B, et al. Endoscopic ultrasound diagnostic gain over computed tomography and magnetic resonance cholangiopancreatography in defining etiology of idiopathic acute pancreatitis[J/OL]. World J Gastrointest Endosc, 2022, 14(6) [2022-10-23]. DOI: 10.4253/wjge.v14.i6.0000.
WANG J W, CHENG R, LI P, et al. Diagnostic value of endoscopic ultrasound in patients preliminarily diagnosed with autoimmune pancreatitis[J]. J Clin Exp Med, 2021, 20(20): 2226-2229. DOI: 10.3969/j.issn.1671-4695.2021.20.028.
ITO T, KAWA S, MATSUMOTO A, et al. Risk factors for pancreatic stone formation in type 1 autoimmune pancreatitis: a long-term Japanese multicenter analysis of 624 patients[J]. Pancreas, 2019, 48(1): 49-54. DOI: 10.1097/MPA.0000000000001210.
KANAI K, MARUYAMA M, KAMEKO F, et al. Autoimmune pancreatitis can transform into chronic features similar to advanced chronic pancreatitis with functional insufficiency following severe calcification[J]. Pancreas, 2016, 45(8): 1189-1195. DOI: 10.1097/MPA.0000000000000598.
CHO M K, MOON S H, SONG T J, et al. Contrast-enhanced endoscopic ultrasound for differentially diagnosing autoimmune pancreatitis and pancreatic cancer[J]. Gut Liver, 2018, 12(5): 591-596. DOI: 10.5009/gnl17391.
OHNO E, HIROOKA Y, KAWASHIMA H, et al. Feasibility and usefulness of endoscopic ultrasonography-guided shear-wave measurement for assessment of autoimmune pancreatitis activity: a prospective exploratory study[J]. J Med Ultrason (2001), 2019, 46(4): 425-433. DOI: 10.1007/s10396-019-00944-4.
TACELLI M, ZACCARI P, PETRONE M C, et al. Differential EUS findings in focal type 1 autoimmune pancreatitis and pancreatic cancer: a proof-of-concept study[J]. Endosc Ultrasound, 2022, 11(3): 216-222. DOI: 10.4103/EUS-D-21-00111.
LEE T Y, KIM M H, PARK D H, et al. Utility of 18F-FDG PET/CT for differentiation of autoimmune pancreatitis with atypical pancreatic imaging findings from pancreatic cancer[J]. Am J Roentgenol, 2009, 193(2): 343-348. DOI: 10.2214/ajr.08.2297.
OZAKI Y, OGUCHI K, HAMANO H, et al. Differentiation of autoimmune pancreatitis from suspected pancreatic cancer by fluorine-18 fluorodeoxyglucose positron emission tomography[J]. J Gastroenterol, 2008, 43(2): 144-151. DOI: 10.1007/s00535-007-2132-y.
OHTANI M, OFUJI K, AKAZAWA Y, et al. Clinical usefulness of [18F]-fluoro-2-deoxy-d-glucose-positron emission tomography/computed tomography for distinguishing between autoimmune pancreatitis and pancreatic cancer[J]. Pancreas, 2021, 50(7): 1014-1019. DOI: 10.1097/MPA.0000000000001873.
DICKERSON L D, FAROOQ A, BANO F, et al. Differentiation of autoimmune pancreatitis from pancreatic cancer remains challenging[J]. World J Surg, 2019, 43(6): 1604-1611. DOI: 10.1007/s00268-019-04928-w.
ZHANG J, JIA G R, ZUO C J, et al. 18F-FDG PET/CT helps differentiate autoimmune pancreatitis from pancreatic cancer[J].BMC Cancer, 2017, 17(1): 1-9. DOI: 10.1186/s12885-017-3665-y.
CHENG M F, GUO Y L, YEN R F, et al. Clinical utility of FDG PET/CT in patients with autoimmune pancreatitis: a case-control study[J]. Sci Rep, 2018, 8: 3651 [2022-10-23]. DOI: 10.1038/s41598-018-21996-5.
ZHANG Y Q, CHENG C, LIU Z B, et al. Differentiation of autoimmune pancreatitis and pancreatic ductal adenocarcinoma based on multi-modality texture features in 18F-FDG PET/CT[J]. China Ind Econ, 2019, 36(5): 755-762. DOI: 10.7507/1001-5515.201807012.
TENG C J, WEI J L, DENG Y Y, et al. Characteristics and application value of 18 F-deoxyglucose PET/CT and MRI images in autoimmune pancreatitis[J]. J Guangxi Med Univ, 2019, 36(3): 447-449. DOI: 10.16190/j.cnki.45-1211/r.2019.03.030.
LIU Z B, LI M, ZUO C J, et al. Radiomics model of dual-time 2-[18F]FDG PET/CT imaging to distinguish between pancreatic ductal adenocarcinoma and autoimmune pancreatitis[J]. Eur Radiol, 2021, 31(9): 6983-6991. DOI: 10.1007/s00330-021-07778-0.
ZHANG Y Q, CHENG C, LIU Z B, et al. Radiomics analysis for the differentiation of autoimmune pancreatitis and pancreatic ductal adenocarcinoma in 18 F-FDG PET/CT[J]. Med Phys, 2019, 46(10): 4520-4530. DOI: 10.1002/mp.13733.

PREV Application progress of diffusion-weighted imaging basded on mono-exponential and intravoxel incoherent motion imaging in autoimmune diseases
NEXT Basic principle of time-dependent diffusion MRI and its application in prostate cancer

Tel & Fax: +8610-67113815    E-mail: