Nougaret Stephanie, Reinhold Caroline, Chong Jaron, Escal Laure, Mercier Gregoire, Fabre Jean Michel, Guiu Boris, Molinari Nicolas
Department of Abdominal Imaging, Saint Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France,
Eur Radiol. 2014 May;24(5):1020-9. doi: 10.1007/s00330-014-3112-2. Epub 2014 Feb 26.
To examine the natural history of incidentally detected pancreatic cysts and whether a simplified MRI protocol without gadolinium is adequate for lesion follow-up.
Over a 10-year period, 301-patients with asymptomatic pancreatic cysts underwent follow-up (45 months ± 30). The magnetic resonance imaging (MRI) protocol included axial, coronal T2-weighted images, MR cholangiopancreatographic and fat suppressed T1-weighted sequences before and after gadolinium. Three radiologists independently reviewed the initial MRI, the follow-up studies using first only unenhanced images, then secondly gadolinium-enhanced-sequences. Lesion changes during follow-up were recorded and the added value of gadolinium-enhanced sequences was determined by classifying the lesions into risk categories.
Three hundred and one patients (1,174 cysts) constituted the study population. Only 35/301 patients (12 %) showed significant lesion change on follow-up. Using multivariate analysis the only independent factor of lesion growth (OR = 2.4; 95 % CI, 1.7-3.3; P < 0.001) and mural nodule development (OR = 1.9; 95 % CI, 1.1-3.4, P = 0.03) during follow-up was initial lesion size. No patient with a lesion initial size less than 2 cm developed cancer during follow-up. Intra-observer agreement with and without gadolinium enhancement ranged from 0.86 to 0.97. After consensus review of discordant cases, gadolinium-enhanced sequences demonstrated no added value.
Most incidental pancreatic cystic lesions did not demonstrate change during follow-up. The addition of gadolinium-enhanced-sequences had no added-value for risk assignment on serial follow-up.
Significant growth of pancreatic cysts occurred in a minority of patients only. No lesion <2 cm demonstrated any change during the first year of follow-up. Intra-observer agreement between MR pancreatic protocols with and without gadolinium was excellent. Gadolinium application had limited value for follow-up of asymptomatic pancreatic cystic lesions.
研究偶然发现的胰腺囊肿的自然病史，以及不使用钆对比剂的简化磁共振成像（MRI）方案是否足以用于病变随访。
在10年期间，对301例无症状胰腺囊肿患者进行随访（45个月±30个月）。MRI方案包括轴位、冠状位T2加权图像、磁共振胰胆管造影以及钆对比剂前后的脂肪抑制T1加权序列。三位放射科医生独立审查初始MRI，后续研究首先仅使用未增强图像，然后使用钆增强序列。记录随访期间病变的变化，并通过将病变分类为风险类别来确定钆增强序列的附加值。
301例患者（1174个囊肿）构成研究人群。随访中仅35/301例患者（12%）出现明显病变变化。多因素分析显示，随访期间病变生长（OR=2.4；95%CI，1.7 - 3.3；P<0.001）和壁结节形成（OR=1.9；95%CI，1.1 - 3.4，P=0.03）的唯一独立因素是初始病变大小。初始病变大小小于2cm的患者在随访期间均未发生癌变。观察者在使用和不使用钆增强情况下的一致性范围为0.86至0.97。在对不一致病例进行共识审查后，钆增强序列未显示出附加值。
大多数偶然发现的胰腺囊性病变在随访期间未出现变化。在连续随访中，添加钆增强序列对风险评估没有附加值。
仅少数患者的胰腺囊肿出现显著生长。在随访的第一年，小于2cm的病变未出现任何变化。使用和不使用钆的MR胰腺检查方案之间观察者的一致性极佳。钆对比剂在无症状胰腺囊性病变随访中的价值有限。
