基于修订版 2017 年国际共识指南的 CT 与 MRI 对胰腺导管内乳头状黏液性肿瘤恶性潜能的评估
Determining Malignant Potential of Intraductal Papillary Mucinous Neoplasm of the Pancreas: CT versus MRI by Using Revised 2017 International Consensus Guidelines.
机构信息
From the Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, 170 Jomaru-ro, Bucheon-Si, Gyeonggi-do 14584, Republic of Korea (J.E.L., S.Y.C., B.H.Y., M.H.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.M.); Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea (S.S.K., J.A.H.); and Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea (J.H.K.).
出版信息
Radiology. 2019 Oct;293(1):134-143. doi: 10.1148/radiol.2019190144. Epub 2019 Sep 3.
Background Several changes have been made to the revised 2017 international consensus guidelines for management of pancreatic intraductal papillary mucinous neoplasms (IPMNs). However, the diagnostic performance is yet to be verified. Purpose To evaluate the revised guidelines for predicting malignant potential of pancreatic IPMNs and to compare diagnostic performance and intermodality agreement between contrast material-enhanced CT and MRI. Materials and Methods In this retrospective study, two radiologists analyzed the preoperative contrast-enhanced CT and MRI of patients with surgically resected pancreatic IPMNs from January 2007 to December 2017. The diagnostic performance of CT and MRI were analyzed by using receiver operating curve analysis. Intermodality agreement was assessed by using weighted κ and intraclass correlation coefficient values. Results A total of 86 patients (mean age, 67.6 years ± 8.9 [standard deviation]; 47 men and 39 women) with pancreatic IPMNs (benign, 58; malignant, 28) were included. At both CT and MRI, enhancing mural nodule ( < .001), abrupt main pancreatic duct caliber change ( < .001), lymphadenopathy ( = .006), larger main pancreatic duct size ( = .003), and faster cyst growth rate ( = .04) were more common in malignant than benign IPMNs. Irrespective of the modality, enhancing mural nodule of 5 mm or greater had the highest odds ratio (25 at CT vs 29 at MRI). The diagnostic performance of CT (area under the receiver operating characteristic curve, 0.83 [95% confidence interval: 0.75, 0.92]) and MRI (area under the receiver operating characteristic curve, 0.86 [95% confidence interval: 0.77, 0.95]) for predicting malignant IPMNs were comparable ( = .43), with good intermodality agreement (κ = 0.70). Conclusion Among revised features, enhancing mural nodule of 5 mm or greater had the strongest association with malignant intraductal papillary mucinous neoplasm (IPMN), and diagnostic performance for prediction of malignant IPMNs were comparable between contrast-enhanced CT and MRI with good intermodality agreement. © RSNA, 2019
背景
2017 年国际胰腺导管内乳头状黏液性肿瘤（IPMN）管理共识指南修订版做了一些改动。然而，其诊断性能仍有待验证。目的：评估修订版指南预测胰腺 IPMN 恶性潜能的能力，并比较增强 CT 和 MRI 的诊断性能和模态间一致性。材料与方法：本回顾性研究纳入了 2007 年 1 月至 2017 年 12 月期间接受手术切除的胰腺 IPMN 患者的术前增强 CT 和 MRI，由两位放射科医生进行分析。采用受试者工作特征曲线分析评估 CT 和 MRI 的诊断性能。采用加权 κ 和组内相关系数值评估模态间一致性。结果：共纳入 86 例胰腺 IPMN 患者（平均年龄，67.6 岁±8.9[标准差]；男 47 例，女 39 例），其中良性 58 例，恶性 28 例。在 CT 和 MRI 上，恶性 IPMN 更常出现强化壁结节（<.001）、主胰管突然变细（<.001）、淋巴结肿大（=.006）、主胰管直径更大（=.003）和囊腔生长速度更快（=.04）。在两种模态上，增强壁结节≥5 mm 的患者发生恶性 IPMN 的比值比均最高（CT 为 25，MRI 为 29）。CT（曲线下面积为 0.83 [95%置信区间：0.75，0.92]）和 MRI（曲线下面积为 0.86 [95%置信区间：0.77，0.95]）预测恶性 IPMN 的诊断性能相当（=.43），模态间一致性良好（κ=0.70）。结论：在修订后的特征中，增强壁结节≥5 mm 与恶性胰管内乳头状黏液性肿瘤（IPMN）关系最密切，增强 CT 和 MRI 预测恶性 IPMN 的诊断性能相当，且模态间一致性良好。
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