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Comparison between multislice CT and MR imaging in the diagnostic evaluation of patients with pancreatic masses

Confronto fra TC multistrato e RM nella valutazione diagnostica dei pazienti con masse pancreatiche

  • Abdominal Radiology/Radiologia Addominale
  • Published:
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Abstract

Purpose

This study compared the results of multislice computed tomography (MSCT) and high-field magnetic resonance imaging (MRI) in the diagnostic evaluation of pancreatic masses.

Materials and methods

Forty patients with clinical and ultrasonographic evidence of pancreatic masses underwent MSCT and MRI. The majority of patients (31/40, 78%) had proven malignant pancreatic tumours (24 ductal adenocarcinoma, six mucinous cystadenocarcinoma, one intraductal papillary mucinous carcinoma), whereas the remaining patients (9/40, 22%) were found to have benign lesions (eight chronic pancreatitis, one serous cystadenoma). Results of the imaging studies were compared with biopsy (n=33) and/or histology (n=7) findings to calculate sensitivity, specificity, accuracy and positive (PPV) and negative (NPV) predictive value for correct identification of tumours and evaluation of resectability of malignancies.

Results

Both for tumour identification and resectability, MSCT and MRI had comparable diagnostic accuracy, with no statistically significant differences between them. Tumour identification CT/MRI: accuracy 98/98%, sensitivity 100/100%, specificity 88/88%, PPV 97/97%, NPV 100/100%; tumour resectability CT/MRI: accuracy 94/90%, sensitivity 92/88%, specificity 100/100%, PPV 100/100%, NPV 78/70%.

Conclusions

MRI represents a valid diagnostic alternative to CT in the evaluation of patients with pancreatic masses, both for correct identification and characterisation of primary lesions and to establish resectability in the case of malignancies. New high-field MRI equipment allows optimal imaging quality with good contrast resolution in evaluating the upper abdomen.

Riassunto

Obiettivo

Scopo del nostro studio è stato effettuare un confronto dei risultati della tomografia computerizzata (TC) multistrato e della risonanza magnetica (RM) ad alto campo nella valutazione diagnostica di pazienti con masse pancreatiche.

Materiali e metodi

Sono stati studiati 40 pazienti con evidenza clinico-ecografica di masse pancreatiche, di cui la maggioranza (78%; n=31) con tumori pancreatici maligni di diverso tipo istologico (adenocarcinoma duttale=24, cistoadenocarcinoma mucinoso=6, carcinoma mucinoso papillifero intraduttale=1); nei restanti 9 pazienti (22%) sono state dimostrate lesioni espansive di tipo benigno da pancreatite cronica (n=8) o da cistoadenoma sieroso (n=1); tutti i pazienti sono stati sottoposti a TC ed RM; i risultati degli esami di imaging sono stati confrontati con i dati bioptici (n=33) e/o istologici (n=7) ai fini del calcolo dei valori diagnostici di sensibilità, specificità, accuratezza, valori predittivi positivo (VPP) e negativo (VPN) per la corretta identificazione dei tumori maligni e la valutazione dell’eventuale resecabilità chirurgica delle lesioni.

Risultati

Sia per l’identificazione delle lesioni neoplastiche che per la valutazione della resecabilità chirurgica, la TC e la RM hanno mostrato valori di accuratezza diagnostica comparabili senza differenze statisticamente significative; identificazione del tumore TC/RM: accuratezza=98%/98%, sensibilità=100%/100%, specificità=88%/88%, VPP=97%/97%, VPN=100%/100%; resecabilità del tumore TC/RM: accuratezza=94%/90%, sensibilità=92%/88%, specificità=100%/100%, VPP=100%/100%, VPN=78%/70%.

Conclusioni

La RM rappresenta una valida alternativa diagnostica all’esame TC nei pazienti con lesioni espansive del pancreas; in particolare, la RM consente sia la corretta identificazione e caratterizzazione delle masse pancreatiche che la valutazione dell’eventuale resecabilità chirurgica in caso di malignità; l’alto campo magnetico delle nuove apparecchiature permette di ottenere un’ottima qualità delle immagini RM che mostrano un’elevata risoluzione di contrasto nello studio dell’addome superiore.

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Authors and Affiliations

  1. Dipartimento di Scienze Biomorfologiche e Funzionali (DSBMF), Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Fondazione SDN (IRCCS), Napoli, Italy

    M. Fusari, S. Maurea, M. Imbriaco, C. Mollica, G. Avitabile, F. Soscia, L. Camera & M. Salvatore

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  1. M. Fusari
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  2. S. Maurea
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  3. M. Imbriaco
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  4. C. Mollica
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  5. G. Avitabile
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  6. F. Soscia
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  7. L. Camera
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  8. M. Salvatore
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Correspondence to S. Maurea.

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Fusari, M., Maurea, S., Imbriaco, M. et al. Comparison between multislice CT and MR imaging in the diagnostic evaluation of patients with pancreatic masses. Radiol med 115, 453–466 (2010). https://doi.org/10.1007/s11547-010-0490-7

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  • DOI: https://doi.org/10.1007/s11547-010-0490-7

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