胰腺导管内乳头状黏液性肿瘤的恶性潜能评估：多排 CT 与 MR 成像及 MR 胆胰管成像的比较。
Assessment of Malignant Potential in Intraductal Papillary Mucinous Neoplasms of the Pancreas: Comparison between Multidetector CT and MR Imaging with MR Cholangiopancreatography.
机构信息
From the Departments of Radiology (H.J.K., J.M.L., I.J., J.H.J., J.K.H.), Surgery (J.Y.J.), Pathology (K.B.L.), and Internal Medicine (J.K.R.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea; Institute of Radiation Medicine, Seoul National University College Medical Research Center, Seoul, Korea (J.M.L., I.J., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L., J.H.J., J.K.H.); Department of Radiology, National Cancer Center, Seoul, Korea (B.Y.H.); and Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.).
出版信息
Radiology. 2016 Apr;279(1):128-39. doi: 10.1148/radiol.2015150217. Epub 2015 Oct 30.
PURPOSE
To compare the diagnostic performance of multidetector computed tomography (CT) and magnetic resonance (MR) imaging with MR cholangiopancreatography (MRCP) in identifying the malignant potential of pancreatic intraductal papillary neoplasms (IPMNs) and evaluate their intermodality agreement.
MATERIALS AND METHODS
Institutional review board approval was obtained, and the requirement for informed consent was waived for this retrospective study. In 129 patients with pathologically proved pancreatic IPMNs, three reviewers independently evaluated their preoperative CT and MR imaging with MRCP findings. Intermodality agreement between multidetector CT and MR imaging with MRCP, as well as interobserver agreement of each imaging modality, for depicting high-risk stigmata and worrisome features were assessed. Diagnostic values of other signs of overt malignancy, including the presence of a parenchymal mass and local-regional extension, were analyzed. Diagnostic performance and intermodality agreement were assessed by using receiver operating characteristics (ROC) curve analysis and weighted κ statistics.
RESULTS
Overall, multidetector CT and MR imaging with MRCP were similar in their ability to depict signs suspicious or indicative of malignancy in patients with IPMN (area under the ROC curve [AUC] = 0.82 for both), with good intermodality agreement (κ = 0.75) and moderate interobserver agreement (κ = 0.47-0.59) when high-grade dysplasia was used as the cutoff for malignancy. When parenchymal masses and local-regional extensions were also considered as overt signs of malignancy, the ability to identify invasive IPMNs significantly increased (AUC = 0.87 for CT and AUC = 0.88 for MR imaging), with high sensitivity (94.3%), while maintaining specificity (69.1%).
CONCLUSION
The diagnostic performance of multidetector CT and MR imaging with MRCP for identifying the malignant potential of pancreatic IPMNs was similar and showed good intermodality agreement, suggesting that follow-up with either modality may be used.
目的
比较多层螺旋 CT（MSCT）与磁共振（MR）成像联合 MR 胆胰管成像（MRCP）在识别胰腺导管内乳头状黏液性肿瘤（IPMN）恶性潜能方面的诊断效能，并评估两者之间的一致性。
材料与方法
本研究经机构审查委员会批准，且获得豁免签署知情同意书。回顾性分析 129 例经病理证实的胰腺 IPMN 患者的术前 MSCT 和 MR 成像联合 MRCP 资料。由 3 位观察者分别独立评估 MSCT 和 MR 成像联合 MRCP 对高危特征和可疑特征的显示能力，评价两种成像模态之间以及每种成像模态观察者间的一致性。分析其他明确恶性征象（如实质肿块和局部区域侵犯）的诊断价值。采用受试者工作特征（ROC）曲线分析和加权κ检验评估诊断效能和两种模态间的一致性。
结果
总体而言，MSCT 和 MR 成像联合 MRCP 对胰腺 IPMN 患者可疑或提示恶性征象的显示能力相似（ROC 曲线下面积 [AUC] 两者均为 0.82），两种模态间具有良好的一致性（κ=0.75），观察者间的一致性也较好（κ=0.47~0.59，以高级别上皮内瘤变为恶性标准）。当将实质肿块和局部区域侵犯也视为明显恶性征象时，MSCT 和 MR 成像联合 MRCP 识别侵袭性 IPMN 的效能明显提高（AUC 分别为 0.87 和 0.88），同时保持较高的特异性（69.1%）。
结论
MSCT 和 MR 成像联合 MRCP 识别胰腺 IPMN 恶性潜能的效能相当，且具有良好的一致性，提示这两种检查方法都可用于胰腺 IPMN 的随访。
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