title: Validation of the 2012 International Consensus Guidelines Using Computed Tomography and Magnetic Resonance Imaging: Branch Duct and Main Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas.
abstract: OBJECTIVE
  To validate the 2012 guidelines for intraductal papillary mucinous neoplasm (IPMN) of the pancreas and to compare diagnostic performances of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiating malignant from benign IPMN.
  
  
  BACKGROUND
  As IPMN has variable risks of malignancy and management of this entity is closely related to its malignant potential, it is important to predict risks of IPMN malignancy.
  
  
  METHODS
  This retrospective study included 158 patients with surgically confirmed IPMN of the pancreas who underwent both preoperative CT and MRI. Two radiologists evaluated the "high-risk stigmata" and "worrisome features" of the 2012 guidelines for branch duct (BD)-IPMN and main duct (MD)-IPMN. Univariate and multivariable analyses were used to identify significant predictors of malignancy in IPMN. The diagnostic performance was compared between CT and MRI.
  
  
  RESULTS
  Malignant IPMN was seen in 8 of 60 patients (13.3%) with BD-IPMN and 44 of 98 patients (44.9%) with MD-IPMN. Presence of mural nodule was the most important predictor in BD-IPMN and MD-IPMN (odds ratios, 9.2 and 7.6, respectively, P = 0.01 on CT; and odds ratios, 5.7 and 13.3, respectively, P ≤ 0.04 on MRI), whereas mural nodule size and lymphadenopathy were significant only in MD-IPMN (P < 0.05). The diagnostic performance of CT and MRI for significant findings was not statistically different in both types of IPMN (P > 0.34).
  
  
  CONCLUSIONS
  The presence of mural nodule was the most important predictor of malignancy in both types of IPMN. Mural nodule size and lymphadenopathy were also significant predictors in MD-IPMN. Computed tomography and MRI showed similar diagnostic performances for differentiating malignant from benign IPMN.
authors.affiliation: *Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea †Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea ‡Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Nieun
authors.initials: N
authors.lastname: Seo
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Byun
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyoung Jung
authors.initials: HJ
authors.lastname: Kim
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Ki Byung
authors.initials: KB
authors.lastname: Song
authors.forename: Song-Cheol
authors.initials: SC
authors.lastname: Kim
authors.forename: Duck Jong
authors.initials: DJ
authors.lastname: Han
authors.forename: Seung-Mo
authors.initials: SM
authors.lastname: Hong
authors.forename: Moon-Gyu
authors.initials: MG
authors.lastname: Lee
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000473:pathology; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007472:Iohexol / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide