title: Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts.
abstract: OBJECTIVE
  The objective of our study was to compare MDCT with MRI-MR cholangiopancreatography (MRCP) in characterizing small pancreatic cysts (< or = 3 cm) and predicting aggressiveness.
  
  
  METHODS
  In a retrospective analysis, contrast-enhanced MDCT and MRI examinations of 30 patients with 38 pathologically confirmed small pancreatic cysts were reviewed. MDCT and MRCP studies were independently evaluated by two readers for cyst morphology, cyst characterization, and prediction of lesion aggressiveness, which included lesions with moderate-grade dysplasia, high-grade dysplasia (carcinoma in situ), and invasive carcinomas. The sensitivity of MDCT and MRI for the detection of each morphologic feature, accuracy for cyst characterization, and predictive values for aggressiveness were calculated.
  
  
  RESULTS
  Of 38 lesions, 14 were side-branch intraductal papillary mucinous neoplasms (IPMNs), 12 mixed IPMNs, six mucinous cystic neoplasms, and six nonneoplastic cysts. On histopathology, 26 lesions were nonaggressive (six nonneoplastic cysts, six benign mucinous cystic neoplasms, 14 low-grade dysplasias in IPMNs), whereas 12 lesions revealed aggressive biology (eight moderate-grade dysplasias, four high-grade dysplasias in IPMNs). The sensitivity of MRCP for the detection of morphologic features was better than that of MDCT, but the differences were not statistically significant (p = 0.25-1). Interreader agreement and MDCT-MRI agreement for morphologic features were good to perfect (kappa = 0.7-1). The accuracy of MDCT and MRI was higher in classifying cysts as mucinous or nonmucinous than in determining a specific diagnosis (71-84.2% vs 39.5-44.7%, respectively), whereas the accuracy of the two techniques in characterizing cysts into nonaggressive and aggressive categories was similar (MDCT vs MRI, 75-78% vs 78-86%, respectively; p > 0.05).
  
  
  CONCLUSIONS
  MRI enables more confident assessment of the morphology of small cysts than MDCT, but the accuracy of the two imaging techniques for cyst characterization is comparable. MDCT and MRI have high accuracy in classifying cysts into mucinous and nonmucinous categories and perform similarly in estimating histologic aggressiveness.
authors.affiliation: Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA 02114-2696, USA.
authors.forename: Nisha I
authors.initials: NI
authors.lastname: Sainani
authors.forename: Anuradha
authors.initials: A
authors.lastname: Saokar
authors.forename: Vikram
authors.initials: V
authors.lastname: Deshpande
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-del Castillo
authors.forename: Peter
authors.initials: P
authors.lastname: Hahn
authors.forename: Dushyant V
authors.initials: DV
authors.lastname: Sahani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D049448:Cholangiopancreatography, Magnetic Resonance; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA