Macari Michael, Finn Myra E, Bennett Genevieve L, Cho Kyunghee C, Newman Elliot, Hajdu Cristina H, Babb James S
Department of Radiology, New York University School of Medicine, New York, NY, USA.
Radiology. 2009 Apr;251(1):77-84. doi: 10.1148/radiol.2511081286.
To retrospectively evaluate the sensitivity and specificity of several morphologic findings that may be seen with cystic pancreatic lesions, in the diagnosis of pseudocyst at magnetic resonance (MR) imaging.
This study was institutional review board approved and HIPAA compliant. From January 1, 2005, to December 31, 2007, electronic radiology and pathology databases were searched to identify patients with pancreatic cystic neoplasms or pseudocysts who underwent pancreatic MR imaging. Twenty-two patients with cystic pancreatic neoplasms that were confirmed at surgical resection (n = 12) or endoscopic ultrasonography (US) with cystic fluid analysis (n = 10) were identified. Of 20 patients with pancreatic pseudocysts, seven had pseudocysts that were identified at pathologic resection and 13 had a clinical history of pancreatitis, with initial computed tomography (CT) revealing no pancreatic cyst and subsequent follow-up MR imaging depicting cystic lesions. Two abdominal radiologists independently and randomly evaluated each case for presence or absence of septa and internal dependent debris and for external cyst morphology on axial and coronal T2-weighted images and three-dimensional gradient-echo T1-weighted images obtained before and after intravenous contrast agent administration. Logistic regression for correlated data was used to assess the usefulness of internal debris, external morphology, and septa for differentiating cystic neoplasms from pseudocysts.
The readers' assessments of the presence or absence of cystic debris were concordant for 40 (95%) of the 42 patients, with a kappa coefficient of 0.889, which indicated nearly perfect agreement. Thirteen (93%) of 14 lesions found to have debris by either or both readers were pseudocysts, and only one (4%) of the 22 cystic neoplasms had debris. Both readers were more likely to identify septa within cystic neoplasms than within pseudocysts; however, the difference was not significant for either reader. The readers were more likely to observe microlobulated morphology in cystic neoplasms than in pseudocysts, with the difference between these lesion types, in terms of prevalence of microlobulated morphology, exhibiting a trend toward-but not reaching-statistical significance (P = .0627).
Presence of internal dependent debris appears to be a highly specific MR finding for the diagnosis of pancreatic pseudocyst.
回顾性评估胰腺囊性病变可能出现的几种形态学表现，在磁共振（MR）成像诊断胰腺假性囊肿中的敏感性和特异性。
本研究经机构审查委员会批准且符合健康保险流通与责任法案（HIPAA）。从2005年1月1日至2007年12月31日，检索电子放射学和病理学数据库，以识别接受胰腺MR成像的胰腺囊性肿瘤或假性囊肿患者。确定了22例经手术切除（n = 12）或经内镜超声检查（US）及囊液分析确诊（n = 10）的胰腺囊性肿瘤患者。在20例胰腺假性囊肿患者中，7例在病理切除时发现假性囊肿，13例有胰腺炎临床病史，初始计算机断层扫描（CT）未显示胰腺囊肿，随后的随访MR成像显示有囊性病变。两名腹部放射科医生独立且随机地评估每个病例，观察轴位和冠状位T2加权图像以及静脉注射造影剂前后获得的三维梯度回波T1加权图像上是否存在分隔、内部重力性碎屑以及外部囊肿形态。使用相关数据的逻辑回归分析来评估内部碎屑、外部形态和分隔对于区分囊性肿瘤和假性囊肿的有用性。
在42例患者中，两位读者对囊性碎屑是否存在的评估结果在40例（95%）中一致，kappa系数为0.889，表明几乎完全一致。两位读者中任何一位或两位读者发现有碎屑的14个病变中有13个（93%）为假性囊肿，22个囊性肿瘤中只有1个（4%）有碎屑。两位读者在囊性肿瘤中比在假性囊肿中更易识别出分隔；然而，对于任何一位读者而言，差异均无统计学意义。读者在囊性肿瘤中比在假性囊肿中更易观察到分叶状形态，就分叶状形态的发生率而言，这些病变类型之间的差异呈现出趋于但未达到统计学意义的趋势（P = 0.0627）。
内部重力性碎屑的存在似乎是诊断胰腺假性囊肿的一项高度特异的MR表现。
