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European Radiology

, Volume 28, Issue 7, pp 2790–2800 | Cite as

Are pancreatic IPMN volumes measured on MRI images more reproducible than diameters? An assessment in a large single-institution cohort

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

Abstract

Objectives

To assess reproducibility of volume and diameter measurement of intraductal papillary mucinous neoplasms (IPMNs) on MRI images.

Methods

Three readers measured the diameters and volumes of 164 IPMNs on axial T2-weighted images and coronal thin-slice navigator heavily T2-weighted images using manual and semiautomatic techniques. Interobserver reproducibility and variability were assessed.

Results

Interobserver intraclass correlation coefficients (ICCs) for the largest diameter measured using manual and semiautomatic techniques were 0.979 and 0.909 in the axial plane, and 0.969 and 0.961 in the coronal plane, respectively. Interobserver ICCs for the volume measurements were 0.973 and 0.970 in axial and coronal planes, respectively. The highest intraobserver reproducibility was noted for coronal manual measurements (ICC 0.981) followed by axial manual measurements (ICC 0.969). For the diameter measurements, Bland-Altman analysis revealed the lowest interobserver variability for manual axial measurements with an average range of 95% limits of agreement (LOA) of 0.68 cm. Axial and coronal volume measurements showed similar 95% LOA ranges (8.9 cm3 and 9.4 cm3, respectively).

Conclusions

Volume and diameter measurements on axial and coronal images show good interobserver and intraobserver reproducibility. The single largest diameter measured manually on axial images showed the highest reproducibility and lowest variability. The 95% LOA may help define reproducible size changes in these lesions using measurements from different readers.

Key Points

• MRI measurements by different radiologists can be used for IPMN follow-up.

• Both diameter and volume measurements demonstrate excellent interobserver and intraobserver reproducibility.

• Manual axial measurements show the highest interobserver reproducibility in determining size.

• Axial and coronal volume measurements show similar limits of agreement.

• Manual axial measurements show the lowest variability in agreement range.

Keywords

Pancreas Cysts Magnetic resonance imaging Observer variation Reproducibility of results 

Abbreviations

ACR

American College of Radiology

B-A

Bland-Altman

CI

Confidence interval

CT

Computed tomography

ICC

Intraclass correlation coefficient

IPMN

Intraductal papillary mucinous neoplasm

LOA

Limits of agreement

MDCT

Multidetector computed tomography

MRCP

Magnetic resonance cholangiopancreatography

MRI

Magnetic resonance imaging

PACS

Picture archiving and communication system

PCN

Pancreatic cystic neoplasm

Notes

Funding

The authors state that this work did not receive any funding.

Compliance with ethical standards

Guarantor

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

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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

