Jeong Daniel, Morse Brian, Polk Stuart Lane, Chen Dung-Tsa, Li Jiannong, Hodul Pamela, Centeno Barbara A, Costello James, Jiang Kun, Machado Sebastian, El Naqa Issam, Farah Paola T, Huynh Tri, Raghunand Natarajan, Mok Shaffer, Dam Aamir, Malafa Mokenge, Qayyum Aliya, Fleming Jason B, Permuth Jennifer B
Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA.
Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 3011 Holly Drive, Tampa, FL 33612, USA.
Cancers (Basel). 2024 Jan 1;16(1):206. doi: 10.3390/cancers16010206.
While multiple cyst features are evaluated for stratifying pancreatic intraductal papillary mucinous neoplasms (IPMN), cyst size is an important factor that can influence treatment strategies. When magnetic resonance imaging (MRI) is used to evaluate IPMNs, no universally accepted sequence provides optimal size measurements. T2-weighted coronal/axial have been suggested as primary measurement sequences; however, it remains unknown how well these and maximum all-sequence diameter measurements correlate with pathology size. This study aims to compare agreement and bias between IPMN long-axis measurements on seven commonly obtained MRI sequences with pathologic size measurements.
This retrospective cohort included surgically resected IPMN cases with preoperative MRI exams. Long-axis diameter tumor measurements and the presence of worrisome features and/orhigh-risk stigmata were noted on all seven MRI sequences. MRI size and pathology agreement and MRI inter-observer agreement involved concordance correlation coefficient (CCC) and intraclass correlation coefficient (ICC), respectively. The presence of worrisome features and high-risk stigmata were compared to the tumor grade using kappa analysis. The Bland-Altman analysis assessed the systematic bias between MRI-size and pathology.
In 52 patients (age 68 ± 13 years, 22 males), MRI sequences produced mean long-axis tumor measurements from 2.45-2.65 cm. The maximum MRI lesion size had a strong agreement with pathology (CCC = 0.82 (95% CI: 0.71-0.89)). The maximum IPMN size was typically observed on the axial T1 arterial post-contrast and MRCP coronal series and overestimated size versus pathology with bias +0.34 cm. The radiologist interobserver agreement reached ICCs 0.74 to 0.91 on the MRI sequences.
The maximum MRI IPMN size strongly correlated with but tended to overestimate the length compared to the pathology, potentially related to formalin tissue shrinkage during tissue processing.
在对胰腺导管内乳头状黏液性肿瘤（IPMN）进行分层评估时，需考量多个囊肿特征，其中囊肿大小是影响治疗策略的重要因素。当运用磁共振成像（MRI）评估IPMN时，尚无普遍认可的序列能提供最佳的大小测量值。有人建议采用T2加权冠状/轴位作为主要测量序列；然而，这些序列以及所有序列的最大直径测量值与病理大小的相关性究竟如何，仍不清楚。本研究旨在比较7种常用MRI序列上IPMN长轴测量值与病理大小测量值之间的一致性和偏差。
本回顾性队列研究纳入了接受手术切除且术前行MRI检查的IPMN病例。记录了所有7种MRI序列上肿瘤的长轴直径测量值以及是否存在可疑特征和/或高危征象。MRI大小与病理的一致性以及MRI观察者间的一致性分别采用一致性相关系数（CCC）和组内相关系数（ICC）进行评估。使用kappa分析比较可疑特征和高危征象的存在情况与肿瘤分级。Bland-Altman分析评估MRI大小与病理之间的系统偏差。
52例患者（年龄68±13岁，男性22例），MRI序列测得的肿瘤平均长轴测量值为2.45 - 2.65 cm。MRI最大病变大小与病理结果具有高度一致性（CCC = 0.82（95%CI：0.71 - 0.89））。IPMN最大大小通常在轴位T1加权动脉期增强扫描和MRCP冠状位序列上观察到，与病理结果相比，大小被高估，偏差为 +0.34 cm。放射科医生在MRI序列上的观察者间一致性ICC值为0.74至0.91。
MRI测得的IPMN最大大小与病理结果高度相关，但与病理长度相比往往高估，这可能与组织处理过程中福尔马林导致的组织收缩有关。
