Abstract
The roles of multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI)/MR cholangiopancreatography (MRCP) in the diagnosis of intraductal papillary mucinous neoplasm (IPMN) include the detection, characterization, evaluation of surgical anatomy, and imaging follow-up.
MRI/MRCP is superior to MDCT in the detection and characterization of IPMN. Since branch duct IPMN (BD-IPMN) is relatively common, imaging findings of BD-IPMN may overlap those of other pancreatic cysts. Especially when MDCT or MRI/MRCP fail to demonstrate communication with the main pancreatic duct (MPD), the differential diagnosis between BD-IPMN and oligocystic serous cystic neoplasm (SCN) may be difficult. The likelihood of malignancy has been mainly assessed by indirect findings related to tumor volume and the degree of mucin hypersecretion, including the presence or absence of mural nodule, cyst size, and MPD diameter.
MDCT compensates for the drawbacks of MRI, especially in cases where the image quality is degraded. Due to its higher spatial resolution, MDCT may be helpful in demonstrating pancreatic parenchymal abnormalities indicative of invasive carcinoma. In addition, MDCT is a reliable modality in evaluating preoperative vascular anatomy. Furthermore, curved planar reformation images created along the course of the MPD are visually demonstrable.
MRI/MRCP is the preferred modality for follow-up imaging because of its lacking in ionizing radiation. MDCT is being utilized adjunctively in the imaging surveillance for pancreatic ductal adenocarcinoma (PDAC) and extrapancreatic diseases.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 2010;7(10):754–73.
Choi JY, Kim MJ, Lee JY, Lim JS, Chung JJ, Kim KW, et al. Typical and atypical manifestations of serous cystadenoma of the pancreas: imaging findings with pathologic correlation. AJR Am J Roentgenol. 2009;193(1):136–42.
Crippa S, Salvia R, Warshaw AL, DomÃnguez I, Bassi C, Falconi M, et al. Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg. 2008;247(4):571–9.
Gupta R, Mortelé KJ, Tatli S, Girshman J, Glickman JN, Levy AD, et al. Pancreatic intraductal papillary mucinous neoplasms: role of CT in predicting pathologic subtypes. AJR Am J Roentgenol. 2008;191(5):1458–64.
Irie H, Honda H, Aibe H, Kuroiwa T, Yoshimitsu K, Shinozaki K, et al. MR cholangiopancreatographic differentiation of benign and malignant intraductal mucin-producing tumors of the pancreas. AJR Am J Roentgenol. 2000;174(5):1403–8.
Irie H, Yoshimitsu K, Aibe H, Tajima T, Nishie A, Nakayama T, et al. Natural history of pancreatic intraductal papillary mucinous tumor of branch duct type: follow-up study by magnetic resonance cholangiopancreatography. J Comput Assist Tomogr. 2004;28(1):117–22.
Ishigami K, Yoshimitsu K, Irie H, Shinozaki K, Nagata S, Yamaguchi K, et al. Imaging of intraductal tubular tumors of the pancreas. AJR Am J Roentgenol. 2008;191(6):1836–40.
Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Nishie A, et al. Diagnostic value of the delayed phase image for iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography. Eur J Radiol. 2009;69(1):139–46.
Kawamoto S, Lawler LP, Horton KM, Eng J, Hruban RH, Fishman EK. MDCT of intraductal papillary mucinous neoplasm of the pancreas: evaluation of features predictive of invasive carcinoma. AJR Am J Roentgenol. 2006;186(3):687–95.
Kimura W, Moriya T, Hanada K, Abe H, Yanagisawa A, Fukushima N, et al. Multicenter study of serous cystic neoplasm of the Japan pancreas society. Pancreas. 2012;41(3):380–7.
Laffan TA, Horton KM, Klein AP, Berlanstein B, Siegelman SS, Kawamoto S, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol. 2008;191(3):802–7.
Manfredi R, Graziani R, Motton M, Mantovani W, Baltieri S, Tognolini A, et al. Main pancreatic duct intraductal papillary mucinous neoplasms: accuracy of MR imaging in differentiation between benign and malignant tumors compared with histopathologic analysis. Radiology. 2009;253(1):106–15.
McNulty NJ, Francis IR, Platt JF, Cohan RH, Korobkin M, Gebremariam A. Multi–detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology. 2001;220(1):97–102.
