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Liu JY, Zhu L, Gao X, Li J, Sun ZY, Jin ZY, Xue HD. Autoimmune Pancreatitis Surveillance: A Simplified MRI Protocol Versus a Comprehensive Pancreatic MRI Protocol. Acad Radiol 2024; 31:1906-1917. [PMID: 38040626 DOI: 10.1016/j.acra.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 12/03/2023]
Abstract
RATIONALE AND OBJECTIVES Magnetic resonance imaging (MRI) has good diagnostic performance and causes no radiation damage, making it an ideal tool for the autoimmune pancreatitis (AIP) surveillance. However, its time cost is high. This study aimed to evaluate (1) whether a simplified protocol (SP) of MRI for AIP surveillance provides information equivalent to the comprehensive protocol (CP) and (2) the time cost reductions associated with using an SP. MATERIALS AND METHODS This retrospective single-institutional study included 40 patients with AIP with at least two contrast-enhanced MRI/magnetic resonance cholangiopancreatography studies. Two radiologists evaluated two imaging sets (CP/SP) per patient, independently. Intra- and inter-observer agreement in the evaluation of the pancreas and extrapancreatic organs involvement using the SP/CP in addition to the time cost differences between the SP and CP were assessed. Intra- and inter-rater reliability were assessed using Cohen's kappa test, intraclass correlations, or the weighted kappa test. The differences in time costs between the CP and SP were compared using the Mann-Whitney U test or Wilcoxon signed-rank test. RESULTS The SP had strong intra- and inter-observer agreement with the CP in evaluating MRI parameters (κ > 0.60, moderate to excellent) and disease activity status (κ > 0.80, all excellent). The overall image acquisition time cost for the SP was 49.2% of the CP. For the two radiologists, the image interpretation time cost of the SP was reduced by approximately 35% and 27% compared to the CP. CONCLUSION For AIP surveillance, SP MRI provides information consistent with the CP and is less time-consuming.
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Affiliation(s)
- Jing-Yi Liu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Liang Zhu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Xin Gao
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Juan Li
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Zhao-Yong Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
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D'Onofrio M, Geraci L, De Robertis RL, Cardobi N, Balduzzi A, Tomaiuolo L, Bardhi E, Faccioli N, Aluffi G, Marchegiani G, Salvia R. Magnetic resonance imaging short protocols for intraductal papillary mucinous neoplasm (IPMN) surveillance: The time has come. Dig Liver Dis 2024:S1590-8658(24)00306-2. [PMID: 38614923 DOI: 10.1016/j.dld.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/19/2024] [Accepted: 03/06/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND/OBJECTIVES To analyze the diagnostic performance of three short magnetic resonance imaging (MRI) protocols for the follow-up of pancratic intraductal papillary mucinous neoplasms (IPMN). METHODS Follow-up MRI examinations of 287 patients with IPMN performed in two centers were retrospectively retrieved. Four MRI protocols were identified as follows: T1-weighted (T1w), T2-weighted (T2w), and MRCP sequences (protocol 1); T1w, T2w, MRCP, and diffusion-weighted (DWI) sequences (protocol 2); T1w, T2w, MRCP, and post-contrast T1w-sequences (protocol 3); and a comprehensive protocol including all previous sequences (protocol 4). Three radiologists with different experience in abdominal imaging expressed their opinion upon the optimal patient's management upon the evaluation of each protocol. Intra-and inter-observer agreement and concordance with the clinical decision expressed by a pancreatic surgeon were calculated with Cohen's kappa test. RESULTS 223 patients were included (66±10 years; 92 men, 131 women). 143 patients had branch-duct-IPMNs, 25 main-duct-IPMNs and 55 mixed-type-IPMNs. 79 patients underwent surgery, resulting in 52 high-grade dysplasia (HGD) and 27 low-grade dysplasia (LGD). Concordance for the expert reader between protocols 1, 2 and 3 and the actual clinical decision were 0.63, 0.72, and 0.74 respectively (95% CI, 0.53-0.73, 0.63-0.81, and 0.65-0.83). Inter-observer agreement between reader 1 and reader 2, reader 1 and reader 3, and reader 2 and reader 3 were: 0.71, 0.50, and 0.75 for protocol 1 (95% CI, 0.63-0.81, 0.40-0.60, and 0.66-0.84);0.68, 0.54, and 0.84 for protocol 2 (95% CI, 0.59-0.77, 0.44-0.64, and 0.76-0.91); and 0.77, 0.65, and 0.86 for protocol 3 (95% CI, 0.69-0.86, 0.55-0.74, and 0.80-0.93). CONCLUSIONS Short MRI protocol is suitable for IPMN surveillance.
