Abstract
PurposeTo evaluate whether an ultrashort-protocol (USP) MRI including only T2-weighted HASTE axial and 3D MRCP SPACE sequences adequately measures the largest diameter of the largest cyst and the main pancreatic duct (MPD) and identifies worrisome features (WF) and high-risk stigmata (HRS) when compared to longer protocols (LP, long protocol; SP, short protocol; S-LP, short or long protocol). We also calculated reductions in costs associated with USP.MethodsThis retrospective study included 183 IPMN patients. Two radiologists compared two imaging sets (USP versus S-LP) per patient, comparing the mean values of the largest cyst and MPD and agreement regarding the presence or absence of cystic or MPD mural nodules and solid pancreatic tumors. The interobserver agreement for cystic mural nodules and WF/HRS was evaluated, using the Bland-Altman plot and Cohen’s Kappa.ResultsA total of 112 IPMN patients were evaluated. For detecting cysts or MPD nodules, WF/HRS, and solid pancreatic tumors, USP and S-LP coincided in 94.9%, 99.1%, 92.4%, and 99.1% of cases, respectively. Both USP and S-LP identified all true cystic mural nodules. The mean size of the largest cyst and MPD was 19.48/19.67 mm and 3.24/3.33 mm using USP versus S-LP, while the mean differences for USP versus S-LP were 0.19 mm and 0.08 mm. The USP cost was 39% of LP cost and 77% of SP. Interobserver agreement was moderate to strong.ConclusionsFor IPMN surveillance, an ultrashort-protocol MRI provides nearly identical information to the more expensive longer protocols.Graphical abstract
Highlights
The prevalence of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas has increased in recent decades, partially due to better detection through the widespread use of improved resolution computed tomography (CT) and magnetic resonance imaging (MRI) [1, 2]
We evaluated the interobserver agreement for cystic mural nodules and worrisome features (WF)/ high-risk stigmata (HRS) and the intra-observer agreement when using USP and S-Long protocol (LP)
When reviewing interobserver agreement of cystic mural nodules, main pancreatic duct (MPD) mural nodules, and solid pancreatic tumors, readers reached the same conclusions using USP compared to S-LP in 94.9%, 99.1%, and 99.1%, respectively, of cases
Summary
The prevalence of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas has increased in recent decades, partially due to better detection through the widespread use of improved resolution computed tomography (CT) and magnetic resonance imaging (MRI) [1, 2]. IPMN changes carry a risk of malignant transformation, such that IPMN patients remain under surveillance [4]. Branch-duct IPMNs (BD-IPMNs) carry a pancreatic malignancy incidence rate of 3.3% at 5 years following diagnosis and 15% at 15 years [6]. The highest risk of malignant transformation accompanies main-duct IPMN (MD-IPMN) and mixedtype IPMN (MX-IPMN)), with risks ranging from 38 to 68% [1, 7]. WF include main pancreatic duct (MPD) dilatation of 5 to 9 mm, a cyst size of ≥ 3 cm, an enhancing mural nodule of < 5 mm, thickened enhanced cyst walls, an abrupt change in the MPD caliber with distal pancreatic atrophy, and lymphadenopathy [1]. HRS includes MPD ≥ 10 mm and an enhanced mural nodule of ≥ 5 mm [1]
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