Value of apparent diffusion coefficient for predicting malignancy of intraductal papillary mucinous neoplasms of the pancreas

Zhang, Lei; Rao, Sheng-Xiang; Xu, Xuefeng; Wang, Dan Song; Jin, Da Yong; Zeng, Meng Su

doi:10.5152/dir.2016.15354

Cited by 7 publications

(10 citation statements)

References 26 publications

(33 reference statements)

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“…Diffusion-weighted imaging (DWI) is widely used for detection and characterization of various types of tumors (8)(9)(10). In recent reports (11)(12)(13)(14)(15)(16), the value of DWI and apparent diffusion coefficient (ADC) for discrimination between benign and malignant IPMNs has been discussed. Thus, we speculated whether its diagnostic performance is comparable with the high-risk stigmata of 2012 ICG.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of diffusion restriction in intraductal papillary mucinous neoplasm of the pancreas in comparison with “high-risk stigmata” of the 2012 international consensus guidelines for prediction of the malignancy and invasiveness

et al. 2017

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Background It is debated whether diagnostic performance of diffusion-weighted imaging (DWI), which is widely used for detection and characterization of various malignant tumors, is comparable with high-risk stigmata of 2012 international consensus guidelines (ICG) for diagnosis of intraductal papillary mucinous neoplasms (IPMNs). Purpose To evaluate the diagnostic accuracy of diffusion restriction in IPMNs for prediction of malignancy and invasiveness in comparison with high-risk stigmata of 2012 ICG. Material and Methods This retrospective study was institutional review board approved and informed consent was waived. A total of 132 patients with surgically proven IPMNs (49 malignant, 83 benign) who underwent gadoxetic acid-enhanced magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and DWI with a b-value of 0, 100, and 800 s/mm using a 3.0 T MR system were included. Two radiologists independently evaluated imaging parameters of high-risk stigmata and worrisome features of 2012 ICG and diffusion restriction in IPMNs. Univariate and multivariate logistic regression analyses and McNemar's test were used for statistical analysis. Results The presence of diffusion restriction in IPMNs was the only independent imaging parameter for prediction of malignancy (odds ratio [OR], 11.98; 95% confidence interval [CI], 3.60-39.87; P < 0.001) and invasiveness (OR, 17.92; 95% CI, 3.91-82.03; P < 0.001) on multivariate analysis. The diagnostic accuracy and specificity of diffusion restriction were significantly improved compared to high-risk stigmata of 2012 ICG to prediction of malignant ( P = 0.006 and P < 0.001, respectively) or invasive IPMNs ( P = 0.009 and P = 0.015, respectively). Conclusion The diffusion restriction in IPMNs could be considered as another high-risk stigma of malignancy and predictor for invasiveness.

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Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of diffusion restriction in intraductal papillary mucinous neoplasm of the pancreas in comparison with “high-risk stigmata” of the 2012 international consensus guidelines for prediction of the malignancy and invasiveness

et al. 2017

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“…Traditionally, 2D analysis is performed using a value from within a manually set ROI on a single-slice image [ 10 , 13 ]. Theoretically, the most viable malignancy component can be located anywhere within the lesion; thus, 2D analysis is prone to subjective evaluation of lesion heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

“…More specifically, diffusion-weighted imaging (DWI) is considered effective for the diagnosis of malignant IPMNs [ 10 - 12 ], but with limited evidence. Malignant pancreatic tumours generally show higher signal intensities on DWI and lower apparent diffusion coefficient (ADC) values than do benign tumours [ 13 , 14 ]. DWI performance in evaluating the malignant potential of cystic pancreatic lesions is comparable to that of contrast-enhanced magnetic resonance imaging (MRI) [ 12 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…DWI performance in evaluating the malignant potential of cystic pancreatic lesions is comparable to that of contrast-enhanced magnetic resonance imaging (MRI) [ 12 , 15 ]. Furthermore, the combined use of DWI and MRCP, and the use of the minimum (ADC min ) and mean ADC (ADC mean ) values, are effective for diagnosing malignant IPMNs and predicting the risk for IPMNs with invasive carcinoma [ 10 , 12 , 13 ]. The lesion-to-spinal cord signal intensity ratio (LSR) was recently proposed as a useful measure for predicting malignancy.…”

Section: Introductionmentioning

confidence: 99%

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3D quantitative analysis of diffusion-weighted imaging for predicting the malignant potential of intraductal papillary mucinous neoplasms of the pancreas

et al. 2021

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IntroductionTo investigate the predictors of intraductal papillary mucinous neoplasms of the pancreas (IPMNs) with high-grade dysplasia, using 2-dimensional (2D) analysis and 3-dimensional (3D) volume-of-interest-based apparent diffusion coefficient (ADC) histogram analysis.Material and methodsThe data of 45 patients with histopathologically confirmed IPMNs with high-grade or low-grade dysplasia were retrospectively assessed. The 2D analysis included lesion-to-spinal cord signal intensity ratio (LSR), minimum ADC value (ADCmin), and mean ADC value (ADCmean). The 3D analysis included the overall mean (ADCoverall mean), mean of the bottom 10th percentile (ADCmean0-10), mean of the bottom 10-25th percentile (ADCmean10-25), mean of the bottom 25-50th percentile (ADCmean25-50), skewness (ADCskewness), kurtosis (ADCkurtosis), and entropy (ADCentropy). Diagnostic performance was compared by analysing the area under the receiver operating characteristic curve (AUC). Inter-rater reliability was assessed by blinded evaluation using the intraclass correlation coefficient.ResultsThere were 16 and 29 IPMNs with high- and low-grade dysplasia, respectively. The LSR, ADCoverall mean, ADCmean0-10, ADCmean10-25, ADCmean25-50, and ADCentropy showed significant between-group differences (AUC = 72-93%; p < 0.05). Inter-rater reliability assessment showed almost perfect agreement for LSR and substantial agreement for ADCoverall mean and ADCentropy. Multivariate logistic regression showed that ADCoverall mean and ADCentropy were significant independent predictors of malignancy (p < 0.05), with diagnostic accuracies of 80% and 73%, respectively.ConclusionsADCoverall mean and ADCentropy from 3D analysis may assist in predicting IPMNs with high-grade dysplasia.

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“…73 Several DWI studies have demonstrated that aggressive IPMNs tend to have lower ADC values than more benign lesions, supporting the use of DWI as a predictor malignant risk. [74][75][76] Malignant IPMNs have also been associated with lower IVIM D slow and higher D fast values relative to more benign IPMNs. 77 Current prognostication guidelines are based entirely on anatomical features-distinction between mucinous content and serous content (and therefore differentiation between mucinous cystic neoplasms and benign serous cystadenomas) would significantly aid diagnosis and prognostication.…”

Section: Focal Pancreatic Massesmentioning

confidence: 99%

Quantitative pancreatic MRI: a pathology-based review

Chouhan

Firmin

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et al. 2019

The British Journal of Radiology

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MRI plays an important role in the clinical management of pancreatic disorders and interpretation is reliant on qualitative assessment of anatomy. Conventional sequences capturing pancreatic structure can however be adapted to yield quantitative measures which provide more diagnostic information, with a view to increasing diagnostic accuracy, improving patient stratification, providing robust non-invasive outcome measures for therapeutic trials and ultimately personalizing patient care. In this review, we evaluate the use of established techniques such as secretin-enhanced MR cholangiopancreatography, diffusion-weighted imaging, T 1, T 2* and fat fraction mapping, but also more experimental methods such as MR elastography and arterial spin labelling, and their application to the assessment of diffuse pancreatic disease (including chronic, acute and autoimmune pancreatitis/IgG4 disease, metabolic disease and iron deposition disorders) and cystic/solid focal pancreatic masses. Finally, we explore some of the broader challenges to their implementation and future directions in this promising area.

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Value of apparent diffusion coefficient for predicting malignancy of intraductal papillary mucinous neoplasms of the pancreas

Cited by 7 publications

References 26 publications

Diagnostic accuracy of diffusion restriction in intraductal papillary mucinous neoplasm of the pancreas in comparison with “high-risk stigmata” of the 2012 international consensus guidelines for prediction of the malignancy and invasiveness

Diagnostic accuracy of diffusion restriction in intraductal papillary mucinous neoplasm of the pancreas in comparison with “high-risk stigmata” of the 2012 international consensus guidelines for prediction of the malignancy and invasiveness

3D quantitative analysis of diffusion-weighted imaging for predicting the malignant potential of intraductal papillary mucinous neoplasms of the pancreas

Quantitative pancreatic MRI: a pathology-based review

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