References

  1. 1.
    Zhang XM, Mitchell DG, Dohke M, Holland GA, Parker L (2002) Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 223:547–553CrossRefPubMedGoogle Scholar
  2. 2.
    Girometti R, Intini S, Brondani G et al (2011) Incidental pancreatic cysts on 3D turbo spin echo magnetic resonance cholangiopancreatography: prevalence and relation with clinical and imaging features. Abdom Imaging 36:196–205CrossRefPubMedGoogle Scholar
  3. 3.
    Gardner TB, Glass LM, Smith KD et al (2013) Pancreatic cyst prevalence and the risk of mucin-producing adenocarcinoma in US adults. Am J Gastroenterol 108:1546–1550CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Moris M, Bridges MD, Pooley RA et al (2016) Association between advances in high-resolution cross-section imaging technologies and increase in prevalence of pancreatic cysts from 2005 to 2014. Clin Gastroenterol Hepatol 14:585–593.e3CrossRefPubMedGoogle Scholar
  5. 5.
    Zanini N, Giordano M, Smerieri E et al (2015) Estimation of the prevalence of asymptomatic pancreatic cysts in the population of San Marino. Pancreatology 15:417–422CrossRefPubMedGoogle Scholar
  6. 6.
    Sahora K, Fernandez-del Castillo C (2015) Intraductal papillary mucinous neoplasms. Curr Opin Gastroenterol 31:424–429CrossRefPubMedGoogle Scholar
  7. 7.
    Stark A, Donahue TR, Reber HA, Hines O (2016) Pancreatic cyst disease: A review. JAMA 315:1882–1893CrossRefPubMedGoogle Scholar
  8. 8.
    Megibow AJ, Baker ME, Morgan DE et al (2017) Management of incidental pancreatic cysts: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol 14:911–923Google Scholar
  9. 9.
    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 12:183–197CrossRefPubMedGoogle Scholar
  10. 10.
    Song SJ, Lee JM, Kim YJ et al (2007) Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. J Magn Reson Imaging 26:86–93CrossRefPubMedGoogle Scholar
  11. 11.
    Berland LL, Silverman SG, Gore RM et al (2010) Managing incidental findings on abdominal CT: white paper of the ACR Incidental Findings Committee. J Am Coll Radiol 7:754–773CrossRefPubMedGoogle Scholar
  12. 12.
    Tanaka M, Chari S, Adsay V et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17–32CrossRefPubMedGoogle Scholar
  13. 13.
    Aghaei Lasboo A, Rezai P, Yaghmai V (2010) Morphological analysis of pancreatic cystic masses. Acad Radiol 17:348–351CrossRefPubMedGoogle Scholar
  14. 14.
    Frenette A, Morrell J, Bjella K, Fogarty E, Beal J, Chaudhary V (2015) Do diametric measurements provide sufficient and reliable tumor assessment? An evaluation of diametric, areametric, and volumetric variability of lung lesion measurements on computerized tomography scans. J Oncol 2015:632943CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Buerke B, Puesken M, Muter S et al (2010) Measurement accuracy and reproducibility of semiautomated metric and volumetric lymph node analysis in MDCT. AJR Am J Roentgenol 195:979–985CrossRefPubMedGoogle Scholar
  16. 16.
    Goldmacher GV, Conklin J (2012) The use of tumour volumetrics to assess response to therapy in anticancer clinical trials. Br J Clin Pharmacol 73:846–854CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Chalian H, Seyal AR, Rezai P et al (2014) Pancreatic mucinous cystic neoplasm size using CT volumetry, spherical and ellipsoid formulas: validation study. JOP 15:25–32PubMedGoogle Scholar
  18. 18.
    Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee; American Gastroenterology Association (2015) American Gastroenterological Association Institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 148:819–822 quize12–13CrossRefPubMedGoogle Scholar
  19. 19.
    Maimone S, Agrawal D, Pollack MJ et al (2010) Variability in measurements of pancreatic cyst size among EUS, CT, and magnetic resonance imaging modalities. Gastrointest Endosc 71:945–950CrossRefPubMedGoogle Scholar
  20. 20.
    Lee YS, Paik KH, Kim HW, Lee JC, Kim J, Hwang JH (2015) Comparison of endoscopic ultrasonography, computed tomography, and magnetic resonance imaging for pancreas cystic lesions. Medicine (Baltimore) 94:e1666CrossRefGoogle Scholar
  21. 21.
    Dunn DP, Brook OR, Brook A et al (2016) Measurement of pancreatic cystic lesions on magnetic resonance imaging: efficacy of standards in reducing inter-observer variability. Abdom Radiol (NY) 41:500–507CrossRefGoogle Scholar
  22. 22.
    McErlean A, Panicek DM, Zabor EC et al (2013) Intra- and interobserver variability in CT measurements in oncology. Radiology 269:451–459CrossRefPubMedGoogle Scholar
  23. 23.
    Pozzi-Mucelli RM, Rinta-Kiikka I, Wunsche K et al (2017) Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol. Eur Radiol 27:41–50CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

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

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