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Affiliation(s)
- Mirko D'Onofrio
- Department of Radiology - G.B. Rossi University Hospital, AOUI Verona, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Luca Geraci
- Department of Radiology - G.B. Rossi University Hospital, AOUI Verona, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Riccardo Lombardi De Robertis
- Department of Radiology - G.B. Rossi University Hospital, AOUI Verona, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Nicolò Cardobi
- Department of Radiology, Ospedale Civile Maggiore, AOUI Verona, 37134 Verona, Italy
| | - Alberto Balduzzi
- Department of General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luisa Tomaiuolo
- Department of Radiology - G.B. Rossi University Hospital, AOUI Verona, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Eda Bardhi
- Department of Radiology - G.B. Rossi University Hospital, AOUI Verona, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Niccolò Faccioli
- Department of Radiology - G.B. Rossi University Hospital, AOUI Verona, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Gregorio Aluffi
- Department of Radiology, Hospital "Casa di Cura Pederzoli," Peschiera del Garda (VR), Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
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Malekzadeh S, Cannella R, Fournier I, Hiroz P, Mottet C, Constantin C, Widmer L. The diagnostic value of abbreviated MRI protocol in the surveillance of Branch-Duct intraductal papillary mucinous neoplasm. Eur J Radiol 2024; 175:111455. [PMID: 38608499 DOI: 10.1016/j.ejrad.2024.111455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/20/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE To assess the diagnostic value of abbreviated protocol (AP) MRI to detect the degeneration signs in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) in patients undergoing a routine MRI follow-up. METHODS This dual-center retrospective study include patients with BD-IPMN diagnosed on initial comprehensive protocol (CP) MRI who underwent routine MRI follow-up. CP included axial and coronal T2-weighted images (T2WI), axial T1-weighted images (T1WI) before and after contrast administration, 3D MR cholangiopancreatography (MRCP) and diffusion-weighted images (DWI). Two APs, eliminating dynamic sequences ± DWI, were extracted from CP. Two radiologists evaluated the APs separately for IPMN degeneration signs according to Fukuoka criteria and compared the results to the follow-up CP. In patients who underwent EUS, imaging findings were correlated with pathological results. Per-patient and per-lesion sensitivity, specificity, PPV, NPV, and accuracy of APs were calculated. Additionally, the acquisition time for different protocols was calculated. RESULTS One hundred-fourteen patients (56.1 % women, median age: 71 years) with 256 lesions were included. Degeneration signs were observed in 24.6 % and 12.1 % per-patient and per-lesion, respectively. Regarding APs, the per patient sensitivity, specificity, PPV, NPV, and accuracy in the detection of the degeneration signs were 100 %, 93.5 %, 83.3 %, 100 %, and 95.1 %, respectively. No additional role for DWI was detected. AP without DWI economized nearly half of CP acquisition time (388 versus 663 s, respectively). CONCLUSION AP can confidently replace CP for BD-IPMN follow-up with high sensitivity and PPV while offering benefits such as patient comfort, improved MRI accessibility, and reduced dedicated time for image analysis. DWI necessitates special consideration. CLINICAL RELEVANCE STATEMENT Our data suggest that APs safely detect all degeneration signs of IPMN. While there is an overestimation of mural nodules due to the lack of contrast injection, this occurs in a negligible number of patients.
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Affiliation(s)
- Sonaz Malekzadeh
- Department of Diagnostic and Interventional Radiology, Av. Du Grand-Champsec 80, Sion Hospital, 1950 Sion, Switzerland.
