nach oben

Erschienen in:

10.08.2021 | Magnetic Resonance

MRI is useful to suggest and exclude malignancy in mucinous cystic neoplasms of the pancreas

verfasst von: Marie-Pierre Vullierme, Jules Gregory, Vinciane Rebours, Jerome Cros, Yasser Abelhady-Attia, Valerie Vilgrain, Lina Aguilera-Munoz, Lucie Laurent, Philippe Levy, Alain Sauvanet, Maxime Ronot

Erschienen in: European Radiology | Ausgabe 2/2022

Einloggen, um Zugang zu erhalten

Abstract

Objectives

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.

Methods

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).

Results

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%).

Conclusions

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.

Key Points

• 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.

Nur mit Berechtigung zugänglich

Nagtegaal ID, Odze RD, Klimstra D et al (2020) The 2019 WHO classification of tumours of the digestive system. Histopathology 76:182–188CrossRef

Zamboni G, Scarpa A, Bogina G et al (1999) Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 23:410–422CrossRef

Nilsson LN, Keane MG, Shamali A et al (2016) Nature and management of pancreatic mucinous cystic neoplasm (MCN): a systematic review of the literature. Pancreatology 16:1028–1036CrossRef

Hui L, Rashid A, Foo WC et al (2018) Significance of T1a and T1b carcinoma arising in mucinous cystic neoplasm of pancreas. Am J Surg Pathol 42:578CrossRef

O'Toole D, Palazzo L, Hammel P et al (2004) Macrocystic pancreatic cystadenoma: the role of EUS and cyst fluid analysis in distinguishing mucinous and serous lesions. Gastrointest Endosc 59:823–829CrossRef

Cizginer S, Turner B, Bilge AR, Karaca C, Pitman MB, Brugge WR (2011) Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas 40:1024–1028CrossRef

Zhong N, Zhang L, Takahashi N et al (2012) Histologic and imaging features of mural nodules in mucinous pancreatic cysts. Clin Gastroenterol Hepatol 10:192–198. e192CrossRef

Genevay M, Mino-Kenudson M, Yaeger K et al (2011) Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts. Ann Surg 254

The European Study Group on Cystic Tumours of the Pancreas (2018) European evidence-based guidelines on pancreatic cystic neoplasms. Gut 67:789–804

10.

Park JW, Jang J-Y, Kang MJ, Kwon W, Chang YR, Kim S-W (2014) Mucinous cystic neoplasm of the pancreas: is surgical resection recommended for all surgically fit patients? Pancreatology 14:131–136CrossRef

11.

Crippa S, Salvia R, Warshaw AL et al (2008) Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg 247:571CrossRef

12.

Yamao K, Yanagisawa A, Takahashi K et al (2011) Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan Pancreas Society. Pancreas 40:67–71CrossRef

13.

Kosmahl M, Egawa N, Schröder S, Carneiro F, Lüttges J, Klöppel G (2002) Mucinous nonneoplastic cyst of the pancreas: a novel nonneoplastic cystic change? Mod Pathol 15:154–158CrossRef

14.

Jais B, Rebours V, Malleo G et al (2016) Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). Gut 65(2):305–312CrossRef

15.

Le Baleur Y, Couvelard A, Vullierme MP et al (2011) Mucinous cystic neoplasms of the pancreas: definition of preoperative imaging criteria for high-risk lesions. Pancreatology 11:495–499CrossRef

16.

Di Paola V, Manfredi R, Mehrabi S et al (2016) Pancreatic mucinous cystoadenomas and cystoadenocarcinomas: differential diagnosis by means of MRI. Br J Radiol 89:20150536CrossRef

17.

Falconi M, Mantovani W, Crippa S, Mascetta G, Salvia R, Pederzoli P (2008) Pancreatic insufficiency after different resections for benign tumours. Br J Surg 95:85–91CrossRef

18.

Regi P, Salvia R, Cena C, Girelli R, Frigerio I, Bassi C (2013) Cystic “feminine” pancreatic neoplasms in men. Do any clinical alterations correlate with these uncommon entities? Int J Surg 11:157–160CrossRef

19.

Procacci C, Carbognin G, Accordini S et al (2001) CT features of malignant mucinous cystic tumors of the pancreas. Eur Radiol 11:1626–1630CrossRef

20.

Garces-Descovich A, Beker K, Castillo-Angeles M et al (2018) Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation. Abdom Radiol (NY) 43:1413–1422CrossRef

21.

Postlewait LM, Ethun CG, McInnis MR et al (2017) Association of preoperative risk factors with malignancy in pancreatic mucinous cystic neoplasms: a multicenter study. JAMA Surg 152:19–25CrossRef

22.

Keane MG, Shamali A, Nilsson LN et al (2018) Risk of malignancy in resected pancreatic mucinous cystic neoplasms. Br J Surg 105:439–446CrossRef

23.

Goh BK, Tan Y-M, Chung Y-FA et al (2006) A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg 30:2236–2245CrossRef

24.

Manfredi R, Ventriglia A, Mantovani W et al (2015) Mucinous cystic neoplasms and serous cystadenomas arising in the body-tail of the pancreas: MR imaging characterization. Eur Radiol 25:940–949CrossRef

25.

Mamone G, Barresi L, Tropea A, Di Piazza A, Miraglia R (2020) MRI of mucinous pancreatic cystic lesions: a new updated morphological approach for the differential diagnosis. Updates Surg 72:617–637CrossRef

Titel: MRI is useful to suggest and exclude malignancy in mucinous cystic neoplasms of the pancreas
verfasst von: Marie-Pierre Vullierme
Jules Gregory
Vinciane Rebours
Jerome Cros
Yasser Abelhady-Attia
Valerie Vilgrain
Lina Aguilera-Munoz
Lucie Laurent
Philippe Levy
Alain Sauvanet
Maxime Ronot
Publikationsdatum: 10.08.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 2/2022
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-021-08091-6

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

MRI is useful to suggest and exclude malignancy in mucinous cystic neoplasms of the pancreas