Abstract
Purpose To evaluate multiparametric analysis in differential diagnosis between pancreatic serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) as well as the differentiation of the benign and malignant MCNs with 18F-FDG (18-fluorodeoxyglucose) PET/CT (positron emission tomography). Methods Forty patients with total of 41 lesions (SCNs: 27/41; MCNs: 14/41), who were preoperatively examined with 18F-FDG PET/CT, were retrospectively analyzed. Multiple quantitative parameters using conventional and texture features were included. The combined model was established with complementary PET/MR parameters. The differential diagnostic efficacy of each independent parameter and the combined model were evaluated with receiver operating characteristic (ROC) analysis. Integrated discriminatory improvement (IDI) and net reclassification improvement (NRI) were used to evaluate improvement of diagnostic efficacy by using combination of multiple parameters. Results Among all independent parameters, the percentile 5th (0.88 ± 0.38 vs 0.47 ± 0.23, P < 0.001) showed the highest discriminative diagnostic value. The combination of multiple parameters can improve the differential diagnostic efficacy of SCNs and MCNs (sensitivity = 71.4%, specificity = 77.8%, and AUC = 0.788), and the addition of texture parameters to the conventional parameters allowed a significant reclassification with IDI = 0.236 (95% CI: 0.095–0.377) and categorical NRI = 0.434 (95% CI: 0.030–0.838). SURmax (tumor to normal pancreas ratio, T/P) and SURmax (tumor to aorta ratio, T/A) both showed the highest discriminative diagnostic value (sensitivity = 100.0%, specificity = 70.0%, AUC = 0.900, and Youden index = 0.700) in the differential diagnosis of benign and malignant MCNs, with the cutoff values of 0.84 and 0.90, respectively. ConclusionCombination of multiple parameters using 18F-FDG PET/CT could further improve differentiation between pancreatic SCNs and MCNs. SURmax (T/P) and SURmax (T/A) could improve differential diagnosis of benign and malignant MCNs.
Highlights
Serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) are two frequent cystic lesions of the pancreas
To the best of our knowledge, no published study has analyzed the histogram and texture features of 18F-FDG PET/computed tomography (CT) to differentiate between SCNs and MCNs. e present study based on conventional and texture analysis with 18F-FDG positron emission tomography/computed tomography (PET/CT) investigated the diagnostic efficacy in the differential diagnosis of pancreatic SCNs and MCNs by using multiple parameters independently and in combination and evaluated the 18F-FDG PET/CT in the differential diagnosis between benign and malignant MCNs
Among all 18F-FDG PET/CT metabolic parameters, our current findings indicated that the percentile 5th with texture analysis was the best to distinguish between SCNs and MCNs independently
Summary
Serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) are two frequent cystic lesions of the pancreas. SCNs are considered as a benign lesion which predominantly occurs at the tail of the pancreas among older women, and the chance of malignant transformation is less than 1% [1, 2]. Multiple imaging features based on histogram, texture, and radiomics analysis can be used to quantitatively evaluate the intertumoral heterogeneity on 18F-FDG PET/ CT [11]. To the best of our knowledge, no published study has analyzed the histogram and texture features of 18F-FDG PET/CT to differentiate between SCNs and MCNs. e present study based on conventional and texture analysis with 18F-FDG PET/CT investigated the diagnostic efficacy in the differential diagnosis of pancreatic SCNs and MCNs by using multiple parameters independently and in combination and evaluated the 18F-FDG PET/CT in the differential diagnosis between benign and malignant MCNs
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