title: Criteria for Determining Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasm Based on Computed Tomography.
abstract: BACKGROUND
  Determining the dignity of intraductal papillary mucinous neoplasms (IPMNs) by imaging procedures is challenging. Various CT-based criteria were evaluated.
  
  
  METHODS
  Preoperative CT scans from 47 patients with IPMN were analyzed. Predefined criteria of malignancy were compared between patients with benign (bIPMN; n = 28) and malignant (mIPMN; n = 19) tumors, and a summation score was determined.
  
  
  RESULTS
  Preoperative carbohydrate-antigen 19-9 levels were higher in patients with mIPMN (p = 0.013). The diameter of the main pancreatic duct was greater in patients with mIPMN (p < 0.0001). More patients with mIPMN showed bile duct obstruction (p = 0.0076), solid tumor components (p = 0.0076), contrast enhancement in cystic walls (p = 0.0086), peripancreatic lymph nodes (p = 0.0076), and abrupt diameter changes of the main pancreatic duct (p = 0.0008). The CT density of the cysts was higher in mIPMN (p = 0.0063). The diagnostic accuracy of the summation score (sensitivity: 0.84, specificity: 0.96) was greater when compared to each individual CT parameter.
  
  
  CONCLUSIONS
  The prevalence and extent of various CT-based abnormalities are greater in patients with mIPMN, but the wide overlap limits the diagnostic value of each individual parameter. A simple summation score largely enhances the diagnostic accuracy.
authors.affiliation: Department of Diagnostic and Interventional Radiology, St. Josef-Hospital, Bochum, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Mönnings
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.forename: Arnd
authors.initials: A
authors.lastname: Giese
authors.forename: Andrea
authors.initials: A
authors.lastname: Tannapfel
authors.forename: Odo
authors.initials: O
authors.lastname: Köster
authors.forename: Juris J
authors.initials: JJ
authors.lastname: Meier
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000097:blood / Q000000981:diagnostic imaging*; D000368:Aged; D018395:CA-19-9 Antigen / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000000981:diagnostic imaging*; D002291:Carcinoma, Papillary / Q000097:blood / Q000000981:diagnostic imaging*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D018395:CA-19-9 Antigen