Paris Diderot University, Sorbonne Paris Cité, INSERM U1149 CRB3, Paris, France.
Imaging Department, Hotel-Dieu de France Hospital, Beirut, Lebanon.
Eur Radiol. 2019 Nov;29(11):5731-5741. doi: 10.1007/s00330-019-06154-3. Epub 2019 Apr 10.
To evaluate whether pancreatic parenchymal abnormalities on magnetic resonance imaging (MRI) are associated with pancreatic intraepithelial neoplasia (PanIN) on histology.
Retrospective study approved by institutional review board. One hundred patients (48 men, 52 women; mean age, 53.2 ± 16.29 [SD]) underwent MRI before pancreatectomy for pancreatic tumors analyzed by two independent observers blinded to histopathological results for the presence of non-communicating microcysts and pancreatic atrophy (global or focal) beside tumors. MRI findings were compared to histopathological findings of resected specimens. Interobserver agreement was calculated. The association between parenchymal abnormalities and presence of PanIN was assessed by uni- and multivariate analyses.
PanIN was present in 65/100 patients (65%). The presence of microcysts on MRI had a sensitivity of 52.3% (34/65 [95%CI, 51.92-52.70%]), a specificity of 77.1% (27/35 [95%CI, 76.70-77.59]), and accuracy of 61% (61/100 95%CI [50.7-70.6]) for the diagnosis of PanIN while global atrophy had a sensitivity of 24.6% (16/6 [95%CI, 24.28-24.95]) and a specificity of 97.1% (34/35 [95%CI, 96.97-97.32%]). In multivariate analysis, the presence of microcysts (OR, 3.37 [95%CI, 1.3-8.76]) (p = 0.0127) and global atrophy (OR, 9.79 [95%CI, 1.21-79.129]) (p = 0.0324) were identified as independent predictors of the presence of PanIN. The combination of these two findings was observed in 10/65 PanIN patients and not in patients without PanIN (p = 0.013 with an OR of infinity [95%CI, 1.3-infinity]) and was not discriminant for PanIN-3 and lower grade (p = 0.22). Interobserver agreement for the presence of microcysts was excellent (kappa = 0.92), and for the presence of global atrophy, it was good (kappa = 0.73).
The presence of non-communicating microcysts on pre-operative MRI can be a significant predictor of PanIN in patients with pancreatic tumors.
• In patients with pancreatic tumors who had partial pancreatectomy, MR non-communicating pancreatic microcysts have a 52.3% sensitivity, a 77.1% specificity, and a 61% accuracy for the presence of PanIN with univariate and with an odds ratio of 3.37 with multivariate analyses. • The association of global atrophy and non-communicating microcysts increases the predictive risk of PanIN.
评估磁共振成像（MRI）上胰腺实质异常与组织学上的胰腺上皮内瘤变（PanIN）之间的关系。
本研究经机构审查委员会批准，为回顾性研究。100 名患者（48 名男性，52 名女性；平均年龄 53.2±16.29[SD]）在胰腺肿瘤切除术前接受 MRI 检查，两名独立观察者对 MRI 进行分析，观察者对存在非交通性微囊和肿瘤旁胰腺萎缩（整体或局灶性）的情况不了解。MRI 检查结果与切除标本的组织病理学结果进行比较。计算观察者间的一致性。采用单因素和多因素分析评估胰腺实质异常与 PanIN 存在的相关性。
65/100 例（65%）患者存在 PanIN。MRI 上存在微囊的敏感性为 52.3%（34/65[95%CI，51.92-52.70%]），特异性为 77.1%（27/35[95%CI，76.70-77.59%]），准确性为 61%（61/100[95%CI，50.7-70.6%]），用于诊断 PanIN；而整体萎缩的敏感性为 24.6%（16/6[95%CI，24.28-24.95%]），特异性为 97.1%（34/35[95%CI，96.97-97.32%]）。多因素分析显示，微囊存在（OR，3.37[95%CI，1.3-8.76]）（p=0.0127）和整体萎缩（OR，9.79[95%CI，1.21-79.129]）（p=0.0324）是 PanIN 存在的独立预测因素。在 65 例 PanIN 患者中有 10 例发现了这两种发现，而在没有 PanIN 的患者中则没有发现（p=0.013，OR 为无穷大[95%CI，1.3-无穷大]），且对 PanIN-3 和低级别肿瘤不具有鉴别力（p=0.22）。微囊存在的观察者间一致性极好（kappa=0.92），整体萎缩的观察者间一致性较好（kappa=0.73）。
术前 MRI 上存在非交通性微囊可显著预测胰腺肿瘤患者的 PanIN。
在接受胰腺部分切除术的胰腺肿瘤患者中，MRI 非交通性胰腺微囊在存在 PanIN 时的敏感性为 52.3%，特异性为 77.1%，准确性为 61%，在单因素和多因素分析中，OR 为 3.37。
整体萎缩与非交通性微囊的联合增加了 PanIN 的预测风险。
