Purpose: Evaluation of mural nodules (MNs) and septa of intraductal papillary mucinous neoplasms (IPMNs) through diffusion-weighted imaging (DWI) and contrast-enhanced magnetic resonance (CE-MR) for the characterization of tumor grade. Material and methods: 91 patients with pancreatic IPMNs were included. All patients had histological diagnosis after surgical resection and a pre-operative MR exam. There were 57 patients with IPMN with low-grade dysplasia and 34 patients with IPMN with high-grade dysplasia. MR exams were retrospectively reviewed by two radiologists. A third experienced radiologist directed conflicting analyses. The presence, number, size of solid nodules, enhancement, signal restriction in DWI sequences, size of the lesion and caliber of Wirsung duct were evaluated. Qualitative imaging characteristics have been compared to histological results. Cohen K coefficient was calculated to evaluate interobserver agreement. Results: Statistically significant difference (p<0.0001) was between nodules >5mm with enhancement and signal restriction in DWI and tumor dysplasia, between size and number of nodules detected by MRI and the grade of dysplasia and between dilatation of the Wirsung duct and grade of dysplasia. ADC map showed statistically significant results (p<0.0001) in the correlation between the entropy parameter and the grade of dysplasia. No statistically significant difference was between nodules <5mm detected by MRI and the pathological analysis and between nodular dimensions and tumor dysplasia. Conclusion: MRI with dynamic study and DWI sequences is an accurate method in the identification of solid nodule with cut-off of 5 mm. DWI sequences and dynamic study with contrast media can be useful in the identification of lesional malignancy. Entropy could be used as a predictive parameter of lesional malignancy.
Diffusion-weighted imaging and dynamic MRI in the study of intraductal papillary mucinous neoplasms: pathological comparison with tumor grade correlation
G. Giannotti;G. Tedesco;A. Beleù;G. Rizzo;N. Cardobi;R. De Robertis;D’Onofrio Mirko
2019-01-01
Abstract
Purpose: Evaluation of mural nodules (MNs) and septa of intraductal papillary mucinous neoplasms (IPMNs) through diffusion-weighted imaging (DWI) and contrast-enhanced magnetic resonance (CE-MR) for the characterization of tumor grade. Material and methods: 91 patients with pancreatic IPMNs were included. All patients had histological diagnosis after surgical resection and a pre-operative MR exam. There were 57 patients with IPMN with low-grade dysplasia and 34 patients with IPMN with high-grade dysplasia. MR exams were retrospectively reviewed by two radiologists. A third experienced radiologist directed conflicting analyses. The presence, number, size of solid nodules, enhancement, signal restriction in DWI sequences, size of the lesion and caliber of Wirsung duct were evaluated. Qualitative imaging characteristics have been compared to histological results. Cohen K coefficient was calculated to evaluate interobserver agreement. Results: Statistically significant difference (p<0.0001) was between nodules >5mm with enhancement and signal restriction in DWI and tumor dysplasia, between size and number of nodules detected by MRI and the grade of dysplasia and between dilatation of the Wirsung duct and grade of dysplasia. ADC map showed statistically significant results (p<0.0001) in the correlation between the entropy parameter and the grade of dysplasia. No statistically significant difference was between nodules <5mm detected by MRI and the pathological analysis and between nodular dimensions and tumor dysplasia. Conclusion: MRI with dynamic study and DWI sequences is an accurate method in the identification of solid nodule with cut-off of 5 mm. DWI sequences and dynamic study with contrast media can be useful in the identification of lesional malignancy. Entropy could be used as a predictive parameter of lesional malignancy.
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