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Added value of apparent diffusion coefficient in distinguishing between serous and mucin-producing pancreatic cystic neoplasms

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the added value of diffusion-weighted imaging (DWI) on MRI in differentiating serous from mucin-producing pancreatic cystic neoplasms (PCNs).

Methods

One hundred seventeen patients with PCN measuring ≥ 10 mm were included. Three readers independently evaluated MRI with and without the use of apparent diffusion coefficient (ADC). Logistic regression was used to analyze whether confidence scores were different with the use of different image sets. Diagnostic performance with and without ADC was compared.

Results

DWI/ADC improved confidence in 44.8%, 73.6%, and 78.2% of patients by the three readers in distinguishing serous from mucin-producing PCNs. The use of ADC increased the probability of a higher confidence in the differentiation as compared to morphological imaging for all three readers (p < 0.001). Odds ratio for increase in the diagnostic confidence with the use of ADC for the three readers with decreasing years of experience were 5.8, 6.8, and 12.7. The diagnostic accuracy of morphological MRI with ADC was higher than that without ADC for two of three readers with lesser experience (87.2% vs. 80.8%; 91.5% vs. 80.8%).

Conclusion

DWI may have added value as a complementary tool to conventional morphological MRI in differentiating between serous and mucin-producing PCNs with possibly greater value for readers with less experience in reading abdominal MRI.

Key Points

• Optimal management of PCNs requires differentiation of serous from mucin-producing PCNs.

• ADC measurements allow increased confidence in differentiating serous from mucin-producing PCNs.

• ADC measurements increase the accuracy in diagnosing serous versus mucin-producing PCNs.

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Abbreviations

ADC:

Apparent diffusion coefficient

BD-IPMN:

Branch duct intraductal papillary mucinous neoplasm

CE-MRI:

Contrast-enhanced magnetic resonance imaging

CT:

Computed tomography

DWI:

Diffusion-weighted imaging

FNA:

Fine needle aspiration

FS:

Fat saturation

GRE:

Gradient echo

IPMN:

Intraductal papillary mucinous neoplasm

MCN:

Mucinous cystic neoplasm

MD-IPMN:

Main duct intraductal papillary mucinous neoplasm

MRCP:

Magnetic resonance cholangiopancreatography

MRI:

Magnetic resonance imaging

PCN:

Pancreatic cystic neoplasm

SCA:

Serous cystadenoma

SD:

Standard deviation

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Russell H. Morgan Department of Radiology and Radiological Sciences, Central Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Room 143, Baltimore, MD, 21287, USA

    Pallavi Pandey, Ankur Pandey, Nannan Shao, Farnaz Najmi Varzaneh, Mounes Aliyari Ghasabeh, Manijeh Zharghampour, Pegah Khoshpouri, Daniel Fouladi, John Eng & Ihab R. Kamel

  2. Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Anne Marie O’Broin-Lennon & Marcia Canto

  3. Department of Pathology, Johns Hopkins Medical Institutions, 1550 Orleans Street, Baltimore, MD, 21231, USA

    Ralph H. Hruban

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  1. Pallavi Pandey
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Correspondence to Ihab R. Kamel.

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The scientific guarantor of this publication is Ihab R. Kamel.

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Pandey, P., Pandey, A., Shao, N. et al. Added value of apparent diffusion coefficient in distinguishing between serous and mucin-producing pancreatic cystic neoplasms. Eur Radiol 29, 4660–4669 (2019). https://doi.org/10.1007/s00330-019-6010-9

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  • DOI: https://doi.org/10.1007/s00330-019-6010-9

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