title: Diffusion-Weighted Magnetic Resonance Imaging in Distinguishing Between Mucin-Producing and Serous Pancreatic Cysts.
abstract: OBJECTIVE
  The aim of this study was to evaluate the feasibility and reproducibility of diffusion-weighted imaging in distinguishing between mucin-producing and serous pancreatic cysts.
  
  
  METHODS
  Forty-four pancreatic cysts (43 patients, 27 women; mean age, 57 years; 26 mucin-producing cysts, 18 serous cysts) that underwent histological examination or cyst analysis after diffusion-weighted magnetic resonance imaging were retrospectively reviewed. Three blinded readers independently evaluated signal intensity and apparent diffusion coefficient (ADC). Intraobserver and interobserver agreements were calculated. Fisher exact test and Welch t test were used to compare signal intensity and ADC values, respectively, with pathological results. Receiver operating characteristic analysis was used to determine diagnostic accuracy of various thresholds for ADC. A P value less than 0.05 was considered statistically significant.
  
  
  RESULTS
  Mean ADC values of the mucin-producing cysts were 3.26 × 10, 3.27 × 10, and 3.35 × 10 mm/s for the 3 readers, respectively. Mean ADC values of the serous cysts were 2.86 × 10, 2.85 × 10, and 2.85 × 10 mm/s for the 3 readers, respectively. Differences in ADC values between the 2 cyst groups were 12.4%, 12.9%, and 14.8% for the 3 readers, respectively (P < 0.001). Intraobserver and interobserver agreement was excellent. A threshold ADC of 3 × 10 mm/s resulted in correct identification of cysts in 77% to 81% of cases, with sensitivity and specificity ranging between 84% and 88% and 66% and 72%, respectively.
  
  
  CONCLUSIONS
  Diffusion-weighted imaging may be a helpful tool in distinguishing between mucin-producing and serous pancreatic cysts.
authors.affiliation: From *The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD; Departments of †Medical, Surgical and Neurosciences, and ‡Molecular and Developmental Medicine, University of Siena, Siena, Italy; and Departments of §Medicine (Gastroenterology), ∥Surgery, and ¶Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD.
authors.forename: Chiara
authors.initials: C
authors.lastname: Pozzessere
authors.forename: Sandra Luz
authors.initials: SL
authors.lastname: Castaños Gutiérrez
authors.forename: Celia Pamela
authors.initials: CP
authors.lastname: Corona-Villalobos
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Righi
authors.forename: Chunmiao
authors.initials: C
authors.lastname: Xu
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.forename: Michael
authors.initials: M
authors.lastname: Goggins
authors.forename: Marcia I
authors.initials: MI
authors.lastname: Canto
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018291:Cystadenoma, Mucinous / Q000000981:diagnostic imaging*; D018293:Cystadenoma, Serous / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity