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01.05.2015 | Gastrointestinal

Implications of Imaging Criteria for the Management and Treatment of Intraductal Papillary Mucinous Neoplasms – Benign versus Malignant Findings

verfasst von: Thula Cannon Walter, Ingo G. Steffen, Lars H. Stelter, Martin H. Maurer, Marcus Bahra, Wladimir Faber, Fritz Klein, Hendrik Bläker, Bernd Hamm, Timm Denecke, Christian Grieser

Erschienen in: European Radiology | Ausgabe 5/2015

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Abstract

Objectives

Evaluation of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiation of pancreatic intraductal papillary mucinous neoplasm (IPMN) subtypes based on objective imaging criteria.

Methods

Fifty-eight patients with 60 histologically confirmed IPMNs were included in this retrospective study. Eighty-three imaging studies (CT,n = 42; MRI,n = 41) were analysed by three independent blinded observers (O1–O3), using established imaging criteria to assess likelihood of malignancy (−5, very likely benign; 5, very likely malignant) and histological subtype (i.e., low-grade (LGD), moderate-grade (MGD), high-grade dysplasia (HGD), early invasive carcinoma (IPMC), solid carcinoma (CA) arising from IPMN).

Results

Forty-one benign (LGD IPMN,n = 20; MGD IPMN,n = 21) and 19 malignant (HGD IPMN,n = 3; IPMC,n = 6; solid CA,n = 10) IPMNs located in the main duct (n = 6), branch duct (n = 37), or both (n = 17) were evaluated. Overall accuracy of differentiation between benign and malignant IPMNs was 86/92 % (CT/MRI). Exclusion of overtly malignant cases (solid CA) resulted in overall accuracy of 83/90 % (CT/MRI). The presence of mural nodules and ductal lesion size ≥30 mm were significant indicators of malignancy (p = 0.02 and p < 0.001, respectively).

Conclusions

Invasive IPMN can be identified with high confidence and sensitivity using CT and MRI. The diagnostic problem that remains is the accurate radiological differentiation of premalignant and non-invasive subtypes.

Key Points

• CT and MRI can differentiate benign from malignant forms of IPMN.

• Identifying (pre)malignant histological IPMN subtypes by CT and MRI is difficult.

• Overall, diagnostic performance with MRI was slightly (not significantly) superior to CT.

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Titel: Implications of Imaging Criteria for the Management and Treatment of Intraductal Papillary Mucinous Neoplasms – Benign versus Malignant Findings
verfasst von: Thula Cannon Walter
Ingo G. Steffen
Lars H. Stelter
Martin H. Maurer
Marcus Bahra
Wladimir Faber
Fritz Klein
Hendrik Bläker
Bernd Hamm
Timm Denecke
Christian Grieser
Publikationsdatum: 01.05.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 5/2015
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3520-3

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Implications of Imaging Criteria for the Management and Treatment of Intraductal Papillary Mucinous Neoplasms – Benign versus Malignant Findings

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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Abstract

Objectives

Methods

Results

Conclusions

Key Points

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