title: Implications of imaging criteria for the management and treatment of intraductal papillary mucinous neoplasms - benign versus malignant findings.
abstract: OBJECTIVE
  Evaluation of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiation of pancreatic intraductal papillary mucinous neoplasm (IPMN) subtypes based on objective imaging criteria.
  
  
  METHODS
  Fifty-eight patients with 60 histologically confirmed IPMNs were included in this retrospective study. Eighty-three imaging studies (CT,n = 42; MRI,n = 41) were analysed by three independent blinded observers (O1-O3), using established imaging criteria to assess likelihood of malignancy (-5, very likely benign; 5, very likely malignant) and histological subtype (i.e., low-grade (LGD), moderate-grade (MGD), high-grade dysplasia (HGD), early invasive carcinoma (IPMC), solid carcinoma (CA) arising from IPMN).
  
  
  RESULTS
  Forty-one benign (LGD IPMN,n = 20; MGD IPMN,n = 21) and 19 malignant (HGD IPMN,n = 3; IPMC,n = 6; solid CA,n = 10) IPMNs located in the main duct (n = 6), branch duct (n = 37), or both (n = 17) were evaluated. Overall accuracy of differentiation between benign and malignant IPMNs was 86/92 % (CT/MRI). Exclusion of overtly malignant cases (solid CA) resulted in overall accuracy of 83/90 % (CT/MRI). The presence of mural nodules and ductal lesion size ≥30 mm were significant indicators of malignancy (p = 0.02 and p < 0.001, respectively).
  
  
  CONCLUSIONS
  Invasive IPMN can be identified with high confidence and sensitivity using CT and MRI. The diagnostic problem that remains is the accurate radiological differentiation of premalignant and non-invasive subtypes.
  
  
  CONCLUSIONS
  • CT and MRI can differentiate benign from malignant forms of IPMN. • Identifying (pre)malignant histological IPMN subtypes by CT and MRI is difficult. • Overall, diagnostic performance with MRI was slightly (not significantly) superior to CT.
authors.affiliation: Klinik für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany, thula.walter@charite.de.
authors.forename: Thula Cannon
authors.initials: TC
authors.lastname: Walter
authors.forename: Ingo G
authors.initials: IG
authors.lastname: Steffen
authors.forename: Lars H
authors.initials: LH
authors.lastname: Stelter
authors.forename: Martin H
authors.initials: MH
authors.lastname: Maurer
authors.forename: Marcus
authors.initials: M
authors.lastname: Bahra
authors.forename: Wladimir
authors.initials: W
authors.lastname: Faber
authors.forename: Fritz
authors.initials: F
authors.lastname: Klein
authors.forename: Hendrik
authors.initials: H
authors.lastname: Bläker
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
authors.forename: Christian
authors.initials: C
authors.lastname: Grieser
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis*; D002291:Carcinoma, Papillary / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed