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Added value of apparent diffusion coefficient in distinguishing between serous and mucin-producing pancreatic cystic neoplasms

  • Pallavi Pandey
  • Ankur Pandey
  • Nannan Shao
  • Farnaz Najmi Varzaneh
  • Mounes Aliyari Ghasabeh
  • Manijeh Zharghampour
  • Pegah Khoshpouri
  • Daniel Fouladi
  • John Eng
  • Anne Marie O’Broin-Lennon
  • Marcia Canto
  • Ralph H. Hruban
  • Ihab R. KamelEmail author
Magnetic Resonance

Abstract

Objectives

To evaluate the added value of diffusion-weighted imaging (DWI) on MRI in differentiating serous from mucin-producing pancreatic cystic neoplasms (PCNs).

Methods

One hundred seventeen patients with PCN measuring ≥ 10 mm were included. Three readers independently evaluated MRI with and without the use of apparent diffusion coefficient (ADC). Logistic regression was used to analyze whether confidence scores were different with the use of different image sets. Diagnostic performance with and without ADC was compared.

Results

DWI/ADC improved confidence in 44.8%, 73.6%, and 78.2% of patients by the three readers in distinguishing serous from mucin-producing PCNs. The use of ADC increased the probability of a higher confidence in the differentiation as compared to morphological imaging for all three readers (p < 0.001). Odds ratio for increase in the diagnostic confidence with the use of ADC for the three readers with decreasing years of experience were 5.8, 6.8, and 12.7. The diagnostic accuracy of morphological MRI with ADC was higher than that without ADC for two of three readers with lesser experience (87.2% vs. 80.8%; 91.5% vs. 80.8%).

Conclusion

DWI may have added value as a complementary tool to conventional morphological MRI in differentiating between serous and mucin-producing PCNs with possibly greater value for readers with less experience in reading abdominal MRI.

Key Points

Optimal management of PCNs requires differentiation of serous from mucin-producing PCNs.

ADC measurements allow increased confidence in differentiating serous from mucin-producing PCNs.

ADC measurements increase the accuracy in diagnosing serous versus mucin-producing PCNs.

Keywords

Magnetic resonance imaging Diffusion MRI Pancreas Cysts Mucin 

Abbreviations

ADC

Apparent diffusion coefficient

BD-IPMN

Branch duct intraductal papillary mucinous neoplasm

CE-MRI

Contrast-enhanced magnetic resonance imaging

CT

Computed tomography

DWI

Diffusion-weighted imaging

FNA

Fine needle aspiration

FS

Fat saturation

GRE

Gradient echo

IPMN

Intraductal papillary mucinous neoplasm

MCN

Mucinous cystic neoplasm

MD-IPMN

Main duct intraductal papillary mucinous neoplasm

MRCP

Magnetic resonance cholangiopancreatography

MRI

Magnetic resonance imaging

PCN

Pancreatic cystic neoplasm

SCA

Serous cystadenoma

SD

Standard deviation

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Ihab R. Kamel.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• diagnostic study

• performed at one institution

Supplementary material

330_2019_6010_MOESM1_ESM.docx (668 kb)
ESM 1 (DOCX 667 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Pallavi Pandey
    • 1
  • Ankur Pandey
    • 1
  • Nannan Shao
    • 1
  • Farnaz Najmi Varzaneh
    • 1
  • Mounes Aliyari Ghasabeh
    • 1
  • Manijeh Zharghampour
    • 1
  • Pegah Khoshpouri
    • 1
  • Daniel Fouladi
    • 1
  • John Eng
    • 1
  • Anne Marie O’Broin-Lennon
    • 2
  • Marcia Canto
    • 2
  • Ralph H. Hruban
    • 3
  • Ihab R. Kamel
    • 1
    Email author
  1. 1.Russell H. Morgan Department of Radiology and Radiological Sciences, Central RadiologyJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Division of GastroenterologyJohns Hopkins Medical InstitutionsBaltimoreUSA
  3. 3.Department of PathologyJohns Hopkins Medical InstitutionsBaltimoreUSA

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