Raffaella Maria Pozzi-Mucelli1, Irina Rinta-Kiikka2, Katharina Wünsche3, Johanna Laukkarinen4, Knut Jørgen Labori5, Kim Ånonsen6, Caroline Verbeke7,8, Marco Del Chiaro9, Nikolaos Kartalis10. 1. Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Radiology, C1-46 Karolinska University Hospital, 14186, Stockholm, Sweden. 2. Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland. 3. Department of Radiology, St.Olavs University Hospital, Trondheim, Norway. 4. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. 5. Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway. 6. Department of Gastroenterology, Oslo University Hospital, Oslo, Norway. 7. Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway. 8. Department of Pathology, Karolinska University Hospital, Stockholm, Sweden. 9. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. 10. Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Radiology, C1-46 Karolinska University Hospital, 14186, Stockholm, Sweden. nikolaos.kartalis@karolinska.se.
Abstract
OBJECTIVES: The study aims were to evaluate: (1) whether a short-protocol (SP) MRI for the surveillance of pancreatic cystic neoplasms (PCN) provides equivalent clinical information as a comprehensive-protocol (CP), and (2) the cost reduction from substituting CP with SP for patient surveillance. METHODS: This retrospective study included 154 consecutive patients (median age: 66, 52 % men) with working-diagnosis of PCN and available contrast-enhanced MRI/MRCP. Three radiologists evaluated independently two imaging sets (SP/CP) per patient. The CP included: T2-weighted (HASTE/MRCP), DWI and T1-weighted (chemical-shift/pre-/post-contrast) images [acquisition time (AT) ≈ 35 min], whereas the SP included: T2-weighted HASTE and T1-weighted pre-contrast images (AT ≈ 8 min). Mean values of largest cyst/main pancreatic duct diameter (DC/DMPD) were compared. Agreement regarding presence/absence of cystic/MPD mural nodules (MNC/MNMPD), inter-observer agreement and cost differences between SP/CP were calculated. RESULTS: For DC and DMPD, mean values with SP/CP were 21.4/21.7 mm and 3.52/3.58 mm, while mean differences SP-CP were 0.3 mm (p = 0.02) and 0.06 mm (p = 0.12), respectively. For presence/absence of MNC and MNMPD, SP/CP coincided in 93 % and 98 % of cases, respectively. Inter-observer agreement was strong for SP/CP. SP-cost was 25 % of CP-cost. CONCLUSIONS: For the surveillance of PCN, short-protocol MRI provides information equivalent to the more time-consuming and costly comprehensive-protocol. KEY POINTS: • Pancreatic cystic neoplasms (PCN) are increasingly diagnosed in the general population. • Multiple imaging controls are recommended for the surveillance of patients with PCN. • Short and comprehensive MRI-protocols are equivalent for decision-making in PCN under surveillance. • Evaluation of imaging risk factors in PCNs is comparable with both MRI-protocols. • Use of the short MRI-protocol may rationalise healthcare resources.
