Advertisement

Abdominal Radiology

, Volume 44, Issue 9, pp 3139–3147 | Cite as

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

  • Noritaka Kamei
  • Yasunari YamadaEmail author
  • Naoki Hijiya
  • Ryo Takaji
  • Maki Kiyonaga
  • Norio Hongo
  • Masayuki Ohta
  • Teijiro Hirashita
  • Masafumi Inomata
  • Shunro Matsumoto
Pancreas
  • 145 Downloads

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.

Keywords

Pancreatic neoplasms Multidetector computed tomography Pancreatic ducts 

Abbreviations

EUS

Endoscopic ultrasonography

MDCT

Multidetector computed tomography

CE

Contrast enhanced

IPMN

Intraductal papillary mucinous neoplasm

MN

Mural nodule

MPD

Main pancreatic duct

Notes

References

  1. 1.
    Hruban RH, Takaori K, Klimstra DS et al. (2004) An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol 28:977-987.CrossRefPubMedGoogle Scholar
  2. 2.
    Sohn TA, Yeo CJ, Cameron JL et al. (2004) Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 239:788-797.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Adsay, N.V., Fukushima, N, Furukawa, T. et al., Intraductal neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. (2010) WHO classification of tumours of the digestive system: Lyon: WHO Press. pp 304-313.Google Scholar
  4. 4.
    Doi R, Fujimoto K, Wada M, Imamura M (2002) Surgical management of intraductal papillary mucinous tumor of the pancreas. Surgery 132:80-85.Google Scholar
  5. 5.
    Nara S, Shimada K, Kosuge T, Kanai Y, Hiraoka N (2008) Minimally invasive intraductal papillary-mucinous carcinoma of the pancreas: clinicopathologic study of 104 intraductal papillary-mucinous neoplasms. Am J Surg Pathol 32:243-255.CrossRefPubMedGoogle Scholar
  6. 6.
    Kang MJ, Lee KB, Jang JY et al. (2013) Disease spectrum of intraductal papillary mucinous neoplasm with an associated invasive carcinoma: invasive IPMN versus pancreatic ductal adenocarcinoma-associated IPMN. Pancreas 42:1267-1274.CrossRefPubMedGoogle Scholar
  7. 7.
    Tian X, Gao H, Ma Y, Zhuang Y, Yang Y (2015) Surgical treatment and prognosis of 96 cases of intraductal papillary mucinous neoplasms of the pancreas: a retrospective cohort study. Int J Surg 13:49-53.CrossRefPubMedGoogle Scholar
  8. 8.
    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 12:183-197.CrossRefGoogle Scholar
  9. 9.
    Seo N, Byun JH, Kim JH et al. (2016) Validation of the 2012 International Consensus Guidelines using computed tomography and magnetic resonance imaging. Ann Surg 263:557-564.CrossRefPubMedGoogle Scholar
  10. 10.
    Shimizu Y, Yamaue H, Maguchi H et al. (2013) Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers. Pancreas 42:883-888.CrossRefPubMedGoogle Scholar
  11. 11.
    Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. (2017) Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 5:738-753.CrossRefGoogle Scholar
  12. 12.
    European Study Group on Cystic Tumours of the Pancreas (2018) European evidence-based guidelines on pancreatic cystic neoplasms. Gut 67:789-804.CrossRefGoogle Scholar
  13. 13.
    Kawada N, Uehara H, Nagata S, Tsuchishima M, Tsutsumi M, Tomita Y (2016) Mural nodule of 10 mm or larger as predictor of malignancy for intraductal papillary mucinous neoplasm of the pancreas: Pathologic and radiological evaluations. Pancreatology 16:441-448.CrossRefPubMedGoogle Scholar
  14. 14.
    Pedrosa I, Boparai D (2010) Imaging considerations in intraductal papillary mucinous neoplasms of the pancreas. World J Gastrointest Surg 27:324-330.CrossRefGoogle Scholar
  15. 15.
    Nakagawa A, Yamaguchi T, Ohtsuka M, et al. (2009) Usefulness of multidetector computed tomography for detecting protruding lesions in intraductal papillary mucinous neoplasm of the pancreas in comparison with single-detector computed tomography and endoscopic ultrasonography. Pancreas 38:131-136.CrossRefPubMedGoogle Scholar
  16. 16.
    Choi SY, Kim JH, Yu MH, Eun HW, Lee HK, Han JK (2017) Diagnostic performance and imaging features for predicting the malignant potential of intraductal papillary mucinous neoplasm of the pancreas: a comparison of EUS, contrast-enhanced CT and MRI. Abdom Radiol (NY) 42:1449-1458.CrossRefGoogle Scholar
