Diffusion-Weighted Magnetic Resonance Imaging of Pancreatic Adenocarcinomas: Association With Histopathology and Tumor Grade

Purpose: To evaluate the utility of diffusion-weighted magnetic resonance imaging (DWI) in pancreatic ductal adenocarcinoma with various grades of differentiation. Materials and Methods: Following Institutional Review Board (IRE) approval, 21 consecutive patients with surgical pathology-proven pancreatic adenocarcinomas were retrospectively evaluated. Histopathologic characteristics and grades of differentiation of adenocarcinomas were analyzed. Twenty-one patients without a known history of pancreatic disease were evaluated as the control group. Anatomic MR images and DW images were acquired using 1.5-T MR systems. DWI with b values of 0 and 500 sec/mm(2) were performed on both patients and control groups. The difference in mean apparent diffusion coefficient (ADC) values among groups of normal pancreatic parenchyma, adenocarcinomas with poor differentiation, and adenocarcinomas with well/moderate differentiation were compared using one-way analysis of variance. Results: Mean ADCs of pancreatic adenocarcinomas (1.77 +/- 0.45 x 10(-3)mm(2)/sec) was not significantly lower than that of normal parenchyma (1.98 +/- 0.31) (P = 0.09). When adenocarcinomas were subdivided based on grades of differentiation, however, poorly differentiated adenocarcinoma with histopathologic characteristics of limited glandular formation and dense fibrosis had significantly lower ADCs (1.46 +/- 0.17) compared to those of well/moderately differentiated adenocarcinomas (2.10 +/- 0.42) characterized by neoplastic tubular structures (P < 0.01). Well/moderately differentiated adenocarcinomas with dense fibrosis showed significantly lower ADC values (1.49 +/- 0.19) than those with loose fibrosis (2.26 +/- 0.30) (P = 0.01). Conclusion: Difference in ADC values using DWI between poorly and well/moderately differentiated pancreatic ductal adenocarcinoma may relate to differences in glandular formation and density of fibrosis.