Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
J Dig Dis. 2019 Oct;20(10):557-562. doi: 10.1111/1751-2980.12801. Epub 2019 Aug 30.
To identify risk factors of imaging progression (increase in cyst size or main pancreatic duct size, or a new mural nodule) in low-risk branch duct intraductal papillary mucinous neoplasm (BD-IPMN), including obesity-related factors such as pancreatic fat content.
Our hospital databases were searched for patients who had completed health checkup, including upper abdominal magnetic resonance imaging (MRI) over 48 months (August 2012 to July 2016). Individuals with BD-IPMN without worrisome features and high-risk stigmata who underwent surveillance with at least one follow-up MRI, irrespective of the follow-up period, were included. Pancreatic computed tomography attenuation indexes were defined as the difference between the pancreas and spleen attenuation (P - S) and the pancreas to spleen attenuation ratio (P/S).
Among 75 patients diagnosed as having low-risk BD-IPMN, during a median follow-up of 36 months, 11 (15%) had imaging progression in cyst size, including two with worrisome features. A multivariate logistic analysis showed that the initial cyst size and both indexes (P - S, or P/S) were significantly associated with imaging progression in IPMN, respectively (Model 1: odds ratio [OR] 1.188, 95% confidence interval [CI] 1.060-1.331, P = 0.003; OR 0.871, 95% CI 0.776-0.977, P = 0.019; Model 2: OR 1.186, 95% CI 1.064-1.322, P = 0.002; OR 0.002, 95% CI 0.000-0.970, P = 0.049).
Pancreatic fat content and initial cyst size were significantly associated with imaging progression in low-risk BD-IPMN. Revisions of international consensus Fukuoka guidelines might be customized based on initial cyst size and pancreatic fat content.
确定低风险分支胰管内乳头状黏液性肿瘤（BD-IPMN）中影像学进展（囊肿大小或主胰管大小增加，或出现新的壁结节）的危险因素，包括与胰腺脂肪含量相关的肥胖相关因素。
我们在医院数据库中搜索了在 48 个月（2012 年 8 月至 2016 年 7 月）期间完成了上腹部磁共振成像（MRI）检查的患者。纳入了无特征性表现和高危特征但有进行监测、至少有一次随访 MRI 检查且随访时间不限的低风险 BD-IPMN 患者。胰腺 CT 衰减指数定义为胰腺与脾脏衰减（P-S）的差值和胰腺与脾脏衰减比值（P/S）。
在 75 例被诊断为低风险 BD-IPMN 的患者中，中位随访 36 个月期间，11 例（15%）出现囊肿大小影像学进展，其中 2 例出现特征性表现。多变量逻辑分析显示，初始囊肿大小和两个指数（P-S 或 P/S）与 IPMN 的影像学进展显著相关（模型 1：优势比[OR]为 1.188，95%置信区间[CI]为 1.060-1.331，P=0.003；OR 为 0.871，95%CI 为 0.776-0.977，P=0.019；模型 2：OR 为 1.186，95%CI 为 1.064-1.322，P=0.002；OR 为 0.002，95%CI 为 0.000-0.970，P=0.049）。
胰腺脂肪含量和初始囊肿大小与低风险 BD-IPMN 的影像学进展显著相关。可能需要根据初始囊肿大小和胰腺脂肪含量对国际共识福冈指南进行修订。
