MRI with mangafodipir trisodium in the detection of pancreatic tumours: comparison with helical CT

The aim was to compare spiral CT and MRI enhanced with mangafodipir trisodium (Mn-DPDP) in the detection and staging of pancreatic lesions. 20 patients with suspected pancreatic cancer were included in a phase III study. Triphasic spiral CT (4 ml s-1) and MRI (axial T1 weighted turbo spin echo with and without fat suppression, T1 weighted gradient echo and T2 weighted turbo spin echo at 1.5 T) were performed. All sequences were repeated following contrast medium using the same instrument settings as in the unenhanced sequences. Mn-DPDP was administered by slow injection of 5 mumol kg-1 body weight. Imaging results were correlated with surgery, laparoscopy, biopsy and/or follow-up. Eight pancreatic adenocarcinomas were present. Ten patients had chronic pancreatitis, and two showed a stenosing papillitis. CT detected eight malignant lesions and MRI detected seven. One pancreatic cancer was not detected with MRI. CT and MRI excluded malignancy in nine patients. MRI and CT returned three false positive results. Mn-DPDP improved delineation of the lesion, resulting in a higher level of diagnostic confidence. Differentiation between pseudotumorous lesions in chronic pancreatitis and pancreatic carcinoma was difficult due to similar slight contrast enhancement. Owing to better delineation of the lesion and the higher confidence in diagnosis, MRI with Mn-DPDP may have the potential to improve the detection rate and the staging accuracy of focal pancreatic lesions. These results need to be confirmed in a larger patient trial.