Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Radiology, Beaujon University Hospital, 100 bd general Leclerc, 92110, Clichy, France.
Université Paris Diderot-Paris 7, Université de Paris, F-75018, Paris, France.
Eur Radiol. 2022 Feb;32(2):1297-1307. doi: 10.1007/s00330-021-08091-6. Epub 2021 Aug 10.
To evaluate the value of MRI in differentiating benign (b-MCN) and malignant (m-MCN) MCN. European guidelines suggest that certain mucinous cystic neoplasms (MCN) of the pancreas can be conservatively managed.
A retrospective single-center study of consecutive patients with resected MCN. MRIs were independently reviewed by two readers blinded to the pathological results. The authors compared b-MCN (i.e., mucinous-cystadenoma comprising high-grade dysplasia (HGD)) and m-MCN (i.e., cystadenocarcinoma).
Sixty-three patients (62 women [98%]) with 63 MCN (6 m-MCN, 2 HGD) were included. m-MCN tumors had a tendency to be larger than b-MCN (median 86 [25-103] vs. 45 [17-130] mm, p = .055). The combination of signal heterogeneity on T2-weighted imaging, wall thickness ≥ 5 mm, the presence of mural nodules ≥ 9 mm, and enhancing septa had an area under the ROC curve of 0.97 (95% CI 0.91-1.00) for the diagnosis of m-MCN. A total of 24 (37%), 20 (32%), 10 (16%), 5 (8%), and 4 (6%) out of 63 MCNs showed 0, 1, 2, 3, and 4 of these features, respectively. The corresponding rate of m-MCN was 0%, 0%, 10%, 20%, and 100%, respectively, with a good-to-excellent inter-reader agreement. Patterns with a high NPV for m-MCN included an absence of enhancing septa or walls (NPV 97% and 100%, respectively), wall thickness < 3 mm (NPV 100%), and no mural nodules (NPV 100%).
A combination of 4 imaging features suggests malignant MCN on MRI. On the other hand, visualization of a thin non-enhancing wall with no mural nodules suggests benign MCN.
• A heterogenous signal on T2-weighted MRI, a ≥ 5-mm-thick wall, mural nodules ≥ 9 mm, and/or enhancing septa suggest malignant MCNs. • A thin non-enhancing wall with no mural nodules suggests benign MCNs. • MRI should be performed in the pre-therapeutic evaluation of MCN to help determine the therapeutic strategy in these patients.
评估 MRI 鉴别良性（b-MCN）和恶性（m-MCN）黏液性囊性肿瘤（MCN）的价值。欧洲指南建议某些胰腺黏液性囊性肿瘤（MCN）可以保守治疗。
这是一项回顾性的单中心研究，纳入了接受 MCN 切除术的连续患者。两位读者独立对 MRI 进行了回顾，他们对病理结果不知情。作者比较了 b-MCN（即高等级异型增生的黏液性囊腺瘤（HGD））和 m-MCN（即囊腺癌）。
共纳入 63 例患者（62 例女性[98%]），共 63 例 MCN（6 例 m-MCN，2 例 HGD）。m-MCN 肿瘤的大小倾向于大于 b-MCN（中位数 86[25-103] vs. 45[17-130]mm，p=0.055）。T2 加权成像信号不均匀、壁厚度≥5mm、壁结节≥9mm、强化分隔的联合特征对 m-MCN 的诊断具有 0.97 的 ROC 曲线下面积（95%CI 0.91-1.00）。63 例 MCN 中，分别有 24（37%）、20（32%）、10（16%）、5（8%）和 4（6%）例存在 0、1、2、3 和 4 个特征，相应的 m-MCN 发生率分别为 0%、0%、10%、20%和 100%，具有良好到极好的读者间一致性。对 m-MCN 具有高阴性预测值的模式包括无强化分隔或壁（NPV 分别为 97%和 100%）、壁厚度<3mm（NPV 为 100%）和无壁结节（NPV 为 100%）。
MRI 上 4 种成像特征联合提示 MCN 为恶性。另一方面，薄壁（<3mm）且无壁结节的 MCN 提示为良性。
T2 加权 MRI 信号不均匀、≥5mm 厚的壁、≥9mm 的壁结节和/或强化分隔提示恶性 MCN。
薄壁（<3mm）且无壁结节提示良性 MCN。
MRI 应在 MCN 的治疗前评估中进行，以帮助确定这些患者的治疗策略。
