Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, South Korea.
Eur Radiol. 2021 May;31(5):3394-3404. doi: 10.1007/s00330-020-07425-0. Epub 2020 Nov 2.
To investigate the utility of MR findings and texture analysis for predicting the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs).
Two hundred forty-eight patients with surgically confirmed IPMNs (106 malignant [invasive carcinoma/high-grade dysplasia] and 142 benign [low/intermediate-grade dysplasia]) and who underwent magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) were included. Two reviewers independently analyzed MR findings as proposed by the 2017 international consensus guidelines. Texture analysis of MRCP was also performed. A multivariate logistic regression analysis was used to identify predictors for malignant IPMNs. Diagnostic performance was also analyzed using receiver operating curve analysis.
Among MR findings, enhancing mural nodule size ≥ 5 mm, main pancreatic duct (MPD) ≥ 10 mm or MPD of 5 to 9 mm, and abrupt change of MPD were significant predictors for malignant IPMNs (p < 0.05). Among texture variables, significant predictors were effective diameter, surface area, sphericity, compactness, entropy, and gray-level co-occurrence matrix entropy (p < 0.05). At multivariate analysis, enhancing mural nodule ≥ 5 mm (odds ratios (ORs), 6.697 and 6.968, for reviewers 1 and 2, respectively), MPD ≥ 10 mm or MPD of 5 to 9 mm (ORs, 4.098 and 4.215, and 2.517 and 3.055, respectively), larger entropy (ORs, 1.485 and 1.515), and smaller compactness (ORs, 0.981 and 0.977) were significant predictors for malignant IPMNs (p < 0.05). When adding texture variable to MR findings, diagnostic performance for predicting malignant IPMNs improved from 0.80 and 0.78 to 0.85 and 0.85 in both reviewers (p < 0.05), respectively.
MRCP-derived texture features are useful for predicting malignant IPMNs, and the addition of texture analysis to MR features may improve diagnostic performance for predicting malignant IPMNs.
• Among the MR imaging findings, an enhancing mural nodule size ≥ 5 mm and dilated main pancreatic ducts are independent predictors for malignant IPMNs. • Greater entropy and smaller compactness on MR texture analysis are independent predictors for malignant IPMNs. • The addition of MR texture analysis improved the diagnostic performance for predicting malignant IPMNs from 0.80 and 0.78 to 0.85 and 0.85, respectively.
探讨磁共振成像（MRI）表现和纹理分析在预测胰腺导管内乳头状黏液性肿瘤（IPMNs）恶性潜能中的应用价值。
纳入 248 例经手术证实的 IPMNs 患者（106 例恶性[浸润性癌/高级别异型增生]和 142 例良性[低/中级别异型增生]），这些患者均接受了 MRI 检查，包括磁共振胰胆管成像（MRCP）。两名审阅者独立分析了 2017 年国际共识指南提出的 MRI 表现。还对 MRCP 的纹理分析进行了分析。采用多变量逻辑回归分析来识别恶性 IPMNs 的预测因子。并使用受试者工作特征曲线分析评估诊断性能。
在 MRI 表现中，增强性壁结节大小≥5mm、主胰管（MPD）≥10mm 或 MPD 为 5 至 9mm 以及 MPD 突然变化是恶性 IPMNs 的显著预测因子（p<0.05）。在纹理变量中，显著预测因子为有效直径、表面积、球形度、紧致度、熵和灰度共生矩阵熵（p<0.05）。多变量分析显示，增强性壁结节≥5mm（审阅者 1 和 2 的比值比（ORs）分别为 6.697 和 6.968）、MPD≥10mm 或 MPD 为 5 至 9mm（ORs 分别为 4.098 和 4.215，2.517 和 3.055）、较大的熵（ORs 分别为 1.485 和 1.515）和较小的紧致度（ORs 分别为 0.981 和 0.977）是恶性 IPMNs 的显著预测因子（p<0.05）。当将纹理变量添加到 MRI 表现中时，预测恶性 IPMNs 的诊断性能从审阅者 1 和 2 的 0.80 和 0.78 分别提高到 0.85 和 0.85（p<0.05）。
MRCP 衍生的纹理特征有助于预测恶性 IPMNs，将纹理分析添加到 MRI 特征中可能会提高预测恶性 IPMNs 的诊断性能。