OBJECTIVES: The study aims were to evaluate: (1) whether a short-protocol (SP) MRI for the surveillance of pancreatic cystic neoplasms (PCN) provides equivalent clinical information as a comprehensive-protocol (CP), and (2) the cost reduction from substituting CP with SP for patient surveillance. METHODS: This retrospective study included 154 consecutive patients (median age: 66, 52 % men) with working-diagnosis of PCN and available contrast-enhanced MRI/MRCP. Three radiologists evaluated independently two imaging sets (SP/CP) per patient. The CP included: T2-weighted (HASTE/MRCP), DWI and T1-weighted (chemical-shift/pre-/post-contrast) images [acquisition time (AT) ≈ 35 min], whereas the SP included: T2-weighted HASTE and T1-weighted pre-contrast images (AT ≈ 8 min). Mean values of largest cyst/main pancreatic duct diameter (DC/DMPD) were compared. Agreement regarding presence/absence of cystic/MPD mural nodules (MNC/MNMPD), inter-observer agreement and cost differences between SP/CP were calculated. RESULTS: For DC and DMPD, mean values with SP/CP were 21.4/21.7 mm and 3.52/3.58 mm, while mean differences SP-CP were 0.3 mm (p = 0.02) and 0.06 mm (p = 0.12), respectively. For presence/absence of MNC and MNMPD, SP/CP coincided in 93 % and 98 % of cases, respectively. Inter-observer agreement was strong for SP/CP. SP-cost was 25 % of CP-cost. CONCLUSIONS: For the surveillance of PCN, short-protocol MRI provides information equivalent to the more time-consuming and costly comprehensive-protocol. KEY POINTS: • Pancreatic cystic neoplasms (PCN) are increasingly diagnosed in the general population. • Multiple imaging controls are recommended for the surveillance of patients with PCN. • Short and comprehensive MRI-protocols are equivalent for decision-making in PCN under surveillance. • Evaluation of imaging risk factors in PCNs is comparable with both MRI-protocols. • Use of the short MRI-protocol may rationalise healthcare resources.
Entities:
Keywords:
Cysts; Interdisciplinary communication; Magnetic Resonance Imaging; Neoplasms; Pancreas
Authors: Lincoln L Berland; Stuart G Silverman; Richard M Gore; William W Mayo-Smith; Alec J Megibow; Judy Yee; James A Brink; Mark E Baker; Michael P Federle; W Dennis Foley; Isaac R Francis; Brian R Herts; Gary M Israel; Glenn Krinsky; Joel F Platt; William P Shuman; Andrew J Taylor Journal: J Am Coll Radiol Date: 2010-10 Impact factor: 5.532
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: Henrik S Thomsen; Sameh K Morcos; Torsten Almén; Marie-France Bellin; Michele Bertolotto; Georg Bongartz; Olivier Clement; Peter Leander; Gertraud Heinz-Peer; Peter Reimer; Fulvio Stacul; Aart van der Molen; Judith A W Webb Journal: Eur Radiol Date: 2012-08-04 Impact factor: 5.315
Authors: Thomas A Laffan; Karen M Horton; Alison P Klein; Bruce Berlanstein; Stanley S Siegelman; Satomi Kawamoto; Pamela T Johnson; Elliot K Fishman; Ralph H Hruban Journal: AJR Am J Roentgenol Date: 2008-09 Impact factor: 3.959
Authors: Aurang Z Khawaja; Deirdre B Cassidy; Julien Al Shakarchi; Damian G McGrogan; Nicholas G Inston; Robert G Jones Journal: Insights Imaging Date: 2015-08-08
Authors: Elizabeth M Hecht; Gaurav Khatri; Desiree Morgan; Stella Kang; Priya R Bhosale; Isaac R Francis; Namita S Gandhi; David M Hough; Chenchan Huang; Lyndon Luk; Alec Megibow; Justin M Ream; Dushyant Sahani; Vahid Yaghmai; Atif Zaheer; Ravi Kaza Journal: Abdom Radiol (NY) Date: 2020-11-13
Authors: Andrea S Kierans; Alexander Gavlin; Natasha Wehrli; Laura M Flisnik; Sarah Eliades; Meredith E Pittman Journal: Abdom Radiol (NY) Date: 2022-02-23
Authors: Michael Goggins; Kasper Alexander Overbeek; Randall Brand; Sapna Syngal; Marco Del Chiaro; Detlef K Bartsch; Claudio Bassi; Alfredo Carrato; James Farrell; Elliot K Fishman; Paul Fockens; Thomas M Gress; Jeanin E van Hooft; R H Hruban; Fay Kastrinos; Allison Klein; Anne Marie Lennon; Aimee Lucas; Walter Park; Anil Rustgi; Diane Simeone; Elena Stoffel; Hans F A Vasen; Djuna L Cahen; Marcia Irene Canto; Marco Bruno Journal: Gut Date: 2019-10-31 Impact factor: 23.059