CT vs MRCP: Optimal classification of IPMN type and extent

被引:166
作者
Waters, Joshua A. [1 ]
Schmidt, C. Max [1 ,2 ,3 ,4 ,7 ]
Pinchot, Jason W. [5 ]
White, Patrick B. [1 ]
Cummings, Oscar W. [6 ]
Pitt, Henry A. [1 ,2 ]
Sandrasegaran, Kumar [5 ]
Akisik, Fatih [5 ]
Howard, Thomas J. [1 ,2 ]
Nakeeb, Attila [1 ,2 ]
Zyromski, Nicholas J. [1 ]
Lillemoe, Keith D. [1 ,2 ]
机构
[1] Indiana Univ, Sch Med, Dept Surg, Indianapolis, IN 46204 USA
[2] Indiana Univ, Ctr Canc, Indianapolis, IN 46204 USA
[3] Indiana Univ, Sch Med, Walther Oncol Ctr, Indianapolis, IN 46202 USA
[4] Richard L Roudebush Vet Affairs Med Ctr, Indianapolis, IN 46202 USA
[5] Indiana Univ, Sch Med, Dept Radiol, Indianapolis, IN 46204 USA
[6] Indiana Univ, Sch Med, Dept Pathol, Indianapolis, IN 46204 USA
[7] Canc Res Inst, Dept Surg, Indianapolis, IN USA
关键词
intraductal papillary mucinous neoplasm; magnetic resonance cholangiopancreatography; computed tomography;
D O I
10.1007/s11605-007-0367-9
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Introduction Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are being diagnosed with increased frequency. CT scanning commonly serves as the primary imaging modality before surgery. We hypothesized MRCP provides better characterization of IPMN type/extent, which more closely matches actual pathology. Methods Of 214 patients treated with IPMN (1991-2006), 30 had both preoperative CT and MRCP. Of these, 18 met imaging study criteria. Independent readers performed retrospective, blinded analyses using standardized criteria for IPMN type and extent. Results A ductal connection was detected on 73% of MRCP scans and only 18% of CT. IPMN type was classified differently in seven (39%); four (22%) of which were read on CT as having main duct involvement where this was not appreciated on MRCP or found on surgical pathology. MRCP showed multifocal disease in 13(72%) versus only 9(50%) on CT. A different disease distribution was seen in 9(50%). Finally, 101 branch lesions were identified on MRCP compared to 46 on CT. Conclusions CT falls short of MRCP in detecting a ductal connection, estimating main duct involvement, and identification of small branch duct cysts. These factors influence diagnostic accuracy, cancer risk stratification and operative strategy. MRCP should be employed for optimal management of patients with IPMN.
引用
收藏
页码:101 / 109
页数:9
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