Magnetic resonance (MR) for mural nodule detection studying Intraductal papillary mucinous neoplasms (IPMN) of pancreas: Imaging-pathologic correlation

Published on Jan 1, 2021in Pancreatology3.629
· DOI :10.1016/J.PAN.2020.11.024
Mirko D'Onofrio58
Estimated H-index: 58
(University of Verona),
Giorgia Tedesco3
Estimated H-index: 3
(University of Verona)
+ 12 AuthorsClaudio Bassi110
Estimated H-index: 110
(University of Verona)
Abstract Purpose Magnetic Resonance (MR) is recommended to diagnose Intraductal Papillary Mucinous Neoplasms (IPMN) and in the follow-up of borderline lesions. The purpose of this work is to evaluate the diagnostic accuracy of dynamic Magnetic Resonance (MR) with Diffusion Weighted Imaging (DWI) in the identification of mural nodules of IPMN of pancreas by using pathological analysis as gold standard. Materials and methods Ninety-one preoperative MR with histopathological diagnosis of IPMN were reviewed by two radiologists. Presence, number and size of mural nodule, signal intensity of the nodule on T1-weighted imaging (T1-WI) after contrast medium administration and on DWI. Inter-observer agreement was evaluated. Results Significant correlation (p   5 mm on MR and pathological specimen, size and number of mural nodule evaluated on pathological review and the degree of dysplasia, size and number of mural nodule evaluated on MR and tumoral dysplasia, presence of nodule > 5 mm with enhancement after contrast medium administration and hyperintensity on DWI and the degree of dysplasia. Interobserver agreement was moderate for the presence of mural nodule (K = 0.56), for the presence of high signal intensity on DWI (K = 0.60) and enhancement of mural nodule (K = 0.58). Apparent Diffusion Coefficient (ADC) map histogram analysis showed a correlation between Entropy of the entire cystic lesion and the degree of dysplasia (p  Conclusions MR with dynamic and DWI sequences is an accurate method for the identification of ≥ 5 mm solid nodules of the IPMNs and correlate with the lesion malignancy. Entropy, calculated from the histogram analysis of the IPMN ADC map, correlates with the lesion dysplasia.
📖 Papers frequently viewed together
13 Citations
39 Citations
43 Citations
#1Giovanni Marchegiani (University of Verona)H-Index: 29
#2Stefano Andrianello (University of Verona)H-Index: 16
Last. Roberto Salvia (University of Verona)H-Index: 52
view all 9 authors...
BACKGROUND: The association between risk of pancreatic cancer and a dilated main pancreatic duct (MPD) in intraductal papillary mucinous neoplasm (IPMN) is debated. The aim of this study was to assess the role of MPD size in predicting pancreatic cancer in resected IPMNs and those kept under surveillance. METHODS: All patients with IPMN referred to the Pancreas Institute, University of Verona Hospital Trust, from 2006 to 2016 were included. The primary endpoint was the occurrence of malignancy d...
15 CitationsSource
#1Giovanni Marchegiani (University of Verona)H-Index: 29
#2Stefano Andrianello (University of Verona)H-Index: 16
Last. Roberto Salvia (University of Verona)H-Index: 52
view all 13 authors...
Abstract Background Mural nodules (MNs) have a predominant role in the 2016 revision of the international guidelines on intraductal papillary mucinous neoplasms (IPMN) of the pancreas. The aim of this study was to evaluate MNs as predictors of invasive cancer (iCa) or high-grade dysplasia (HGD) in IPMNs and to investigate the role of MN size in risk prediction. Methods A PRISMA-compliant systematic review of the literature and meta-analysis on selected studies were conducted. The random effect m...
34 CitationsSource
#1Marco Del ChiaroH-Index: 31
#2Marc G. Besselink (UniSR: Vita-Salute San Raffaele University)H-Index: 84
Last. L. WustenH-Index: 1
view all 89 authors...
Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts perf...
402 CitationsSource
#1Jiyoung Hwang (SCH: Soonchunhyang University)H-Index: 9
#2Young Kon Kim (SMC: Samsung Medical Center)H-Index: 32
Last. Hyun-Joo Kim (SCH: Soonchunhyang University)H-Index: 9
view all 6 authors...
Objective To compare diagnostic performance of magnetic resonance imaging (MRI) and endoscopic ultrasonography (EUS) for differentiating malignant from benign intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) of the pancreas.
19 CitationsSource
#1Masao TanakaH-Index: 105
#2Carlos Fernandez-del Castillo (Harvard University)H-Index: 101
Last. Christopher L. Wolfgang (Johns Hopkins University)H-Index: 102
view all 10 authors...
Abstract The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant ch...
598 CitationsSource
#1Tyler J. Fraum (WashU: Washington University in St. Louis)H-Index: 9
#2Daniel R. Ludwig (WashU: Washington University in St. Louis)H-Index: 8
Last. Kathryn J. Fowler (WashU: Washington University in St. Louis)H-Index: 33
view all 4 authors...
Gadolinium-based contrast agents (GBCAs) have been used in magnetic resonance imaging (MRI) since the 1980s and are now administered in up to 35% of all MRI examinations. While GBCAs were initially felt to carry minimal risk, the subsequent identification of GBCAs as the key etiologic factor in the development of nephrogenic systemic fibrosis (NSF) has raised concerns about the broader health impacts of gadolinium exposure. Clinicians, radiologists, and patients should be aware of the most up-to...
164 CitationsSource
#1Huyen T. Nguyen (OSU: Ohio State University)H-Index: 4
#2Zarine K. Shah (OSU: Ohio State University)H-Index: 14
Last. Michael V. Knopp (OSU: Ohio State University)H-Index: 78
view all 8 authors...
Objectives To quantify the heterogeneity of the tumour apparent diffusion coefficient (ADC) using voxel-based analysis to differentiate malignancy from benign wall thickening of the urinary bladder.
10 CitationsSource
#1David Hoffman (NYU: New York University)H-Index: 6
#2Justin M. Ream (NYU: New York University)H-Index: 14
Last. Andrew B. Rosenkrantz (NYU: New York University)H-Index: 61
view all 4 authors...
Purpose To evaluate whole-lesion ADC histogram metrics for assessing the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs), including in comparison with conventional MRI features.
24 CitationsSource
#1Seo-Youn Choi (SCH: Soonchunhyang University)H-Index: 14
#2Jung Hoon Kim (SNU: Seoul National University)H-Index: 23
Last. Joon Koo Han (New Generation University College)H-Index: 42
view all 6 authors...
Purpose To compare diagnostic performance for prediction of malignant potential in IPMNs between EUS, contrast-enhanced CT and MRI.
30 CitationsSource
#1Mimi Kim (Hanyang University)H-Index: 3
#2Kyung Mi JangH-Index: 17
Last. Heejin YooH-Index: 9
view all 10 authors...
BackgroundIt 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).PurposeTo evaluate the diagnostic accuracy of diffusion restriction in IPMNs for prediction of malignancy and invasiveness in comparison with high-risk stigmata of 2012 I...
8 CitationsSource
Cited By1
#1Naziheh Assarzadegan (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 7
#2Elizabeth D. Thompson (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 20
Last. Ralph H. Hruban (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 208
view all 8 authors...
BACKGROUND Intraductal papillary mucinous neoplasms (IPMNs) represent a unique opportunity to treat and prevent a curable neoplasm before it has the chance to progress to incurable cancer. This prospect, however, has to be balanced with the real risk of over treating patients with lesions that would, in fact, never progress during the life of the patient. PURPOSE Informed clinical decisions in the treatment of IPMNs are first and foremost based on a deep understanding of the pathology of these l...