title: CT vs MRCP: optimal classification of IPMN type and extent.
abstract: BACKGROUND
  Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are being diagnosed with increased frequency. CT scanning commonly serves as the primary imaging modality before surgery. We hypothesized MRCP provides better characterization of IPMN type/extent, which more closely matches actual pathology.
  
  
  METHODS
  Of 214 patients treated with IPMN (1991-2006), 30 had both preoperative CT and MRCP. Of these, 18 met imaging study criteria. Independent readers performed retrospective, blinded analyses using standardized criteria for IPMN type and extent.
  
  
  RESULTS
  A ductal connection was detected on 73% of MRCP scans and only 18% of CT. IPMN type was classified differently in seven (39%); four (22%) of which were read on CT as having main duct involvement where this was not appreciated on MRCP or found on surgical pathology. MRCP showed multifocal disease in 13(72%) versus only 9(50%) on CT. A different disease distribution was seen in 9(50%). Finally, 101 branch lesions were identified on MRCP compared to 46 on CT.
  
  
  CONCLUSIONS
  CT falls short of MRCP in detecting a ductal connection, estimating main duct involvement, and identification of small branch duct cysts. These factors influence diagnostic accuracy, cancer risk stratification and operative strategy. MRCP should be employed for optimal management of patients with IPMN.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Waters
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Jason W
authors.initials: JW
authors.lastname: Pinchot
authors.forename: Patrick B
authors.initials: PB
authors.lastname: White
authors.forename: Oscar W
authors.initials: OW
authors.lastname: Cummings
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Kumar
authors.initials: K
authors.lastname: Sandrasegaran
authors.forename: Fatih
authors.initials: F
authors.lastname: Akisik
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Howard
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000145:classification* / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000145:classification* / Q000175:diagnosis / Q000601:surgery; D002291:Carcinoma, Papillary / Q000145:classification* / Q000175:diagnosis / Q000601:surgery; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*