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Diagnostic performance of magnetic resonance image for malignant intraductal papillary mucinous neoplasms: the importance of size of enhancing mural nodule within cyst

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Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the clinical significance of enhancing mural nodules ≥ 5 mm by comparing the diagnostic performance of high-risk stigmata for diagnosing the malignant IPMN between the international consensus guideline (ICG) 2012 and 2017 in pancreatic magnetic resonance image (MRI).

Materials and Methods

In this retrospective study, we reviewed preoperative pancreatic MRI with surgically confirmed IPMNs between May 2009 and April 2021. High-risk stigmata, defined by ICG 2012 and ICG 2017, associated with malignant IPMN were evaluated using logistic regression analysis. We calculated and compared the sensitivity and specificity of ICG 2012 and ICG 2017 for diagnosing malignant IPMNs. Receiver-operating characteristic (ROC) curves were used to compare ICG 2012 to ICG 2017.

Results

A total of 73 patients (43 men and 30 women; mean age, 69 years; standard deviation, 8 years) with 34 malignant IPMNs and 39 benign IPMNs were included. Among high-risk stigmata, enhancing mural nodule ≥ 5 mm, and MPD diameter ≥ 10 mm were the significant predictor of malignant IPMN, in multivariate logistic regression (P < 0.001 for all). For the diagnosis of malignant IPMN, the specificity of ICG 2017 for enhancing mural nodules ≥ 5 mm as the high-risk stigmata was significantly higher than that of ICG 2012 (87.2% vs. 64.1%, P = 0.008). However, there was no significant difference in sensitivity between the two guidelines (94.1% vs. 97.1%, P = 1.0). The comparison of the ROC curves showed that the diagnostic performance of ICG 2017 for malignant IPMNs (AUC, 0.91) significantly improved when compared to that of ICG 2012 (AUC, 0.81) (P = 0.01).

Conclusion

When applying enhancing mural nodule ≥ 5 mm as a high-risk stigmata, ICG 2017 provided a significantly higher specificity than ICG 2012 without a reduction in sensitivity.

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Abbreviations

ICG:

International consensus guidelines

IPMN:

Intraductal papillary mucinous neoplasm

MRI:

Magnetic resonance image

ROC:

Receiver-operating characteristic

MPD:

Main pancreatic duct

AUC:

Area under the ROC curve

EUS:

Endoscopic ultrasonography

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Authors and Affiliations

  1. Department of Radiology and Biomedical Research Institute of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, Korea

    Seung Baek Hong, Nam Kyung Lee & Suk Kim

  2. Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

    Hyung-Il Seo, Young Mok Park & Byeong Gwan Noh

  3. Department of Internal Medicine, Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea

    Dong Uk Kim & Sung Yong Han

  4. Department of Radiology, Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea

    Tae Un Kim

Authors
  1. Seung Baek Hong
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  2. Nam Kyung Lee
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  3. Suk Kim
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  4. Hyung-Il Seo
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  5. Young Mok Park
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  6. Byeong Gwan Noh
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  7. Dong Uk Kim
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  8. Sung Yong Han
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  9. Tae Un Kim
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Contributions

SB Hong and NK Lee contributed to the study concept and design. SB Hong, HI Seo, and S Kim acquired the data. SB Hong, and NK Lee analyzed and interpreted the data. SB Hong, and NK Lee drafted the manuscript. NK Lee performed statistical analysis. NK Lee, YM Park, BG Noh, DW Kim, SY Han, and TU Kim made critical revisions to the manuscript. NK Lee supervised the study.

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Correspondence to Nam Kyung Lee.

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We confirm that the manuscript represents valid original work and that neither this manuscript nor one with substantially similar content under our authorship has been published or is being considered for publication elsewhere. The manuscript has been read and approved by all the authors, who are willing to undertake the possible costs of publication. Furthermore, we confirm that there is no conflict of interest (financial or otherwise) that may directly or indirectly influence the content of our submitted manuscript.

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Hong, S.B., Lee, N.K., Kim, S. et al. Diagnostic performance of magnetic resonance image for malignant intraductal papillary mucinous neoplasms: the importance of size of enhancing mural nodule within cyst. Jpn J Radiol 40, 1282–1289 (2022). https://doi.org/10.1007/s11604-022-01312-y

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  • DOI: https://doi.org/10.1007/s11604-022-01312-y

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