Innocenti Tommaso, Danti Ginevra, Lynch Erica Nicola, Dragoni Gabriele, Gottin Matteo, Fedeli Filippo, Palatresi Daniele, Biagini Maria Rosa, Milani Stefano, Miele Vittorio, Galli Andrea
Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence 50134, Italy.
Emergency Radiology Unit, Department of Services, Careggi University Hospital, Florence 50134, Italy.
World J Clin Cases. 2022 Jun 16;10(17):5667-5679. doi: 10.12998/wjcc.v10.i17.5667.
Branch duct-intraductal papillary mucinous neoplasms (BD-IPMNs) are the most common pancreatic cystic tumours and have a low risk of malignant transformation. Current guidelines only evaluate cyst diameter as an important risk factor but it is not always easy to measure, especially when comparing different methods. On the other side, cyst volume is a new parameter with low inter-observer variability and is highly reproducible over time.
To assess both diameter and volume growth rate of BD-IPMNs and evaluate their correlation with the development of malignant characteristics.
Computed tomography scans and magnetic resonance imaging exams were retrospectively reviewed. The diameter was measured on three planes, while the volume was calculated by segmentation: The volume of the entire cyst was determined by manually drawing a region of interest along the edge of the neoplasm on each consecutive slice covering the whole lesion; therefore, a three-dimensional volume of interest was finally obtained with the calculated value expressed in cm. Changes in size over time were measured. The development of worrisome features was evaluated.
We evaluated exams of 98 patients across a 40.5-mo median follow-up time. Ten patients developed worrisome features. Cysts at baseline were significantly larger in patients who developed worrisome features (diameters = 0.0035, = 0.00652, = 0.00424; volume = 0.00222). Volume growth rate was significantly higher in patients who developed worrisome features (1.12 cm/year 0 cm/year, = 0.0001); diameter growth rate was higher as well, but the difference did not always reach statistical significance. Volume but not diameter growth rate in the first year of follow-up was higher in patients who developed worrisome features (0.46 cm/year 0 cm/year, = 0.00634).
The measurement of baseline volume and its variation over time is a reliable tool for the follow-up of BD-IPMNs. Volume measurement could be a better tool than diameter measurement to predict the development of worrisome features.
分支导管内乳头状黏液性肿瘤（BD-IPMN）是最常见的胰腺囊性肿瘤，恶变风险较低。目前的指南仅将囊肿直径作为重要的风险因素进行评估，但直径测量并不总是容易的，尤其是在比较不同测量方法时。另一方面，囊肿体积是一个新的参数，观察者间变异性低，且随时间高度可重复。
评估BD-IPMN的直径和体积增长率，并评估它们与恶性特征发展的相关性。
回顾性分析计算机断层扫描和磁共振成像检查。在三个平面上测量直径，通过分割计算体积：在覆盖整个病变的每个连续切片上，沿着肿瘤边缘手动绘制感兴趣区域来确定整个囊肿的体积；因此，最终获得一个三维感兴趣体积，计算值以厘米表示。测量随时间的大小变化。评估令人担忧的特征的发展情况。
我们评估了98例患者的检查，中位随访时间为40.5个月。10例患者出现了令人担忧的特征。出现令人担忧特征的患者基线时的囊肿明显更大（直径 = 0.0035， = 0.00652， = 0.00424；体积 = 0.00222）。出现令人担忧特征的患者体积增长率明显更高（1.12 cm/年 0 cm/年， = 0.0001）；直径增长率也更高，但差异并非总是具有统计学意义。出现令人担忧特征的患者在随访第一年的体积增长率而非直径增长率更高（0.46 cm/年 0 cm/年， = 0.00634）。
基线体积及其随时间的变化测量是BD-IPMN随访的可靠工具。体积测量可能是比直径测量更好的预测令人担忧特征发展的工具。
