INTRODUCTION: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are being diagnosed with increased frequency. CT scanning commonly serves as the primary imaging modality before surgery. We hypothesized MRCP provides better characterization of IPMN type/extent, which more closely matches actual pathology. METHODS: Of 214 patients treated with IPMN (1991-2006), 30 had both preoperative CT and MRCP. Of these, 18 met imaging study criteria. Independent readers performed retrospective, blinded analyses using standardized criteria for IPMN type and extent. RESULTS: A ductal connection was detected on 73% of MRCP scans and only 18% of CT. IPMN type was classified differently in seven (39%); four (22%) of which were read on CT as having main duct involvement where this was not appreciated on MRCP or found on surgical pathology. MRCP showed multifocal disease in 13(72%) versus only 9(50%) on CT. A different disease distribution was seen in 9(50%). Finally, 101 branch lesions were identified on MRCP compared to 46 on CT. CONCLUSIONS: CT falls short of MRCP in detecting a ductal connection, estimating main duct involvement, and identification of small branch duct cysts. These factors influence diagnostic accuracy, cancer risk stratification and operative strategy. MRCP should be employed for optimal management of patients with IPMN.
INTRODUCTION: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are being diagnosed with increased frequency. CT scanning commonly serves as the primary imaging modality before surgery. We hypothesized MRCP provides better characterization of IPMN type/extent, which more closely matches actual pathology. METHODS: Of 214 patients treated with IPMN (1991-2006), 30 had both preoperative CT and MRCP. Of these, 18 met imaging study criteria. Independent readers performed retrospective, blinded analyses using standardized criteria for IPMN type and extent. RESULTS: A ductal connection was detected on 73% of MRCP scans and only 18% of CT. IPMN type was classified differently in seven (39%); four (22%) of which were read on CT as having main duct involvement where this was not appreciated on MRCP or found on surgical pathology. MRCP showed multifocal disease in 13(72%) versus only 9(50%) on CT. A different disease distribution was seen in 9(50%). Finally, 101 branch lesions were identified on MRCP compared to 46 on CT. CONCLUSIONS: CT falls short of MRCP in detecting a ductal connection, estimating main duct involvement, and identification of small branch duct cysts. These factors influence diagnostic accuracy, cancer risk stratification and operative strategy. MRCP should be employed for optimal management of patients with IPMN.
Authors: Dushyant V Sahani; Rajagopal Kadavigere; Michael Blake; Carlos Fernandez-Del Castillo; Gregory Y Lauwers; Peter F Hahn Journal: Radiology Date: 2006-02 Impact factor: 11.105
Authors: Suresh T Chari; Dhiraj Yadav; Thomas C Smyrk; Eugene P DiMagno; Laurence J Miller; Massimo Raimondo; Jonathan E Clain; Ian A Norton; Randall K Pearson; Bret T Petersen; Maurits J Wiersema; Michael B Farnell; Michael G Sarr Journal: Gastroenterology Date: 2002-11 Impact factor: 22.682
Authors: Y Fukukura; F Fujiyoshi; M Sasaki; N Ichinari; H Inoue; Y Kajiya; M Nakajo Journal: J Comput Assist Tomogr Date: 1999 Mar-Apr Impact factor: 1.826
Authors: T Wakabayashi; Y Kawaura; H Morimoto; K Watanabe; D Toya; Y Asada; Y Satomura; H Watanabe; T Okai; N Sawabu Journal: Pancreas Date: 2001-05 Impact factor: 3.327
Authors: Kristine S Spinelli; Travis E Fromwiller; Roger A Daniel; James M Kiely; Attila Nakeeb; Richard A Komorowski; Stuart D Wilson; Henry A Pitt Journal: Ann Surg Date: 2004-05 Impact factor: 12.969
Authors: Taylor A Sohn; Charles J Yeo; John L Cameron; Ralph H Hruban; Noriyoshi Fukushima; Kurtis A Campbell; Keith D Lillemoe Journal: Ann Surg Date: 2004-06 Impact factor: 12.969
Authors: Reto M Käppeli; Sascha A Müller; Bianka Hummel; Christina Kruse; Philip Müller; Jürgen Fornaro; Alexander Wilhelm; Marcel Zadnikar; Bruno M Schmied; Ignazio Tarantino Journal: Langenbecks Arch Surg Date: 2013-09-03 Impact factor: 3.445