Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

Abstract

AIM:To retrospectively evaluate the imaging features of pancreatic intraductal papillary mucinous neoplasms (IPMNs) in multi-detector row computed tomography (MDCT). METHODS:A total of 20 patients with pathologicallyconfirmed intraductal papillary mucinous neoplasms (IPMNs) were included in this study. Axial MDCT images combined with CT angiography (CTA) and multiplanar volume reformations (MPVR) or curved reformations (CR) were preoperatively acquired. Two radiologists (Tan L and Wang DB) reviewed all the images in consensus using an interactive picture archiving and communication system. The disputes in readings were resolved through consultation with a third experienced radiologist (Chen KM). Finally, the findings and diagnoses were compared with the pathologic results. RESULTS:The pathological study revealed 12 malignant IPMNs and eight benign IPMNs. The diameters of the cystic lesions and main pancreatic ducts (MPDs) were significantly larger in malignant IPMNs compared with those of the benign IPMNs (P < 0.05). The combinedtype IPMNs had a higher rate of malignancy than the other two types of IPMNs (P < 0.05). Tumors with mural nodules and thick septa had a significantly higher incidence of malignancy than tumors without these features (P < 0.05). Communication of side-branch IPMNs with the MPD was present in nine cases at pathologic examination. Seven of them were identified from CTA and MPVR or CR images. From comparison with the pathological diagnosis, the sensitivity, specificity, and accuracy of MDCT in characterizing the malignancy of IPMN of the pancreas were determined to be 100%, 87.5% and 95%, respectively.

What Is the Best Way to Identify Malignant Transformation Within Pancreatic IPMN: A Systematic Review and Meta-Analyses

“…33 , 35 , 38 , 39 , 41 , 44 , 45 , 46 , 48 , 50 , 51 , 52 , 53 , 54 , 55 , 56 The pooled sensitivity was 0.682 (95% CI 0.575–0.789) and specificity was 0.574 (95% CI 0.43–0.702) ( Table 3 and Supplementary Figure S1 online). Twelve of these studies (898 patients) 26 , 35 , 38 , 39 , 41 , 45 , 46 , 51 , 53 , 54 , 55 , 56 were limited to BD-IPMN, and here the pooled sensitivity was 0.671 (95% CI 0.527–0.804) and specificity was 0.574 (95% CI 0.413–0.722) ( Table 4 and Supplementary Figure S2 ). The majority of studies used 3 cm as cutoff (12 studies), whereas 2 cm was used in two studies 44 , 48 and 3.5 cm in one study.…”

“…Nine studies were included in the systematic review (295 patients), 22 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 but meta-analyses could only be performed using data from four studies (159 patients); 22 , 25 , 26 , 27 Sperti et al 22 evaluated 64 patients with helical CT (2.5 mm slices) and 60 patients with MRI/secretin-stimulated magnetic resonance cholangiopancreatography and reported the pooled results. Ogawa et al 27 evaluated contrast-enhanced CT scans of 61 consecutive resections for IPMN using a multiphase scanner with either 4 or 16 detector rows and reconstruction with 5 mm thickness.…”

“…The two radiologists were blinded to the findings at surgery/histology, and consensus of opinion was used to come to a conclusion. Tan et al 26 employed 4- or 16-slice dual-phase CT with multiplanar volume reformations or curved reformations. Two radiologists blinded to the findings at surgery/histology reviewed the scans, and any difference of opinion was resolved by seeking input from a third radiologist.…”

“…Systematic review and meta-analysis of 3 studies (106 patients) were undertaken. Hong et al 26 used a PET scanner with axial field view of 15.7 cm, and maximal standardized uptake value (SUV) cutoff of 2.5. They opined that PET outperformed CT in detecting malignant IPMN.…”

Imaging considerations in intraductal papillary mucinous neoplasms of the pancreas

“…The importance of cross-sectional imaging in the presurgical evaluation of IPMN has been extensively emphasized in the literature [7][8][9][10][11][12][13][14] . The tight correlation between imaging findings and histopathological features of these neoplasms, with further sub-classification based on the location and degree of involvement of the pancreas, provides the basis for including imaging in a decision-making algorithm proposed for the management of IPMN [15] .…”