Kim Mimi, Mi Jang Kyung, Kim Seong Hyun, Doo Song Kyoung, Jeong Woo Kyoung, Kang Tae Wook, Kim Young Kon, Cha Dong Ik, Kim Kyunga, Yoo Heejin
1 Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea.
2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Acta Radiol. 2017 Oct;58(10):1157-1166. doi: 10.1177/0284185116685921. Epub 2017 Jan 13.
Background It is debated whether diagnostic performance of diffusion-weighted imaging (DWI), which is widely used for detection and characterization of various malignant tumors, is comparable with high-risk stigmata of 2012 international consensus guidelines (ICG) for diagnosis of intraductal papillary mucinous neoplasms (IPMNs). Purpose To evaluate the diagnostic accuracy of diffusion restriction in IPMNs for prediction of malignancy and invasiveness in comparison with high-risk stigmata of 2012 ICG. Material and Methods This retrospective study was institutional review board approved and informed consent was waived. A total of 132 patients with surgically proven IPMNs (49 malignant, 83 benign) who underwent gadoxetic acid-enhanced magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and DWI with a b-value of 0, 100, and 800 s/mm using a 3.0 T MR system were included. Two radiologists independently evaluated imaging parameters of high-risk stigmata and worrisome features of 2012 ICG and diffusion restriction in IPMNs. Univariate and multivariate logistic regression analyses and McNemar's test were used for statistical analysis. Results The presence of diffusion restriction in IPMNs was the only independent imaging parameter for prediction of malignancy (odds ratio [OR], 11.98; 95% confidence interval [CI], 3.60-39.87; P < 0.001) and invasiveness (OR, 17.92; 95% CI, 3.91-82.03; P < 0.001) on multivariate analysis. The diagnostic accuracy and specificity of diffusion restriction were significantly improved compared to high-risk stigmata of 2012 ICG to prediction of malignant ( P = 0.006 and P < 0.001, respectively) or invasive IPMNs ( P = 0.009 and P = 0.015, respectively). Conclusion The diffusion restriction in IPMNs could be considered as another high-risk stigma of malignancy and predictor for invasiveness.
对于广泛用于各种恶性肿瘤检测和特征描述的扩散加权成像（DWI）的诊断性能是否与2012年国际共识指南（ICG）中关于导管内乳头状黏液性肿瘤（IPMN）诊断的高危特征相当，目前存在争议。目的：与2012年ICG的高危特征相比，评估IPMN中扩散受限对预测恶性和侵袭性的诊断准确性。材料与方法：本回顾性研究经机构审查委员会批准，无需知情同意。纳入了132例经手术证实的IPMN患者（49例恶性，83例良性），这些患者接受了钆塞酸增强磁共振成像（MRI）、磁共振胰胆管造影（MRCP）以及使用3.0 T MR系统进行的b值为0、100和800 s/mm²的DWI检查。两名放射科医生独立评估2012年ICG的高危特征和可疑特征的成像参数以及IPMN中的扩散受限情况。采用单因素和多因素逻辑回归分析以及McNemar检验进行统计分析。结果：多因素分析显示，IPMN中存在扩散受限是预测恶性（比值比[OR]，11.98；95%置信区间[CI]，3.60 - 39.87；P < 0.001）和侵袭性（OR，17.92；95% CI，3.91 - 82.03；P < 0.001）的唯一独立成像参数。与2012年ICG的高危特征相比，扩散受限对预测恶性IPMN（分别为P = 0.006和P < 0.001）或侵袭性IPMN（分别为P = 0.009和P = 0.015）的诊断准确性和特异性显著提高。结论：IPMN中的扩散受限可被视为恶性的另一种高危特征和侵袭性的预测指标。
