Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Mathematics, Ajou University, Suwon, Republic of Korea.
Eur Radiol. 2021 Jul;31(7):4774-4784. doi: 10.1007/s00330-020-07583-1. Epub 2021 Jan 6.
To assess the diagnostic performance of the 2017 international consensus guidelines for intraductal papillary mucinous neoplasm (IPMN) of the pancreas and to compare the diagnostic performance and intermodality agreement between contrast-enhanced CT and MRI.
We retrospectively evaluated patients with surgical resection of IPMN of the pancreas who underwent preoperative CT and MRI between 2009 and 2019. Two radiologists evaluated the clinical and imaging features of IPMN of pancreas according to the 2017 international consensus guideline. Univariable and multivariable analyses were performed to identify significant predictors of malignancy in IPMN. The diagnostic abilities of CT and MRI were compared, and their intermodality agreement was determined.
Of 175 patients (mean age, 64 years; 116 males), 88 (50.3%) had malignant IPMN. On multivariable analysis, all three high-risk stigmata (main pancreatic duct [MPD] ≥ 10 mm, mural nodule ≥ 5 mm, and obstructive jaundice) and two worrisome features (MPD 5-9 mm and elevated carbohydrate antigen 19-9) were associated with malignant IPMN on CT and MRI (p < 0.05). A mural nodule < 5 mm on MRI was also associated with malignant IPMN (OR 5.3, p = 0.009). The diagnostic accuracy of high-risk stigmata showed no difference between CT and MRI (73.7% vs. 75.4%, p = 0.505), with good to excellent intermodality agreement.
Current high-risk stigmata had the strongest association with malignant IPMN on CT and MRI. Although MRI is superior to CT for identifying mural nodules, diagnostic performance for differentiating malignant from benign IPMNs was similar between CT and MRI.
• The current high-risk stigmata in the 2017 International Consensus Guidelines had the strongest association with malignant IPMN on CT and MRI. • MRI is better than CT for identifying enhancing mural nodule. • Diagnostic performance for differentiating malignant from benign IPMNs was similar between CT and MRI.
评估 2017 年国际胰腺导管内乳头状黏液性肿瘤（IPMN）共识指南的诊断性能，并比较增强 CT 和 MRI 之间的诊断性能和模态间一致性。
我们回顾性评估了 2009 年至 2019 年间接受术前 CT 和 MRI 检查并接受胰腺 IPMN 切除术的患者。两名放射科医生根据 2017 年国际共识指南评估胰腺 IPMN 的临床和影像学特征。进行单变量和多变量分析以确定 IPMN 恶性的显著预测因素。比较 CT 和 MRI 的诊断能力，并确定其模态间一致性。
在 175 例患者（平均年龄 64 岁，男性 116 例）中，88 例（50.3%）为恶性 IPMN。多变量分析显示，所有三种高危特征（主胰管[MPD]≥10mm、壁结节≥5mm 和阻塞性黄疸）和两种令人担忧的特征（MPD 5-9mm 和升高的糖链抗原 19-9）与 CT 和 MRI 上的恶性 IPMN 相关（p<0.05）。MRI 上的壁结节<5mm 也与恶性 IPMN 相关（OR 5.3，p=0.009）。高危特征的诊断准确性在 CT 和 MRI 之间无差异（73.7%对 75.4%，p=0.505），模态间具有良好到极好的一致性。
目前的高危特征与 CT 和 MRI 上的恶性 IPMN 相关性最强。尽管 MRI 优于 CT 识别壁结节，但 CT 和 MRI 对鉴别良恶性 IPMN 的诊断性能相似。
