Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol
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The study aims were to evaluate: (1) whether a short-protocol (SP) MRI for the surveillance of pancreatic cystic neoplasms (PCN) provides equivalent clinical information as a comprehensive-protocol (CP), and (2) the cost reduction from substituting CP with SP for patient surveillance.
This retrospective study included 154 consecutive patients (median age: 66, 52 % men) with working-diagnosis of PCN and available contrast-enhanced MRI/MRCP. Three radiologists evaluated independently two imaging sets (SP/CP) per patient. The CP included: T2-weighted (HASTE/MRCP), DWI and T1-weighted (chemical-shift/pre-/post-contrast) images [acquisition time (AT) ≈ 35 min], whereas the SP included: T2-weighted HASTE and T1-weighted pre-contrast images (AT ≈ 8 min). Mean values of largest cyst/main pancreatic duct diameter (DC/DMPD) were compared. Agreement regarding presence/absence of cystic/MPD mural nodules (MNC/MNMPD), inter-observer agreement and cost differences between SP/CP were calculated.
For DC and DMPD, mean values with SP/CP were 21.4/21.7 mm and 3.52/3.58 mm, while mean differences SP-CP were 0.3 mm (p = 0.02) and 0.06 mm (p = 0.12), respectively. For presence/absence of MNC and MNMPD, SP/CP coincided in 93 % and 98 % of cases, respectively. Inter-observer agreement was strong for SP/CP. SP-cost was 25 % of CP-cost.
For the surveillance of PCN, short-protocol MRI provides information equivalent to the more time-consuming and costly comprehensive-protocol.
• Pancreatic cystic neoplasms (PCN) are increasingly diagnosed in the general population.
• Multiple imaging controls are recommended for the surveillance of patients with PCN.
• Short and comprehensive MRI-protocols are equivalent for decision-making in PCN under surveillance.
• Evaluation of imaging risk factors in PCNs is comparable with both MRI-protocols.
• Use of the short MRI-protocol may rationalise healthcare resources.
KeywordsMagnetic Resonance Imaging Pancreas Cysts Neoplasms Interdisciplinary communication
Combined applications to reduce exposure
European experts consensus statement
Intraductal papillary mucinous neoplasm
Mucinous cystic neoplasm
Multidisciplinary tumour board
Maximum intensity projection
Main pancreatic duct
Nephrogenic systemic fibrosis
Pancreatic cystic neoplasm
Pancreatic ductal adenocarcinoma
Serous cystic neoplasm
The scientific guarantor of this publication is Nikolaos Kartalis. 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. The biostatistician Per Näsman (KTH Royal Institute of Technology, Stockholm, Sweden) kindly provided statistical advice for this manuscript. Region Ethics Review Board approval was obtained. Written informed consent was waived by the Region Ethics Review Board. Methodology:retrospective, observational, multicenter study.
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