T1 signal intensity ratio of the pancreas as an imaging biomarker for the staging of chronic pancreatitis

Temel Tirkes; Anil K Dasyam; Zarine K Shah; Evan L Fogel; Santhi Swaroop Vege; Liang Li; Shuang Li; Stephanie T Chang; Carlos A Farinas; Joseph R Grajo; Kareem Mawad; Naoki Takahashi; Sudhakar K Venkatesh; Ashley Wachsman; William E Fisher; Christopher E Forsmark; Phil A Hart; Stephen J Pandol; Walter G Park; Stephen K Van Den Eeden; Yunlong Yang; Mark Topazian; Dana K Andersen; Jose Serrano; Darwin L Conwell; Dhiraj Yadav; Consortium for the Study of Chronic Pancreatitis, Diabetes, Pancreatic Cancer (CPDPC)

doi:10.1007/s00261-022-03611-4

T1 signal intensity ratio of the pancreas as an imaging biomarker for the staging of chronic pancreatitis

Abdom Radiol (NY). 2022 Oct;47(10):3507-3519. doi: 10.1007/s00261-022-03611-4. Epub 2022 Jul 20.

Authors

Temel Tirkes¹, Anil K Dasyam², Zarine K Shah³, Evan L Fogel⁴, Santhi Swaroop Vege⁵, Liang Li⁶, Shuang Li⁶, Stephanie T Chang⁷, Carlos A Farinas⁸, Joseph R Grajo⁹, Kareem Mawad¹⁰, Naoki Takahashi¹¹, Sudhakar K Venkatesh¹¹, Ashley Wachsman¹², William E Fisher¹³, Christopher E Forsmark¹⁴, Phil A Hart¹⁵, Stephen J Pandol¹⁶, Walter G Park¹⁷, Stephen K Van Den Eeden¹⁸, Yunlong Yang⁶, Mark Topazian¹⁹, Dana K Andersen²⁰, Jose Serrano²⁰, Darwin L Conwell²¹, Dhiraj Yadav²²; Consortium for the Study of Chronic Pancreatitis, Diabetes, Pancreatic Cancer (CPDPC)

Affiliations

¹ Department of Radiology & Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd. Suite 0663, Indianapolis, IN, 46202, USA. atirkes@iupui.edu.
² Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³ Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁴ Lehman, Bucksot and Sherman Section of Pancreatobiliary Endoscopy, Indiana University School of Medicine, Indianapolis, IN, USA.
⁵ Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
⁶ Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁷ Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
⁸ Baylor College of Medicine, Radiology Department, TX, Houston, USA.
⁹ University of Florida College of Medicine, Gainesville, FL, USA.
¹⁰ The Permanente Medical Group, South San Francisco Medical Center, South San Francisco, CA, 94080, USA.
¹¹ Department of Radiology, Mayo Clinic, Rochester, MN, USA.
¹² Department of Radiology, Cedars-Sinai Medical Center, University of California in Los Angeles, Los Angeles, CA, USA.
¹³ Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
¹⁴ Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, 32610, USA.
¹⁵ Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
¹⁶ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁷ Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA.
¹⁸ Kaiser Permanente Division of Research, Oakland, CA, USA.
¹⁹ Mayo Clinic, Rochester, MN, USA.
²⁰ Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
²¹ Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.
²² Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Abstract

Purpose: Our purpose was to validate the T1 SIR (T1 score) as an imaging biomarker for the staging of CP in a large, multi-institutional, prospective study.

Methods: The prospective study population included 820 participants enrolled in the PROCEED study from nine clinical centers between June 2017 and December 2021. A radiologist at each institution used a standardized method to measure the T1 signal intensity of the pancreas and the reference organs (spleen, paraspinal muscle, liver), which was used to derive respective T1 scores. Participants were stratified according to the seven mechanistic stages of chronic pancreatitis (MSCP 0-6) based on their clinical history, MRCP, and CT findings.

Results: The mean pancreas-to-spleen T1 score was 1.30 in participants with chronic abdominal pain, 1.22 in those with acute or recurrent acute pancreatitis, and 1.03 in definite CP. After adjusting for covariates, we observed a linear, progressive decline in the pancreas-to-spleen T1 score with increasing MSCP from 0 to 6. The mean pancreas-to-spleen T1 scores were 1.34 (MSCP 0), 1.27 (MSCP 1), 1.21 (MSCP 2), 1.16 (MSCP 3), 1.18 (MSCP 4), 1.12 (MSCP 5), and 1.05 (MSCP 6) (p < 0.0001). The pancreas-to-liver and pancreas-to-muscle T1 scores showed less linear trends and wider confidence intervals.

Conclusion: The T1 score calculated by SIR of the pancreas-to-spleen shows a negative linear correlation with the progression of chronic pancreatitis. It holds promise as a practical imaging biomarker in evaluating disease severity in clinical research and practice.

Keywords: MRI; Mechanistic Stages of Chronic Pancreatitis; T1 score.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Acute Disease
Biomarkers
Humans
Magnetic Resonance Imaging* / methods
Pancreas / diagnostic imaging
Pancreatitis, Chronic* / diagnostic imaging
Prospective Studies

Substances

Biomarkers

Abstract

Publication types

MeSH terms

Substances

Grants and funding