Kim Dong Wook, Koo Boyeon, Byun Jae Ho, Song In Hye, Lee Hwajin, Kim Jin Hee, Lee Seung Soo, Kim Hyoung Jung, Song Ki Byung, Lee Jae Hoon, Hwang Dae Wook
University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea.
Abdom Radiol (NY). 2025 Jan 25. doi: 10.1007/s00261-025-04801-6.
To evaluate the measurement of main pancreatic duct (MPD) diameter on MRI for predicting MPD involvement in intraductal papillary mucinous neoplasms (IPMN).
This retrospective study included 595 patients with surgically confirmed IPMN who underwent preoperative MRI from 2015 to 2022. Three independent readers measured the maximum MPD diameter on two-dimensional axial and coronal T2-weighted imaging. Inter-plane and inter-reader agreements were assessed using the intraclass correlation coefficient (ICC). Multivariable logistic regression identified clinical and radiological factors associated with MPD involvement. Accuracy, sensitivity, and specificity of MPD diameter cutoffs, including the 5-mm threshold from the 2024 International Consensus Guidelines, were calculated.
Of the 595 patients (mean age: 64.6 years ± 8.6, 394 men), 423 (71.1%) had IPMN with MPD involvement, whereas 172 (28.9%) did not have MPD involvement. The mean maximum MPD diameter was 7.9 ± 5.1 mm. Inter-plane agreement was excellent (ICC = 0.977-0.988), as was inter-reader agreement (ICC = 0.963). Only a large MPD diameter on MRI was independently associated with MPD involvement (odds ratio = 1.29 [95% confidence interval; 1.14-1.47], p <.01). Use of a maximum MPD diameter cutoff of ≥ 5 mm for MPD involvement yielded accuracy, sensitivity, and specificity of 76.0%, 79.2%, and 68.0%, respectively.
Despite excellent inter-plane and inter-reader agreement, the MRI-based prediction of MPD involvement in IPMN has limitations.
评估磁共振成像（MRI）测量主胰管（MPD）直径对预测导管内乳头状黏液性肿瘤（IPMN）中MPD受累情况的价值。
这项回顾性研究纳入了595例经手术确诊的IPMN患者，这些患者在2015年至2022年期间接受了术前MRI检查。三位独立阅片者在二维轴向和冠状位T2加权成像上测量MPD的最大直径。使用组内相关系数（ICC）评估层面间和阅片者间的一致性。多变量逻辑回归分析确定与MPD受累相关的临床和影像学因素。计算MPD直径截断值的准确性、敏感性和特异性，包括来自2024年国际共识指南的5毫米阈值。
595例患者（平均年龄：64.6岁±8.6，394例男性）中，423例（71.1%）的IPMN累及MPD，而172例（28.9%）未累及MPD。MPD的平均最大直径为7.9±5.1毫米。层面间一致性极佳（ICC = 0.977 - 0.988），阅片者间一致性也极佳（ICC = 0.963）。MRI上仅MPD直径增大与MPD受累独立相关（比值比 = 1.29 [95%置信区间；1.14 - 1.47]，p <.01）。使用≥5毫米的MPD最大直径截断值来判断MPD受累，其准确性、敏感性和特异性分别为76.0%、79.2%和68.0%。
尽管层面间和阅片者间一致性良好，但基于MRI预测IPMN中MPD受累仍存在局限性。
