Intraductal papillary mucinous neoplasms of the pancreas: correlation of helical CT and dynamic MR imaging features with pathologic findings

Abstract

We assessed the imaging features of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas paying special attention to underlying pancreatic fibrosis on three-phase helical computed tomography (CT) and dynamic magnetic resonance (MR) imaging. Sixteen patients with histopathologically proven IPMNs underwent three-phase helical CT and dynamic MR imaging. IPMNs were seen as a cluster of cyst-like structures in branch duct (n = 5) and combined types (n = 10), and as a fusiform appearance in the main duct type (n = 1). IPMN shape was most easily visualized at the portal venous dominant phase or delayed phase owing to rim-like enhancement of the dilated ducts. Pathologically mild to severe fibrosis was seen on this enhanced rim replacing the surrounding pancreatic parenchyma. Communication between the dilated branch ducts and main pancreatic duct was identified in 15 patients on helical CT and 14 patients on dynamic MR imaging. In patients with fibrosis of pancreatic parenchyma surrounding this, communication was most easily visualized at the later phase on CT and MR imaging. Adenocarcinomas were depicted as papillary projections in eight of nine patients on CT and MR imaging. Invasion of the pancreatic parenchyma was seen in five of six patients as a solid mass in the pancreatic parenchyma. These masses were most easily visualized at the arterial dominant phase on both CT and MR imaging. Three-phase helical CT and dynamic MR imaging were useful in the diagnosis of IPMN of the pancreas.