Department of Radiology, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
Eur Radiol. 2020 Jul;30(7):3711-3722. doi: 10.1007/s00330-020-06736-6. Epub 2020 Feb 24.
To clarify the pre-operative imaging and clinical features differentiating malignant from benign intraductal papillary mucinous neoplasm (IPMN) of the pancreas and develop a nomogram for estimating the individualized risk of malignant IPMN.
One hundred twenty-six patients with IPMN (72 benign and 54 malignant) who underwent pre-operative contrast-enhanced CT or MRI from 2010 to 2018 were retrospectively evaluated in two tertiary institutions. All lesions were pathologically proven by surgery or biopsy. Significant imaging and clinical findings for malignancy were assessed by univariate and multivariable logistic regression analyses. Based on the significant variables in the multivariable analysis, we developed a nomogram to predict malignant potential in patients with IPMNs, and the area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic value.
Multivariable analysis revealed that enhancing mural nodule ≥ 5 mm (odds ratio (OR), 48.30; 95% confidence interval (CI), 11.69-199.49), increased serum carbohydrate antigen 19-9 (CA19-9) (OR, 8.69; 95% CI, 2.04-36.92), main pancreatic duct (MPD) diameter ≥ 10 mm (OR, 6.34; 95% CI, 1.21-33.30), and acute pancreatitis (OR, 4.77; 95% CI, 1.12-20.36) were independent significant parameters to predict malignant IPMN. Among them, enhancing mural nodule ≥ 5 mm showed the highest OR and predictor point on the nomogram. The AUC for the nomogram was 0.955 (95% CI, 0.903-0.984).
Pre-operative imaging findings could aid in predicting malignant potential of IPMN using the significant findings of enhancing mural nodule ≥ 5 mm, increased serum CA19-9, MPD diameter ≥ 10 mm, and acute pancreatitis.
• Among pre-operative imaging and clinical features, enhancing mural nodule ≥ 5 mm, increased serum CA19-9, main pancreatic duct diameter ≥ 10 mm, and acute pancreatitis were independent significant parameters to predict malignant IPMN. • Enhancing mural nodule ≥ 5 mm was a single predictor for malignant IPMN, with the highest diagnostic values compared to other significant parameters. • A constructed nomogram using these parameters could aid in predicting malignant potential in patients with IPMN of the pancreas.
阐明区分胰腺良恶性导管内乳头状黏液性肿瘤（IPMN）的术前影像学和临床特征，并制定一个列线图来估计恶性 IPMN 的个体化风险。
回顾性分析 2010 年至 2018 年在两家三级医疗机构接受术前增强 CT 或 MRI 检查的 126 例 IPMN 患者（72 例良性和 54 例恶性）。所有病变均经手术或活检证实为病理。采用单因素和多因素逻辑回归分析评估恶性的显著影像学和临床特征。基于多变量分析中的显著变量，我们开发了一个列线图来预测 IPMN 患者的恶性潜能，并用受试者工作特征曲线下面积（AUC）评估诊断价值。
多因素分析显示，增强壁结节≥5mm（优势比（OR），48.30；95%置信区间（CI），11.69-199.49）、血清糖类抗原 19-9（CA19-9）升高（OR，8.69；95%CI，2.04-36.92）、主胰管（MPD）直径≥10mm（OR，6.34；95%CI，1.21-33.30）和急性胰腺炎（OR，4.77；95%CI，1.12-20.36）是预测恶性 IPMN 的独立显著参数。其中，增强壁结节≥5mm 在列线图上具有最高的 OR 和预测点。该列线图的 AUC 为 0.955（95%CI，0.903-0.984）。
术前影像学表现可通过增强壁结节≥5mm、血清 CA19-9 升高、MPD 直径≥10mm 和急性胰腺炎等显著发现来帮助预测 IPMN 的恶性潜能。
在术前影像学和临床特征中，增强壁结节≥5mm、血清 CA19-9 升高、主胰管直径≥10mm 和急性胰腺炎是预测恶性 IPMN 的独立显著参数。
增强壁结节≥5mm 是恶性 IPMN 的单一预测指标，与其他显著参数相比，具有最高的诊断价值。
使用这些参数构建的列线图可帮助预测胰腺 IPMN 的恶性潜能。
