Objective
To evaluate the feasibility and the reproducibility of diffusion-weighted imaging (DWI) in distinguishing between mucin-producing and serous pancreatic cysts.
Methods
Forty-four pancreatic cysts (43 patients; 27 females; mean age 57 years-old; 26 mucin-producing cysts; 18 serous cysts) underwent histological examination or cyst analysis after DW-MRI were retrospectively reviewed. Three blinded readers independently evaluated SI and ADC. Intra-observer and inter-observer agreements were calculated. Fisher's exact test and Welch's t test were used to compare SI and ADC values respectively, to pathological results. ROC analysis was used to determine diagnostic accuracy of various thresholds for ADC. A p value < 0.05 was considered statistically significant.
Results
Mean ADC value of the mucin-producing cysts was 3.26 ×10−3 mm2/sec, 3.27 ×10−3 mm2/sec and 3.35 ×10−3 mm2/sec for the three readers, respectively. Mean ADC value of the serous cysts was 2.86 ×10−3 mm2/sec, 2.85 ×10−3 mm2/sec and 2.85 ×10−3 mm2/sec for the three readers, respectively. Difference in ADC values between the two cyst groups was 12.4%, 12.9% and 14.8% for the three readers, respectively (p<0.001). Intra-observer and inter-observer agreement was excellent. A threshold ADC of 3×10−3 mm2/sec resulted in correct identification of cysts in 77-81% of cases, with sensitivity and specificity ranging between 84-88% and 66-72%, respectively.
Conclusions
DWI may be a helpful tool in distinguishing between mucin-producing and serous pancreatic cysts.
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