Intraductal Papillary Mucinous Neoplasm of the Pancreas: Assessment of the Likelihood of Invasiveness with Multisection CT

Ogawa, Hiroshi; Itoh, Shigeki; Ikeda, Mitsuru; Suzuki, Kôjiro; Naganawa, Shinji

doi:10.1148/radiol.2482071578

Cited by 102 publications

(69 citation statements)

References 44 publications

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“…The sensitivity, specificity, and accuracy of MDCT in characterizing the malignancy of IPMNs were 100%, 87.5% and 95%, respectively. They were a little bit higher than the data in the published literature [2,15] . This could be explained possibly by the bias generated by the small number of purely main duct IPMNs and the limited size of the entire patient population in this group.…”

Section: Discussioncontrasting

confidence: 56%

“…Thinner-slice reformed CTA and MPVR or CR images showed other malignant signs clearly, including vascular invasion, lymph node enlargement, and duodenal involvement, as well as dilatation of the common bile duct and common hepatic duct (Figure 3). Ogawa et al [15] reported that the sensitivity, specificity, and accuracy for identifying malignancy were 83%, 81% and 82% and for identifying pancreatic parenchymal invasion were 90%, 88% and 89%, respectively. According to the International Consensus Guidelines for management of IPMN, the branch duct IPMNs are benign more frequently than the main duct IPMNs [2] .…”

Section: Discussionmentioning

confidence: 99%

“…Axial CT images combined with multiplanar volume reformations (MPVR) or curved reformations (CR) and CT angiography (CTA) with maximum intensity projection should display the imaging features of IPMNs in more detail. Recent studies assessed the capability of MDCT in defining the invasiveness of the IPMN and in evaluating the resectability of IPMNs [14,15] . The IPMN can evolve through all biological stages, from slight dysplasia to carcinoma.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

Tan

Ya-e²,

Wang³

et al. 2009

WJG

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AIM:To retrospectively evaluate the imaging features of pancreatic intraductal papillary mucinous neoplasms (IPMNs) in multi-detector row computed tomography (MDCT). METHODS:A total of 20 patients with pathologicallyconfirmed intraductal papillary mucinous neoplasms (IPMNs) were included in this study. Axial MDCT images combined with CT angiography (CTA) and multiplanar volume reformations (MPVR) or curved reformations (CR) were preoperatively acquired. Two radiologists (Tan L and Wang DB) reviewed all the images in consensus using an interactive picture archiving and communication system. The disputes in readings were resolved through consultation with a third experienced radiologist (Chen KM). Finally, the findings and diagnoses were compared with the pathologic results. RESULTS:The pathological study revealed 12 malignant IPMNs and eight benign IPMNs. The diameters of the cystic lesions and main pancreatic ducts (MPDs) were significantly larger in malignant IPMNs compared with those of the benign IPMNs (P < 0.05). The combinedtype IPMNs had a higher rate of malignancy than the other two types of IPMNs (P < 0.05). Tumors with mural nodules and thick septa had a significantly higher incidence of malignancy than tumors without these features (P < 0.05). Communication of side-branch IPMNs with the MPD was present in nine cases at pathologic examination. Seven of them were identified from CTA and MPVR or CR images. From comparison with the pathological diagnosis, the sensitivity, specificity, and accuracy of MDCT in characterizing the malignancy of IPMN of the pancreas were determined to be 100%, 87.5% and 95%, respectively.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

Tan

Ya-e²,

Wang³

et al. 2009

WJG

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“…1). Of these studies, 33 investigated mural nodules5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 21 examined dilatation of the main pancreatic duct (MPD)7 9, 15 16, 18 21, 23 26, 27 30, 32 36, 38, 39, 40, 41, 42, 43, 44, 45, 46, 21 analysed cyst size5 7, 8, 9 14, 15 18, 20 23, 25 27, 28 31, 36 38, 40 41, 43 47, 48, 49, 17 assessed CA19‐9 increase…”

Section: Resultsmentioning

confidence: 99%

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

et al. 2018

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BackgroundEstimation of the risk of malignancy in intraductal papillary mucinous neoplasia (IPMN) of the pancreas is a clinical challenge. Several routinely used clinical factors form the basis of the current consensus guidelines. This study aimed to determine the predictive values of the most commonly assessed risk factors.MethodsA meta‐analysis of individual risk factors of malignancy in IPMN was performed. Contingency tables were derived from these data, and sensitivity, specificity, negative and positive predictive values, and diagnostic odds ratios (DOR) were determined. Hierarchical summary receiver operating characteristic (HSROC) curves for each factor were calculated and the respective area under the curve (AUC) was assessed.ResultsA total of 3443 studies were screened initially. Analysis of recent literature revealed 60 studies with 13 relevant risk factors including clinical, serological and radiological parameters. The largest area under the HSROC curve was found for weight loss (0·84) and jaundice/raised bilirubin level (0·80), followed by increased carcinoembryonic antigen (CEA) (0·79) or carbohydrate antigen (CA) 19‐9 (0·78) levels. The most sensitive factors were patient age (71 per cent) and mural nodules (65 per cent), and jaundice/raised bilirubin level (97 per cent) and increased CEA level (95 per cent) were most specific. None of the analysed factors reached a positive or negative level of prediction beyond 90 per cent.ConclusionNone of the established criteria safely distinguishes malignant from non‐malignant lesions.

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“…In this regard, both CT scan and MRI with MRCP have demonstrated high accuracy (Figs. 3 and 4); however, magnetic resonance is more effective in depicting the communication between the IPMN and the ductal system [28,29]. EUS can be used as a second level examination in patients with "worrisome features" (cyst >3 cm, thickened enhanced cyst walls, MPD size of 5-9 mm, non-enhanced mural nodules, abrupt change in the MPD caliber, and lymphadenopathy) for detecting mural nodules and it allows fluid aspiration and targeted biopsies.…”

Section: Intraductal Papillary Mucinous Neoplasmmentioning

confidence: 99%

Cystic Neoplasm of the Pancreas

et al. 2015

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Cystic neoplasms of the pancreas (CNPs) are not considered as rare entities any more. Imaging-based population studies attested an overall prevalence of 2 %, but that becomes five times higher on individuals of more than 70 year old. This family of neoplasms includes a wide spectrum of benign, borderline, and malignant lesions whose actual biological behavior has not been completely clarified yet. Moreover, the management of CNPs still represents a challenge for gastrointestinal (GI) specialists. While many CNPs have an indolent behavior that justifies surveillance, others should be resected because of the risk of progression to invasive cancer. Due to the high morbidity related to pancreatic resections, the surgeon should balance very carefully the advantages of a radical resection with the risks of an unrequested dangerous procedure. We reviewed the current issues regarding CNPs, with a particular focus on the clinical and radiological features that are integrated in the current guidelines and that drive the management of these patients.

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Intraductal Papillary Mucinous Neoplasm of the Pancreas: Assessment of the Likelihood of Invasiveness with Multisection CT

Abstract: Multisection CT is useful for distinguishing among adenoma, noninvasive carcinoma, and invasive carcinoma in patients with IPMN.

Cited by 102 publications

References 44 publications

Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas

Cystic Neoplasm of the Pancreas

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