Journal of Gastrointestinal Surgery

, Volume 12, Issue 1, pp 101–109

CT vs MRCP: Optimal Classification of IPMN Type and Extent

  • Joshua A. Waters
  • C. Max Schmidt
  • Jason W. Pinchot
  • Patrick B. White
  • Oscar W. Cummings
  • Henry A. Pitt
  • Kumar Sandrasegaran
  • Fatih Akisik
  • Thomas J. Howard
  • Attila Nakeeb
  • Nicholas J. Zyromski
  • Keith D. Lillemoe
AHPBA annual meeting

DOI: 10.1007/s11605-007-0367-9

Cite this article as:
Waters, J.A., Schmidt, C.M., Pinchot, J.W. et al. J Gastrointest Surg (2008) 12: 101. doi:10.1007/s11605-007-0367-9

Abstract

Introduction

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are being diagnosed with increased frequency. CT scanning commonly serves as the primary imaging modality before surgery. We hypothesized MRCP provides better characterization of IPMN type/extent, which more closely matches actual pathology.

Methods

Of 214 patients treated with IPMN (1991–2006), 30 had both preoperative CT and MRCP. Of these, 18 met imaging study criteria. Independent readers performed retrospective, blinded analyses using standardized criteria for IPMN type and extent.

Results

A ductal connection was detected on 73% of MRCP scans and only 18% of CT. IPMN type was classified differently in seven (39%); four (22%) of which were read on CT as having main duct involvement where this was not appreciated on MRCP or found on surgical pathology. MRCP showed multifocal disease in 13(72%) versus only 9(50%) on CT. A different disease distribution was seen in 9(50%). Finally, 101 branch lesions were identified on MRCP compared to 46 on CT.

Conclusions

CT falls short of MRCP in detecting a ductal connection, estimating main duct involvement, and identification of small branch duct cysts. These factors influence diagnostic accuracy, cancer risk stratification and operative strategy. MRCP should be employed for optimal management of patients with IPMN.

Keywords

Intraductal papillary mucinous neoplasm Magnetic resonance cholangiopancreatography Computed tomography 

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Joshua A. Waters
    • 1
  • C. Max Schmidt
    • 1
    • 2
    • 3
    • 4
    • 5
    • 8
    • 9
  • Jason W. Pinchot
    • 6
  • Patrick B. White
    • 1
  • Oscar W. Cummings
    • 7
  • Henry A. Pitt
    • 1
    • 3
  • Kumar Sandrasegaran
    • 6
  • Fatih Akisik
    • 6
  • Thomas J. Howard
    • 1
    • 3
  • Attila Nakeeb
    • 1
    • 3
  • Nicholas J. Zyromski
    • 1
  • Keith D. Lillemoe
    • 1
    • 3
  1. 1.Department of SurgeryIndiana University School of MedicineIndianapolisUSA
  2. 2.Biochemistry/Molecular BiologyIndiana University School of MedicineIndianapolisUSA
  3. 3.Indiana University Cancer CenterIndianapolisUSA
  4. 4.Walther Oncology CenterIndianapolisUSA
  5. 5.Richard L. Roudebush Veterans Affairs Medical CenterIndianapolisUSA
  6. 6.Department of RadiologyIndiana University School of MedicineIndianapolisUSA
  7. 7.Department of PathologyIndiana University School of MedicineIndianapolisUSA
  8. 8.Department of SurgeryCancer Research InstituteIndianapolisUSA
  9. 9.Department of Biochemistry and Molecular BiologyCancer Research InstituteIndianapolisUSA