European Radiology

, Volume 25, Issue 5, pp 1329–1338 | Cite as

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

  • 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
Gastrointestinal
First Online:
Received:
Revised:
Accepted:

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.

Keywords

IPMN CT MRI Pancreatic cancer Intraductal papillary mucinous neoplasm 
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Notes

Acknowledgments

The scientific guarantor of this publication is Dr. med. Christian Grieser. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (I. Steffen,) has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Thula Cannon Walter
    • 1
  • Ingo G. Steffen
    • 1
  • Lars H. Stelter
    • 1
  • Martin H. Maurer
    • 4
  • Marcus Bahra
    • 2
  • Wladimir Faber
    • 2
  • Fritz Klein
    • 2
  • Hendrik Bläker
    • 3
  • Bernd Hamm
    • 1
  • Timm Denecke
    • 1
  • Christian Grieser
    • 1
  1. 1.Klinik für Radiologie, Campus Virchow-KlinikumCharité – Universitätsmedizin BerlinBerlinGermany
  2. 2.Klinik für Allgemein-, Viszeral- und Transplantationschirurgie Campus Virchow-KlinikumCharité – Universitätsmedizin BerlinBerlinGermany
  3. 3.Institut für Pathologie, Campus Charité MitteCharité – Universitätsmedizin BerlinBerlinGermany
  4. 4.Universitätsinstitut für Radiologe, InselspitalUniversitätsklinik BernBernSchweiz

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