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Intraductal papillary mucinous neoplasm of the pancreas: diagnostic performance of the 2017 international consensus guidelines using CT and MRI

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

To assess the diagnostic performance of the 2017 international consensus guidelines for intraductal papillary mucinous neoplasm (IPMN) of the pancreas and to compare the diagnostic performance and intermodality agreement between contrast-enhanced CT and MRI.

Methods

We retrospectively evaluated patients with surgical resection of IPMN of the pancreas who underwent preoperative CT and MRI between 2009 and 2019. Two radiologists evaluated the clinical and imaging features of IPMN of pancreas according to the 2017 international consensus guideline. Univariable and multivariable analyses were performed to identify significant predictors of malignancy in IPMN. The diagnostic abilities of CT and MRI were compared, and their intermodality agreement was determined.

Results

Of 175 patients (mean age, 64 years; 116 males), 88 (50.3%) had malignant IPMN. On multivariable analysis, all three high-risk stigmata (main pancreatic duct [MPD] ≥ 10 mm, mural nodule ≥ 5 mm, and obstructive jaundice) and two worrisome features (MPD 5–9 mm and elevated carbohydrate antigen 19–9) were associated with malignant IPMN on CT and MRI (p < 0.05). A mural nodule < 5 mm on MRI was also associated with malignant IPMN (OR 5.3, p = 0.009). The diagnostic accuracy of high-risk stigmata showed no difference between CT and MRI (73.7% vs. 75.4%, p = 0.505), with good to excellent intermodality agreement.

Conclusions

Current high-risk stigmata had the strongest association with malignant IPMN on CT and MRI. Although MRI is superior to CT for identifying mural nodules, diagnostic performance for differentiating malignant from benign IPMNs was similar between CT and MRI.

Key Points

• The current high-risk stigmata in the 2017 International Consensus Guidelines had the strongest association with malignant IPMN on CT and MRI.

• MRI is better than CT for identifying enhancing mural nodule.

• Diagnostic performance for differentiating malignant from benign IPMNs was similar between CT and MRI.

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Abbreviations

CA 19-9:

Carbohydrate antigen 19−9

ICG:

International consensus guidelines

IPMN:

Intraductal papillary mucinous neoplasm

MDCT:

Multidetector-row computed tomography

MPD:

Main pancreatic duct

MRCP:

MR cholangiopancreatography

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PPV:

Positive predictive value

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the South Korean government (MSIT) (No. 2020R1F1A1071531) and Samsung Medical Center Grant #SMO1200031.

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Ji Hye Min, Young Kon Kim, Seon Kyoung Kim & Honsoul Kim

  2. Department of Mathematics, Ajou University, Suwon, Republic of Korea

    Soohyun Ahn

Authors
  1. Ji Hye Min
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  2. Young Kon Kim
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  3. Seon Kyoung Kim
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  4. Honsoul Kim
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Corresponding author

Correspondence to Young Kon Kim.

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Guarantor

The scientific guarantor of this publication is Young Kon Kim in Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

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

One (Soohyun Ahn, PhD) of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The part of study samples was included in the prior reports from our institution (Abdominal Radiology (2020) 45:4290–4301; Prognosis of resected intraductal papillary mucinous neoplasm of the pancreas: using revised 2017 international consensus guidelines). Among the 175 patients with resected IPMN in our study, 101 (57.7%) patients have been previously reported. Previous study focused on the postoperative death or recurrence based on the MRI features. In the current study, we compared diagnostic abilities between CT and MRI for predicting malignant IPMNs, focusing on the identification of the high-risk stigmata and worrisome features of pancreas IPMN on each imaging modality.

Methodology

• Retrospective

• Diagnostic study

• Performed at one institution

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Min, J.H., Kim, Y.K., Kim, S.K. et al. Intraductal papillary mucinous neoplasm of the pancreas: diagnostic performance of the 2017 international consensus guidelines using CT and MRI. Eur Radiol 31, 4774–4784 (2021). https://doi.org/10.1007/s00330-020-07583-1

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  • DOI: https://doi.org/10.1007/s00330-020-07583-1

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