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Computed tomography nomogram to predict a high-risk intraductal papillary mucinous neoplasm of the pancreas

  • Pancreas
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

The intraductal papillary mucinous neoplasm (IPMN) of the pancreas is regarded as a precursor to pancreatic cancer; this study aimed to develop and validate a model based on CT characteristics for the non-invasive prediction of the high-risk IPMN of the pancreas.

Materials and methods

In this retrospective study, all patients underwent multidetector CT and surgical resection. A prediction model was developed based on a training set consisting of 136 patients with low-risk IPMN and 85 patients with high-risk IPMN between October 2012 and April 2019, and a multivariable logistic regression model was adopted to establish a nomogram. The nomogram performance was determined by its discrimination, calibration, and clinical usefulness. The model was validated in 80 consecutive patients between May 2019 and April 2020, of which 47 and 33 patients had low-risk and high-risk IPMNs, respectively.

Results

The multivariable logistic regression model of CT characteristics included the enhancing mural nodule size, the main pancreatic duct (MPD) diameter, the abrupt change in caliber of the MPD with distal pancreatic atrophy, cyst size, thickened enhancing cyst wall, and the presence of lymphadenopathy. The individualized prediction nomogram using these predictors of the high-risk IPMN achieved an area under the curve (AUC) of 0.92 (95% CI 0.88–0.95) in the training set and 0.87 (95% CI 0.79–0.95) in the validation set. The decision curve analysis demonstrated that the nomogram was clinically useful.

Conclusion

The CT nomogram, which is a non-invasive predictive tool, can preoperatively predict the risk of malignant IPMN and help identify patients who require a surgical procedure.

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Funding

This work was supported in part by the National Natural Science Foundation of China (81871352); Major Clinical Research Project of Shanghai Shenkang Hospital Development Center (SHDC2020CR4073); The Natural Science Foundation of Shanghai Science and Technology Innovation Action Plan (21ZR1478500); 234 Platform Discipline Consolidation Foundation Project (2019YPT001).

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Authors and Affiliations

  1. Department of Radiology, Changhai Hospital, Naval Medical University, Changhai Road 168, Shanghai, 200434, China

    Xu Fang, Fang Liu, Jing Li, Kai Cao, Tiegong Wang, Hao Zhang, Qi Li, Yinghao Meng, Jieyu Yu, Xiaochen Feng, Li Wang, Jianping Lu, Chengwei Shao & Yun Bian

  2. Department of Pathology, Changhai Hospital, Naval Medical University, Changhai Road 168, Shanghai, 200434, China

    Hui Jiang

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  1. Xu Fang
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  2. Fang Liu
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Correspondence to Chengwei Shao or Yun Bian.

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Fang, X., Liu, F., Li, J. et al. Computed tomography nomogram to predict a high-risk intraductal papillary mucinous neoplasm of the pancreas. Abdom Radiol 46, 5218–5228 (2021). https://doi.org/10.1007/s00261-021-03247-w

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