Accelerated Pancreatobiliary MRI for Pancreatic Cancer Surveillance in Patients With Pancreatic Cystic Neoplasms.

Abstract

Pancreatobiliary MRI is often recommended for patients at risk of developing pancreas cancer. But the surveillance MRI protocol has not yet been widely accepted. To establish an accelerated MRI protocol targeting the table time of 15 minutes for pancreatic cancer surveillance and test its performance in lesion characterization. Prospective. A total of 30 participants were enrolled, who were undergoing follow-up care for intraductal papillary mucinous neoplasms or newly diagnosed pancreatic cysts (≥10 mm) and were scheduled for or had recently undergone contrast-enhanced CT (CECT). A 3 T; heavily T2WI, 3D MRCP, DWI, dynamic T1WI, two-point Dixon. In-room time and table time were measured. Seven radiologists independently reviewed image quality of MRI and then the presence of high-risk stigmata and worrisome features in addition to diagnostic confidence for accelerated MRI, CECT, and the noncontrast part of accelerated MRI (NC-MRI). Fisher's exact test was used for categorical variables and either the Student's t-test or Mann-Whitney test was performed for continuous variables. The generalized estimated equation was used to compare the diagnostic performance of examinations on a per-patient basis. Interobserver agreement was evaluated via Fleiss kappa. A P value of <0.05 was considered to be statistically significant. The in-room time was 18.5 ± 2.6minutes (range: 13.7-24.9) and the table time was 13.9 ± 1.9minutes (range: 10.7-17.5). There was no significant difference between the diagnostic performances of the three examinations (pooled sensitivity: 75% for accelerated MRI and CECT, 68% for NC-MRI, P=0.95), with the highest significant diagnostic confidence for accelerated MRI (4.2 ± 0.1). With accelerated MRI, the interobserver agreement was fair to excellent for high-risk stigmata (κ=0.34-0.98). Accelerated MRI protocol affords a table time of 15 minutes, making it potentially suitable for cancer surveillance in patients at risk of developing pancreatic cancer. 2 TECHNICAL EFFICACY STAGE: 2.