Abstract
Pancreatic cystic lesions (PCL) are a frequent and underreported incidental finding on CT scans and can transform into neoplasms with devastating consequences. We developed and evaluated an algorithm based on a two-step nnU-Net architecture for automated detection of PCL on CTs. A total of 543 cysts on 221 abdominal CTs were manually segmented in 3D by a radiology resident in consensus with a board-certified radiologist specialized in abdominal radiology. This information was used to train a two-step nnU-Net for detection with the performance assessed depending on lesions’ volume and location in comparison to three human readers of varying experience. Mean sensitivity was 78.8 ± 0.1%. The sensitivity was highest for large lesions with 87.8% for cysts ≥220 mm3 and for lesions in the distal pancreas with up to 96.2%. The number of false-positive detections for cysts ≥220 mm3 was 0.1 per case. The algorithm’s performance was comparable to human readers. To conclude, automated detection of PCL on CTs is feasible. The proposed model could serve radiologists as a second reading tool. All imaging data and code used in this study are freely available online.
Highlights
Pancreatic cystic lesions (PCLs) are a common finding in cross-sectional imaging
intraductal papillary mucinous neoplasms (IPMNs) represent the most frequent premalignant PCLs and about 50% of all resected pancreatic cysts [6,7]. They are topographically classified according to their relation with the main pancreatic duct (MPD), with progression to invasive cancer in 42–48% of the main duct-IPMNs and mixed type-IPMNs, and 11–26% of the BD-IPMNs [5,6,8,9]
The aim of this study is to develop and test an nnU-Net algorithm for automated detection of pancreatic cystic lesions
Summary
Pancreatic cystic lesions (PCLs) are a common finding in cross-sectional imaging. The prevalence of incidental pancreatic cysts in abdominal CTs range from 2.6 to 5.4% in the normal population [1,2], increasing with age [1,3]. Whereas non-neoplastic lesions, like retention cysts or pseudocysts consecutive to pancreatitis, are not at risk for malignant transformation, mucinous cysts are considered potential cancer precursors [5]. IPMNs represent the most frequent premalignant PCLs and about 50% of all resected pancreatic cysts [6,7]. They are topographically classified according to their relation with the main pancreatic duct (MPD), with progression to invasive cancer in 42–48% of the main duct-IPMNs and mixed type-IPMNs, and 11–26% of the BD-IPMNs [5,6,8,9]. Apart from the malignant degeneration of an IPMN into an invasive carcinoma, the rate of concomitant carcinoma in the presence of an IPMN can be as high as
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