Andrea S Kierans1, Alexander Gavlin2, Natasha Wehrli2, Laura M Flisnik3, Sarah Eliades4, Meredith E Pittman5. 1. Department of Radiology, Weill Cornell Medical College, 1305 York Avenue, New York, NY, 10021, USA. ank9134@med.cornell.edu. 2. Department of Radiology, Weill Cornell Medical College, 1305 York Avenue, New York, NY, 10021, USA. 3. Department of Radiology, Westchester Medical Center, Valhalla, NY, 10595, USA. 4. Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA. 5. Maimonides Medical Center, Brooklyn, NY, 11219, USA.
Abstract
PURPOSE: To determine if gadolinium is necessary for the diagnosis of a pancreatic cystic lesion (PCL) as benign or malignant by assessing inter- and intra-observer agreement and diagnostic accuracy for the presence of worrisome features/high-risk stigmata on non-contrast MRI compared to MRI with and without contrast, with cytopathology as a reference standard. METHODS: The institutional database was searched to identify consecutive patients that underwent EUS/FNA or surgical resection of an asymptomatic PCL performed from 01/01/2015 to 01/01/2019. Two abdominal radiologists independently evaluated PCLs on MRI with all sequences except for contrast-enhanced sequences followed by a second reading with data from the entire MRI including pre- and post-contrast sequences. Cyst size, growth, and the presence of worrisome features/high-risk stigmata were assessed for each cyst on both datasets. RESULTS: There were 87 patients with 87 pancreatic cysts; 76(87.4%) were benign and 11 (12.7%) were malignant. The presence of any worrisome features/high-risk stigmata for reader 1 was concordant on both MRIs in 95.4% (83/87; k = 0.874) of cases and for reader 2 was concordant in 96.6% (84/87; k = 0.920) of cases. The diagnostic accuracy of the two datasets when the presence of any worrisome feature/high-risk stigmata was predictive of malignancy was identical for reader 1 (AUC = 0.622 for both; p = 1.0) and similar for reader 2 (AUC 0.569 and 0.589; p = 0.08) for both MRI datasets. CONCLUSION: The addition of gadolinium had no significant impact in the diagnosis of a benign versus malignant PCL, with similar intra-observer agreement and diagnostic accuracy for both readers when using contrast-enhanced and unenhanced MRI datasets.
PURPOSE: To determine if gadolinium is necessary for the diagnosis of a pancreatic cystic lesion (PCL) as benign or malignant by assessing inter- and intra-observer agreement and diagnostic accuracy for the presence of worrisome features/high-risk stigmata on non-contrast MRI compared to MRI with and without contrast, with cytopathology as a reference standard. METHODS: The institutional database was searched to identify consecutive patients that underwent EUS/FNA or surgical resection of an asymptomatic PCL performed from 01/01/2015 to 01/01/2019. Two abdominal radiologists independently evaluated PCLs on MRI with all sequences except for contrast-enhanced sequences followed by a second reading with data from the entire MRI including pre- and post-contrast sequences. Cyst size, growth, and the presence of worrisome features/high-risk stigmata were assessed for each cyst on both datasets. RESULTS: There were 87 patients with 87 pancreatic cysts; 76(87.4%) were benign and 11 (12.7%) were malignant. The presence of any worrisome features/high-risk stigmata for reader 1 was concordant on both MRIs in 95.4% (83/87; k = 0.874) of cases and for reader 2 was concordant in 96.6% (84/87; k = 0.920) of cases. The diagnostic accuracy of the two datasets when the presence of any worrisome feature/high-risk stigmata was predictive of malignancy was identical for reader 1 (AUC = 0.622 for both; p = 1.0) and similar for reader 2 (AUC 0.569 and 0.589; p = 0.08) for both MRI datasets. CONCLUSION: The addition of gadolinium had no significant impact in the diagnosis of a benign versus malignant PCL, with similar intra-observer agreement and diagnostic accuracy for both readers when using contrast-enhanced and unenhanced MRI datasets.
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Authors: Koen de Jong; C Yung Nio; John J Hermans; Marcel G Dijkgraaf; Dirk J Gouma; Casper H J van Eijck; Eddy van Heel; Gunter Klass; Paul Fockens; Marco J Bruno Journal: Clin Gastroenterol Hepatol Date: 2010-06-01 Impact factor: 11.382
Authors: Alec J Megibow; Mark E Baker; Desiree E Morgan; Ihab R Kamel; Dushyant V Sahani; Elliot Newman; William R Brugge; Lincoln L Berland; Pari V Pandharipande Journal: J Am Coll Radiol Date: 2017-05-19 Impact factor: 5.532
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Authors: Timothy B Gardner; Lisa M Glass; Kerrington D Smith; Gregory H Ripple; Richard J Barth; David A Klibansky; Thomas A Colacchio; Michael J Tsapakos; Arief A Suriawinata; Gregory J Tsongalis; J Marc Pipas; Stuart R Gordon Journal: Am J Gastroenterol Date: 2013-10 Impact factor: 10.864