LAUSR

Editorial for “Evaluation of Pancreatic Fibrosis Grading by Multiparametric Functional Magnetic Resonance Imaging” Pancreatic fibrosis (PF) is detected in different diseases including chronic pancreatitis and pancreatic ductal adenocarcinoma and represents a reparative tissue response to injuries. This condition may lead to pancreatic insufficiency, and significantly impact radiological–surgical–pathological management, as well as drug resistance and metastatic spread of tumor cells. Early detection of fibrotic changes in the pancreatic parenchyma could potentially help to prevent more severe morphologic disruption and fibrosis progression. Unfortunately, while functional examinations of the pancreas are rarely used in a clinical setup and often not reliable and reproducible, pancreatic biopsies are invasive with possible for complications and demand high-grade technical skill, making it unpractical for routine evaluation of PF. Improvement in pancreatic magnetic resonance (MR) image quality and resolution has recently been achieved with reduced field of view techniques. The reduction of the typical pancreatic imaging artifacts due to bowel air and motion allows for reliable application of multiparametric MR imaging to different pancreatic diseases and quantification of pancreatic fat and fibrous tissue with T2*-corrected Dixon technique and intravoxel incoherent motion model (IVIM) diffusion-weighted imaging (DWI). In this issue of JMRI, Liu C et al reported on multiparametric MR assessment of PF in 144 consecutive patients with different pancreatic diseases, comparing MR elastography (MRE), T1 mapping, and IVIM-DWI findings to postoperative histopathologic assessment. In this framework, each imaging parameter was firstly extracted and correlated to tissue PF grading; following, a multivariate logistic regression model was built to evaluate the possible combination of imaging subsets to better characterize gland fibrotic infiltration. The authors conclude that a combination of MRE and T1 mapping seems the most promising in diagnosing various grades of PF, particularly at an early stage, downgrading the role of IVIM-DWI for this purpose. The sample heterogeneity both as disease than as fibrotic infiltration distribution, together with possible sequences’ spatial incongruence (e.g., different slice thickness and scanner) and histological matching represent a major limitation of this study. The differences in functional status of the pancreas may also have a significant impact on the evaluated parameters, and a limit of the heterogeneous patient population. The work of Liu C et al. despite the limitations represents an important step in the direction of improving functional imaging of the pancreas providing novel data. The time of MRE-based assessment of PF probably in conjunction with other biological markers is getting closer.