Advertisement

European Radiology

, Volume 27, Issue 1, pp 41–50 | Cite as

Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol

  • Raffaella Maria Pozzi-Mucelli
  • Irina Rinta-Kiikka
  • Katharina Wünsche
  • Johanna Laukkarinen
  • Knut Jørgen Labori
  • Kim Ånonsen
  • Caroline Verbeke
  • Marco Del Chiaro
  • Nikolaos Kartalis
Hepatobiliary-Pancreas

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

For the surveillance of PCN, short-protocol MRI provides information equivalent to the more time-consuming and costly comprehensive-protocol.

Key Points

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.

Keywords

Magnetic Resonance Imaging Pancreas Cysts Neoplasms Interdisciplinary communication 

Abbreviations

AT

Acquisition time

BD

Branch duct

CARE

Combined applications to reduce exposure

EECS

European experts consensus statement

IPMN

Intraductal papillary mucinous neoplasm

MCN

Mucinous cystic neoplasm

MDT

Multidisciplinary tumour board

MIP

Maximum intensity projection

MPD

Main pancreatic duct

NSF

Nephrogenic systemic fibrosis

PCN

Pancreatic cystic neoplasm

PDAC

Pancreatic ductal adenocarcinoma

SCN

Serous cystic neoplasm

Notes

Acknowledgments

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.

References

  1. 1.
    Laffan TA, Horton KM, Klein AP et al (2008) Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 191:802–807CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    de Jong K, Nio CY, Hermans JJ et al (2010) High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol 8:806–811CrossRefPubMedGoogle Scholar
  3. 3.
    Spinelli KS, Fromwiller TE, Daniel RA et al (2004) Cystic pancreatic neoplasms: observe or operate. Ann Surg 239:651–657CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lee KS, Sekhar A, Rofsky NM, Pedrosa I (2010) Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 105:2079–2084CrossRefPubMedGoogle Scholar
  5. 5.
    Girometti R, Intini S, Brondani G et al (2011) Incidental pancreatic cysts on 3D turbo spin echo magnetic resonance cholangio-pancreatography: prevalence and relation with clinical and imagingfeatures. Abdom Imaging 36:196–205CrossRefPubMedGoogle Scholar
  6. 6.
    Kimura W, Nagai H, Kuroda A et al (1995) Analysis of small cystic lesions of the pancreas. Int J Pancreatol 18:197–206PubMedGoogle Scholar
  7. 7.
    Kosmahl M, Pauser U, Peters K et al (2004) Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal. Virchows Arch 445:168–178CrossRefPubMedGoogle Scholar
  8. 8.
    Del Chiaro M, Verbeke C, Salvia R et al (2013) European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 45:703–711CrossRefPubMedGoogle Scholar
  9. 9.
    Berland LL, Silverman SG, Gore RM et al (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7:754–773CrossRefPubMedGoogle Scholar
  10. 10.
    Sainani NI, Saokar A, Deshpande V et al (2009) Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. AJR Am J Roentgenol 193:722–731CrossRefPubMedGoogle Scholar
  11. 11.
    Walter TC, Steffen IG, Stelter LH et al (2015) Implications of imaging criteria for the management and treatment of intraductal papillary mucinous neoplasms - benign versus malignant findings. Eur Radiol 25:1329–1338CrossRefPubMedGoogle Scholar
  12. 12.
    Thomsen HS, Morcos SK, Almén T et al (2013) Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 23:307–318CrossRefPubMedGoogle Scholar
  13. 13.
    Tirkes T, Menias CO, Sandrasegaran K (2012) MR Imaging Techniques for Pancreas. Radiol Clin N Am 50:379–393CrossRefPubMedGoogle Scholar
  14. 14.
    Tanaka M, Fernández-del Castillo C, Adsay V et al (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197CrossRefPubMedGoogle Scholar
  15. 15.
    World Health Organization (2014) World health statistics 2014. World Health Organization, Geneva. Available via http://apps.who.int/iris/bitstream/10665/112738/1/9789240692671_eng.pdf?ua=1. Accessed 05 Jan 2016
  16. 16.
    Daniel WW (1995) Biostatistics: A Foundation for Analysis in the Health Sciences, 6th edn. John Wiley & Sons, New YorkGoogle Scholar
  17. 17.
    Montgomery DC (1991) Design and Analysis of Experiments, 3rd edn. John Wiley & Sons, New YorkGoogle Scholar
  18. 18.
    Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428CrossRefPubMedGoogle Scholar
  19. 19.
    Knoke D, Bohrnstedt GW (1991) Basic Social Statistics. F.E. Peacock Publishers, ItascaGoogle Scholar
  20. 20.
    Macari M, Lee T, Kim S et al (2009) Is gadolinium necessary for MRI follow-up evaluation of cystic lesions in the pancreas? Preliminary results. Am J Roentgenol 192:159–164CrossRefGoogle Scholar
  21. 21.
    Nougaret S, Reinhold C, Chong J et al (2014) Incidental pancreatic cysts: natural history and diagnostic accuracy of a limited serial pancreatic cyst MRI protocol. Eur Radiol 24:1020–1029CrossRefPubMedGoogle Scholar
  22. 22.
    Khawaja AZ, Cassidy DB, Al Shakarchi J, McGrogan DG, Inston NG, Jones RG (2015) Revisiting the risks of MRI with Gadolinium based contrast agents-review of literature and guidelines. Insights Imaging 6:553–558CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Zhang B, Liang L, Chen W, Liang C, Zhang S (2015) An Updated Study to Determine Association between Gadolinium-Based Contrast Agents and Nephrogenic Systemic Fibrosis. PLoS One 10, e0129720CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Raffaella Maria Pozzi-Mucelli
    • 1
  • Irina Rinta-Kiikka
    • 2
  • Katharina Wünsche
    • 3
  • Johanna Laukkarinen
    • 4
  • Knut Jørgen Labori
    • 5
  • Kim Ånonsen
    • 6
  • Caroline Verbeke
    • 7
    • 8
  • Marco Del Chiaro
    • 9
  • Nikolaos Kartalis
    • 1
  1. 1.Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of RadiologyC1-46 Karolinska University HospitalStockholmSweden
  2. 2.Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital DistrictTampere University HospitalTampereFinland
  3. 3.Department of RadiologySt.Olavs University HospitalTrondheimNorway
  4. 4.Department of Gastroenterology and Alimentary Tract SurgeryTampere University HospitalTampereFinland
  5. 5.Department of Hepato-Pancreato-Biliary SurgeryOslo University HospitalOsloNorway
  6. 6.Department of GastroenterologyOslo University HospitalOsloNorway
  7. 7.Institute of Clinical MedicineOslo University HospitalOsloNorway
  8. 8.Department of PathologyKarolinska University HospitalStockholmSweden
  9. 9.Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive DiseasesKarolinska University HospitalStockholmSweden

Personalised recommendations