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Invasive intraductal papillary mucinous neoplasms of the pancreas: relationships between mural nodules detected on thin-section contrast-enhanced MDCT and invasive components

  • Pancreas
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Abstract

Purpose

To elucidate the relationships between mural nodules (MNs) and invasive components in patients with invasive intraductal papillary mucinous neoplasm (IPMN) on the basis of thin-section contrast-enhanced multidetector CT (CE-MDCT) and pathologic findings.

Methods

This retrospective study included 28 patients with surgically confirmed invasive IPMN. Two radiologists independently evaluated the thin-section (1-mm section thickness, no overlap) triple-phase CE-MDCT images for MNs, invasive components, and the continuity between them using a five-point scale (confidence scores of 1–3 as negative, 4 and 5 as positive). Kappa statistic was used to evaluate interobserver agreement. The CE-MDCT findings were correlated with pathologic findings.

Results

Interobserver agreement was good or excellent. MNs consisting of tumor cells were recognized in 12 (42.9%) of 28 patients with no discrepancy between the two radiologists. Invasive components were detected in 85.7% and 82.1% in the pancreatic parenchymal phase for radiologist 1 and 2, respectively, and recognized as hypoattenuating areas. Pathologic continuities between MNs and invasive components were confirmed in five (41.7%) of 12 patients with MNs and these were detected on CE-MDCT. When combined seven patients without continuities between MNs and invasive components and 16 patients without MNs, the invasive components pathologically derived from non-nodular low-height papillary epithelium in 23 (82.1%) of 28 patients.

Conclusions

The invasive components derived more often from low-height papillary epithelium without MN appearance on CE-MDCT than from MN. Careful attention should be paid to the existence of an invasive component even in the absence of an enhancing MN.

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Abbreviations

EUS:

Endoscopic ultrasonography

MDCT:

Multidetector computed tomography

CE:

Contrast enhanced

IPMN:

Intraductal papillary mucinous neoplasm

MN:

Mural nodule

MPD:

Main pancreatic duct

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Authors and Affiliations

  1. Department of Radiology, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan

    Noritaka Kamei, Yasunari Yamada, Ryo Takaji, Maki Kiyonaga, Norio Hongo & Shunro Matsumoto

  2. Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan

    Naoki Hijiya

  3. Department of Gastrointestinal and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan

    Masayuki Ohta, Teijiro Hirashita & Masafumi Inomata

Authors
  1. Noritaka Kamei
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  2. Yasunari Yamada
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  3. Naoki Hijiya
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  10. Shunro Matsumoto
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Correspondence to Yasunari Yamada.

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Kamei, N., Yamada, Y., Hijiya, N. et al. Invasive intraductal papillary mucinous neoplasms of the pancreas: relationships between mural nodules detected on thin-section contrast-enhanced MDCT and invasive components. Abdom Radiol 44, 3139–3147 (2019). https://doi.org/10.1007/s00261-019-02084-2

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  • DOI: https://doi.org/10.1007/s00261-019-02084-2

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