CT vs MRCP: optimal classification of IPMN type and extent.
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.
Waters
Joshua A
JA
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Schmidt
C Max
CM
Pinchot
Jason W
JW
White
Patrick B
PB
Cummings
Oscar W
OW
Pitt
Henry A
HA
Sandrasegaran
Kumar
K
Akisik
Fatih
F
Howard
Thomas J
TJ
Nakeeb
Attila
A
Zyromski
Nicholas J
NJ
Lillemoe
Keith D
KD
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*