Multiparametric 18F–FDG PET/MR follow-up in a patient with autoimmune pancreatitis
© The Author(s) 2017
Received: 12 July 2017
Accepted: 23 October 2017
Published: 22 November 2017
Positron emission tomography/magnetic resonance imaging (PET/MR) is a new multimodal imaging technique, which might improve the diagnostic performance not only in oncological patients but also in patients with non-neoplastic inflammatory lesions as routinely used 18F-FDG is not a cancer specific agent.
Multiparametric 18F–FDG PET/MR in a woman with pain in the upper abdomen and inconclusive laboratory and clinical data presenting with moderately increased, diffuse 18F–FDG uptake with delayed contrast enhancement, diffusion-restriction and focal enlargement in the pancreatic body being suggestive for autoimmune pancreatitis (AIP). Follow-up 18F–FDG PET/MR after initiation of steroid therapy confirmed complete resolution of imaging abnormalities.
18F–FDG PET/MR might be valuable in the management of AIP providing complementary data regarding accurate diagnosis and monitoring therapy response to avoid unnecessary surgery.
Recently, positron emission tomography/magnetic resonance imaging (PET/MR) has been introduced as a new multimodal imaging technique combining morphological and functional information. For the diagnosis of pancreatic cancer, fluorine-18 fluorodeoxyglucose (18F–FDG)-PET has been most widely used (Rijkers et al., 2014). However, 18F–FDG is not a cancer specific agent and its uptake has been described in non-neoplastic inflammatory lesions as well (Ozaki et al., 2008).
Along with clinical, laboratory, and histopathological data, imaging plays an important role in the diagnosis and management of AIP, however, imaging appearance of AIP varies widely. Certain nonspecific imaging features in cross-sectional imaging have been defined which are more likely to represent AIP than alternate diagnoses (e.g. pancreatic cancer) (Lee & Sahani, 2014). Recent studies suggest that 18F–FDG PET may prove valuable in providing complementary data in delineating the extent of organ involvement and staging the extent of disease as extra-pancreatic sites of involvement are also often seen in AIP (Lee & Sahani, 2014). Further, additional 18F–FDG PET might help guiding biopsy early in the diagnostic evaluation, and monitoring response to therapy.
In complex cases, when it’s important to gather all available functional and morphological information to exclude malignancy, combined 18F–FDG PET/MR may prove valuable in the management of AIP regarding accurate diagnosis and monitoring therapy response to avoid unnecessary surgery.
The publication of this article was supported by funds of the European Association of Nuclear Medicine (EANM).
No funding was received for this study.
Conception and design: IR; ME; HA; JTS; GW; AMS; AJB. Acquisition of data, analysis and interpretation of data: IR; ME; HA; JTS; GW; AMS; AJB. Drafting the article and final approval of the revised manusript: IR; ME; HA; JTS; GW; AMS; AJB. All authors read and approved the final manuscript.
Ethics approval and consent to participate
For this case report, informed written consent for publication was obtained from the patient. As the FDG-PET/CT was part of a routinely performed clinical examination no ethics approval was needed.
The authors declare that they have no conflicts of interest or competing interests.
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