  17. 17.
    Kang HJ, Lee JM, Joo I, et al. (2016) Assessment of Malignant Potential in Intraductal Papillary Mucinous Neoplasms of the Pancreas: Comparison between Multidetector CT and MR Imaging with MR Cholangiopancreatography. Radiology 279:128-139.CrossRefGoogle Scholar
  18. 18.
    Vullierme MP, Giraud-Cohen M, Hammel P, et al. (2007) Malignant intraductal papillary mucinous neoplasm of the pancreas: in situ versus invasive carcinoma surgical resectability. Radiology 245:483-490.CrossRefPubMedGoogle Scholar
  19. 19.
    Manfredi R, Graziani R, Motton M, et al. (2009) Main pancreatic duct intraductal papillary mucinous neoplasms: accuracy of MR imaging in differentiation between benign and malignant tumors compared with histopathologic analysis. Radiology 253:106-115.CrossRefPubMedGoogle Scholar
  20. 20.
    Ogawa H, Itoh S, Ikeda M, Suzuki K, Naganawa S (2008) Intraductal papillary mucinous neoplasm of the pancreas: assessment of the likelihood of invasiveness with multisection CT. Radiology 248:876-886.CrossRefPubMedGoogle Scholar
  21. 21.
    Yamada Y, Mori H, Matsumoto S, Kiyosue H, Hori Y, Hongo N (2010) Pancreatic adenocarcinoma versus chronic pancreatitis: differentiation with triple-phase helical CT. Abdom Imaging 35:163-171.CrossRefPubMedGoogle Scholar
  22. 22.
    Furuhashi N, Suzuki K, Sakurai Y, Ikeda M, Kawai Y (2015) Naganawa S, Differentiation of focal-type autoimmune pancreatitis from pancreatic carcinoma: assessment by multiphase contrast-enhanced CT. Eur Radiol 25:1366-1374.CrossRefPubMedGoogle Scholar
  23. 23.
    Tamada T, Ito K, Kanomata N et al. (2016) Pancreatic adenocarcinomas without secondary signs on multiphasic multidetector CT: association with clinical and histopathologic features. Eur Radiol 26:646-655.CrossRefPubMedGoogle Scholar
  24. 24.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159-174.CrossRefGoogle Scholar
  25. 25.
    Koshita S, Fujita N, Noda Y et al. (2015) Invasive carcinoma derived from "flat type" branch duct intraductal papillary mucinous neoplasms of the pancreas: impact of classification according to the height of mural nodule on endoscopic ultrasonography. J Hepatobiliary Pancreat Sci 22:301-309.CrossRefPubMedGoogle Scholar
  26. 26.
    Kim JH, Eun HW, Kim KW et al. (2013) Intraductal papillary mucinous neoplasms with associated invasive carcinoma of the pancreas: imaging findings and diagnostic performance of MDCT for prediction of prognostic factors. AJR Am J Roentgenol 201:565-572.CrossRefPubMedGoogle Scholar
  27. 27.
    Yamada Y, Mori H, Matsumoto S, Hijiya N, Hongo N, Moriyama M (2010) Invasive carcinomas originating from intraductal papillary mucinous neoplasms of the pancreas: conspicuity and primary sites of the solid masses on triple-phase dynamic CT imaging. Abdom Imaging 35:181-188.CrossRefPubMedGoogle Scholar
  28. 28.
    Hattori YI, Gabata T, Matsui O et al. (2009) Enhancement patterns of pancreatic adenocarcinoma on conventional dynamic multi-detector row CT: correlation with angiogenesis and fibrosis. World J Gastroenterol 15:3114-3131.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Vege SS, Ziring B, Jain R, Moayyedi P (2015); Clinical Guidelines Committee; American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 148:819-822.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Noritaka Kamei
    • 1
  • Yasunari Yamada
    • 1
    Email author
  • Naoki Hijiya
    • 2
  • Ryo Takaji
    • 1
  • Maki Kiyonaga
    • 1
  • Norio Hongo
    • 1
  • Masayuki Ohta
    • 3
  • Teijiro Hirashita
    • 3
  • Masafumi Inomata
    • 3
  • Shunro Matsumoto
    • 1
  1. 1.Department of RadiologyOita University Faculty of MedicineYufuJapan
  2. 2.Department of Molecular PathologyOita University Faculty of MedicineYufuJapan
  3. 3.Department of Gastrointestinal and Pediatric SurgeryOita University Faculty of MedicineYufuJapan

Personalised recommendations