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)
Source
Abstract
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.
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