Siemens Healthcare GmbH, Erlangen, Germany.
Philips Korea Ltd.
Invest Radiol. 2020 May;55(5):262-269. doi: 10.1097/RLI.0000000000000636.
To determine the clinical feasibility of abbreviated magnetic resonance image (MRI) using breath-hold 3-dimensional magnetic resonance cholangiopancreatography (3D-MRCP) (aMRI-BH) for pancreatic intraductal papillary mucinous neoplasm (IPMN) surveillance.
In this retrospective study, 123 patients with 158 pancreatic IPMNs (pathologically proven [n = 73] and typical image feature with ≥2-year stability [n = 85]) who underwent conventional MRI (cMRI) consisting of contrast-enhanced pancreatobiliary MRI with conventional and BH-3D-MRCP were included. Two readers independently evaluated aMRI-BH protocols consisting of heavily T2-weighted, precontrast T1-weighted, and BH-3D-MRCP sequences. The diagnostic performance of aMRI-BH for detecting malignant IPMNs was assessed using the following criteria: category 3, presence of mural nodule 5 mm or bigger and/or main pancreatic duct (MPD) 10 mm or bigger; category 2, more than one of the following: cyst size 30 mm or greater, mural nodule smaller than 5 mm, thickened cyst walls, MPD of 5 to 9 mm, lymphadenopathy, and an abrupt MPD caliber change with distal atrophy; and category 1, none of the above. Categories 2 or 3 were considered positive results of surveillance. Interreader agreement of image features by intraclass correlation and κ statistics were analyzed.
The total acquisition times of cMRI and aMRI-BH were 32.7 ± 8 and 5.5 ± 2.1 minutes, respectively (P < 0.01). Among 158 IPMNs, 33 lesions were malignant. The aMRI-BH presented a sensitivity of 100% and a negative predictive value of 100% for evaluating malignant IPMNs in both readers, with substantial interreader agreements (intraclass correlation or к values, range: 0.73-0.93 for cMRI and 0.57-0.94 for aMRI-BH) in significant imaging features based on revised Fukuoka guidelines, except for thickened cyst walls and lymphadenopathy (к values: 0.10 and 1.00 for cMRI and 0.13 and 0.49 for aMRI-BH, respectively).
The aMRI-BH provided high sensitivity and negative predictive value to evaluate malignant IPMNs by using predetermined criteria, and aMRI-BH might be a potential tool for pancreatic IPMN surveillance with significantly lower acquisition time.
确定使用呼吸门控三维磁共振胰胆管成像（3D-MRCP）（aMRI-BH）进行胰腺导管内乳头状黏液性肿瘤（IPMN）监测的缩短磁共振成像（MRI）的临床可行性。
本回顾性研究纳入了 123 例接受包括对比增强胰胆管 MRI 加常规和 BH-3D-MRCP 的常规 MRI（cMRI）的胰腺 IPMN 患者（经病理证实[n=73]和具有≥2 年稳定性的典型影像学特征[n=85]）。两位读者独立评估了由重 T2 加权、预对比 T1 加权和 BH-3D-MRCP 序列组成的 aMRI-BH 方案。使用以下标准评估 aMRI-BH 检测恶性 IPMN 的诊断性能：类别 3，存在 5mm 或更大的壁结节和/或 10mm 或更大的主胰管（MPD）；类别 2，存在以下一种或多种情况：囊肿大小 30mm 或更大、壁结节小于 5mm、囊壁增厚、MPD 为 5 至 9mm、淋巴结病和远端萎缩的 MPD 口径突然变化；类别 1，不存在上述任何一种情况。类别 2 或 3 被认为是监测的阳性结果。通过组内相关系数和κ 统计分析读者间对图像特征的一致性。
cMRI 和 aMRI-BH 的总采集时间分别为 32.7±8 和 5.5±2.1 分钟（P<0.01）。在 158 个 IPMN 中，33 个病变为恶性。两位读者的 aMRI-BH 对评估恶性 IPMN 的敏感性均为 100%，阴性预测值均为 100%，基于修订后的福冈指南，除了囊壁增厚和淋巴结病（cMRI 的κ 值为 0.10 和 1.00，aMRI-BH 的κ 值为 0.13 和 0.49）外，在显著的影像学特征方面具有显著的读者间一致性（组内相关系数或κ 值范围：cMRI 为 0.73-0.93，aMRI-BH 为 0.57-0.94）。
使用预定标准，aMRI-BH 对恶性 IPMN 具有较高的敏感性和阴性预测值，aMRI-BH 可能是一种具有显著较低采集时间的胰腺 IPMN 监测的潜在工具。
