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Assessment of main pancreatic duct cutoff with dilatation, but without visible pancreatic focal lesion on MDCT: a novel diagnostic approach for malignant stricture using a CT-based nomogram

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To identify useful features to predict hidden pancreatic malignancies in patients with main pancreatic duct (MPD) abrupt cutoff and dilatation, but without visible focal pancreatic lesions on CT.

Methods

This retrospective study included 92 patients (mean age, 63.4 ± 10.6 years, 63 men and 29 women) with MPD abrupt cutoff and dilatation, but without visible focal pancreatic lesion on contrast-enhanced CT between 2009 and 2021. Two radiologists independently evaluated the CT imaging features. Multivariable logistic regression analysis was performed to identify clinical and CT imaging features for hidden pancreatic malignancies. A nomogram was developed based on these results and assessed its performance.

Results

Thirty-eight (41.3%) and 54 (58.7%) were classified into the malignant and benign groups, respectively. In the multivariable analysis, CA19-9 elevation (odds ratio [OR] 7.5, p = 0.003), duct cutoff site at the head/neck (OR 7.6, p = 0.006), parenchymal contour abnormality at the duct cutoff site (OR 13.7, p < 0.001), and presence of acute pancreatitis (OR 11.5, p = 0.005) were independent predictors of pancreatic malignancy. A combination of any two significant features showed an accuracy of 77.2%, and a combination of any three features exhibited a specificity of 100%. The CT-based nomogram showed an area under the curve (AUC) of 0.84 (95% confidence interval, 0.77–0.90).

Conclusions

The three CT imaging features and CA19-9 elevation translated into a nomogram permit a reliable estimation of hidden pancreatic malignancies in patients with MPD abrupt cutoff without visible focal pancreatic lesion. It may facilitate determining whether to proceed to further diagnostic tests.

Key Points

• Isoattenuating pancreatic ductal adenocarcinoma can manifest only as an isolated main pancreatic duct (MPD) dilatation with abrupt cutoff, making it difficult to distinguish from benign strictures.

• Along with the serum CA 19-9 elevation, MPD cutoff site at the pancreas head or neck, parenchymal contour abnormality at the duct cutoff site, and associated acute pancreatitis indicated a higher probability of the malignant MPD strictures.

• The CT-based nomogram provided excellent diagnostic performance (AUC of 0.84) for hidden pancreatic malignancies in patients with MPD abrupt cutoff and dilatation.

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Abbreviations

AUC:

Area under the ROC curve

CI:

Confidence interval

DM:

Diabetes mellitus

EUS:

Endoscopic ultrasonography

FNA:

Fine needle aspiration

ICC:

Intraclass correlation coefficients

IPMN:

Intraductal papillary mucinous neoplasm

LR (+):

Positive likelihood ratio

LR (−):

Negative likelihood ratio

MPD:

Main pancreatic duct

OR:

Odds ratio

PDAC:

Pancreatic ductal adenocarcinoma

ROC curve:

Receiver operating characteristic curve

CA 19-9:

Carbohydrate antigen 19-9

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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).

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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

    Chae Young Lim, Ji Hye Min, Jeong Ah Hwang & Seong Eun Ko

  2. Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea

    Seo-Youn Choi

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  1. Chae Young Lim
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Corresponding author

Correspondence to Ji Hye Min.

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Guarantor

The scientific guarantor of this publication is Ji Hye Min 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

A statistician (Ji Eun Moon) of medical statistics (Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Korea) kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (IRB FILE No: 2021-10-076).

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• retrospective

• diagnostic study

• performed at one institution

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Lim, C.Y., Min, J.H., Hwang, J.A. et al. Assessment of main pancreatic duct cutoff with dilatation, but without visible pancreatic focal lesion on MDCT: a novel diagnostic approach for malignant stricture using a CT-based nomogram. Eur Radiol 32, 8285–8295 (2022). https://doi.org/10.1007/s00330-022-08928-8

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  • DOI: https://doi.org/10.1007/s00330-022-08928-8

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