Mori Y, Ohtsuka T, Kono H, Ideno N, Aso T, Nagayoshi Y, et al. Management strategy for multifocal branch duct intraductal papillary mucinous neoplasms of the pancreas. Pancreas. 2012;41(7):1008–12.
Nara S, Onaya H, Hiraoka N, Shimada K, Sano T, Sakamoto Y, et al. Preoperative evaluation of invasive and noninvasive intraductal papillary-mucinous neoplasms of the pancreas: clinical, radiological, and pathological analysis of 123 cases. Pancreas. 2009;38(1):8–16.
Ogawa H, Itoh S, Ikeda M, Suzuki K, Naganawa S. Intraductal papillary mucinous neoplasm of the pancreas: assessment of the likelihood of invasiveness with multisection CT. Radiology. 2008;248(3):876–86.
Pedrosa I, Boparai D. Imaging considerations in intraductal papillary mucinous neoplasms of the pancreas. World J Gastrointest Surg. 2010;2(10):324–30.
Reddy RP, Smyrk TC, Zapiach M, Levy MJ, Pearson RK, Clain JE, et al. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastroenterol Hepatol. 2004;2(11):1026–31.
Spinelli KS, Fromwiller TE, Daniel RA, Kiely JM, Nakeeb A, Komorowski RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg. 2004;239(5):651–7. discussion 657–9.
Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y. Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg. 2003;90(10):1244–9.
Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, et al. International association of pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183–97.
Vullierme MP, Giraud-Cohen M, Hammel P, Sauvanet A, Couvelard A, O'Toole D, et al. Malignant intraductal papillary mucinous neoplasm of the pancreas: in situ versus invasive carcinoma surgical resectability. Radiology. 2007;245(2):483–90.
Waters JA, Schmidt CM, Pinchot JW, White PB, Cummings OW, Pitt HA, et al. CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg. 2008;12(1):101–9.
Yamaguchi K, Ogawa Y, Chijiiwa K, Tanaka M. Mucin-hypersecreting tumors of the pancreas: assessing the grade of malignancy preoperatively. Am J Surg. 1996;171(4):427–31.
Yamaguchi H, Ishigami K, Inoue T, Eguchi T, Nagata S, Kuroda Y, et al. Three cases of serous oligocystic adenomas of the pancreas; evaluation of cyst wall thickness for preoperative differentiation from mucinous cystic neoplasms. J Gastrointest Cancer. 2007;38(1):52–8.
Yamaguchi H, Shimizu M, Ban S, Koyama I, Hatori T, Fujita I, et al. Intraductal tubulopapillary neoplasms of the pancreas distinct from pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2009;33(8):1164–72.
Yamaguchi K, Kanemitsu S, Hatori T, Maguchi H, Shimizu Y, Tada M, et al. Pancreatic ductal adenocarcinoma derived from IPMN and pancreatic ductal adenocarcinoma concomitant with IPMN. Pancreas. 2011;40(4):571–80.
Yamao K, Yanagisawa A, Takahashi K, Kimura W, Doi R, Fukushima N, et al. Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan pancreas society. Pancreas. 2011;40(1):67–71.
Yoon LS, Catalano OA, Fritz S, Ferrone CR, Hahn PF, Sahani DV. Another dimension in magnetic resonance cholangiopancreatography: comparison of 2- and 3-dimensional magnetic resonance cholangiopancreatography for the evaluation of intraductal papillary mucinous neoplasm of the pancreas. J Comput Assist Tomogr. 2009;33(3):363–8.
Yoon SH, Lee JM, Cho JY, Lee KB, Kim JE, Moon SK, et al. Small (≤20 mm) pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology. 2011;259(2):442–52.
Zhang XM, Mitchell DG, Dohke M, Holland GA, Parker L. Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology. 2002;223(2):547–53.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Japan
About this chapter
Cite this chapter
Ishigami, K. (2014). CT and MRI/MRCP. In: Tanaka, M. (eds) Intraductal Papillary Mucinous Neoplasm of the Pancreas. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54472-2_5
Download citation
DOI: https://doi.org/10.1007/978-4-431-54472-2_5
Published:
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-54471-5
Online ISBN: 978-4-431-54472-2
eBook Packages: MedicineMedicine (R0)