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Pancreatic cystic neoplasms and post-inflammatory cysts: interobserver agreement and diagnostic performance of MRI with MRCP

  • Pancreas
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Abstract

Purpose

We aimed to answer several clinically relevant questions; (1) the interobserver agreement, (2) diagnostic performance of MRI with MRCP for (a) branch duct intraductal papillary mucinous neoplasms (BD-IPMN), mucinous cystic neoplasms (MCN) and serous cystic neoplasms (SCN), (b) distinguishing mucinous (BD-IPMN and MCN) from non-mucinous cysts, and (c) distinguishing three pancreatic cystic neoplasms (PCN) from post-inflammatory cysts (PIC).

Methods

A retrospective analysis was performed at a tertiary referral center for pancreatic diseases on 71 patients including 44 PCNs and 27 PICs. All PCNs were confirmed by surgical pathology to be 17 BD-IPMNs, 13 MCNs, and 14 SCNs. Main duct and mixed type IPMNs were excluded. Two experienced abdominal radiologists blindly reviewed all the images.

Results

Sensitivity of two radiologists for BD-IPMN, MCN and SCN was 88–94%, 62–69% and 57–64%, specificity of 67–78%, 67–78% and 67–78%, and accuracy of 77–82%, 65–75% and 63–73%, respectively. There was 80% sensitivity, 63–73% specificity, 70–76% accuracy for distinguishing mucinous from non-mucinous neoplasms, and 73–75% sensitivity, 67–78% specificity, 70–76% accuracy for distinguishing all PCNs from PICs. There was moderate-to-substantial interobserver agreement (Cohen’s kappa: 0.65).

Conclusion

Two experienced abdominal radiologists had moderate-to-high sensitivity, specificity, and accuracy for BD-IPMN, MCN, and SCN. The interobserver agreement was moderate-to-substantial. MRI with MRCP can help workup of incidental pancreatic cysts by distinguishing PCNs from PICs, and premalignant mucinous neoplasms from cysts with no malignant potential.

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Funding

Dr. Tirkes is supported by National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Numbers 1R01DK116963, U01DK127382 (Type 1 Diabetes in Acute Pancreatitis Consortium) and U01DK108323 (Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd UH 0663, Indianapolis, IN, 46202, USA

    Temel Tirkes, Aashish A. Patel, Bilal Tahir & Fatih M. Akisik

  2. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Rachel C. Kim & C. Max Schmidt

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  1. Temel Tirkes
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Correspondence to Temel Tirkes.

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Tirkes, T., Patel, A.A., Tahir, B. et al. Pancreatic cystic neoplasms and post-inflammatory cysts: interobserver agreement and diagnostic performance of MRI with MRCP. Abdom Radiol 46, 4245–4253 (2021). https://doi.org/10.1007/s00261-021-03116-6

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