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Ian Fournier
- Department of Surgery, Sion Hospital, Av. Du Grand-Champsec 80, 1950 Sion, Switzerland; Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Philippe Hiroz
- Department of Gastroenterology, Sion Hospital, Av. Du Grand-Champsec 80, 1950 Sion, Switzerland
| | - Christian Mottet
- Department of Gastroenterology, Sion Hospital, Av. Du Grand-Champsec 80, 1950 Sion, Switzerland
| | - Christophe Constantin
- Department of Diagnostic and Interventional Radiology, Av. Du Grand-Champsec 80, Sion Hospital, 1950 Sion, Switzerland
| | - Lucien Widmer
- Department of Diagnostic and Interventional Radiology, Fribourg Cantonal Hospital, Chemin Des Pensionnats 2, 1700 Fribourg, Switzerland
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Brandi N, Renzulli M. Towards a Simplified and Cost-Effective Diagnostic Algorithm for the Surveillance of Intraductal Papillary Mucinous Neoplasms (IPMNs): Can We Save Contrast for Later? Cancers (Basel) 2024; 16:905. [PMID: 38473267 DOI: 10.3390/cancers16050905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
The increased detection of pancreatic cysts in recent years has triggered extensive diagnostic investigations to clarify their potential risk of malignancy, resulting in a large number of patients undergoing numerous imaging follow-up studies for many years. Therefore, there is a growing need for optimization of the current surveillance protocol to reduce both healthcare costs and waiting lists, while still maintaining appropriate sensibility and specificity. Imaging is an essential tool for evaluating patients with intraductal papillary mucinous neoplasms (IPMNs) since it can assess several predictors for malignancy and thus guide further management recommendations. Although contrast-enhanced magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) has been widely recommended by most international guidelines, recent results support the use of unenhanced abbreviated-MRI (A-MRI) protocols as a surveillance tool in patients with IPMN. In fact, A-MRI has shown high diagnostic performance in malignant detection, with high sensitivity and specificity as well as excellent interobserver agreement. The aim of this paper is, therefore, to discuss the current available evidence on whether the implementation of an abbreviated-MRI (A-MRI) protocol for cystic pancreatic lesion surveillance could improve healthcare economics and reduce waiting lists in clinical practice without significantly reducing diagnostic accuracy.
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Affiliation(s)
- Nicolò Brandi
- Department of Radiology, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Department of Radiology, AUSL Romagna, 48018 Faenza, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Vierula JP, Nurminen J, Jussila V, Nyman M, Heikkinen J, Pape B, Sorvettula K, Mattila K, Hirvonen J. Diagnostic performance of short noncontrast biparametric 3-T MRI for tonsillar infections: comparison with a full protocol including contrast-enhanced sequences. Eur Radiol Exp 2023; 7:65. [PMID: 37872406 PMCID: PMC10593634 DOI: 10.1186/s41747-023-00379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/22/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND We investigated whether a short, 5-min magnetic resonance imaging (MRI) protocol consisting of only axial T2-weighted and diffusion-weighted imaging (DWI) sequences can discriminate between tonsillar infections, peritonsillar abscesses and deeply extending abscesses in a retrospective, blinded, multireader setting. METHODS We included patients sent by emergency physicians with suspected pharyngotonsillar infections who underwent emergency neck 3-T MRI from April 1 2013 to December 31 2018. Three radiologists (with 10-16 years of experience) reviewed the images for abscesses and their extension into deep neck spaces. Data were reviewed first using only axial T2-weighted Dixon images and DWI (short protocol) and second including other sequences and contrast-enhanced T1-weighted Dixon images (full protocol). Diagnostic accuracy, interobserver agreement, and reader confidence were measured. Surgical findings and clinical course served as standard of reference. RESULTS The final sample consisted of 52 patients: 13 acute tonsillitis with no abscesses, 19 peritonsillar abscesses, and 20 deeply extending abscesses. Using the short protocol, diagnostic accuracy for abscesses across all readers was good-to-excellent: sensitivity 0.93 (95% confidence interval 0.87-0.97), specificity 0.85 (0.70-0.93), accuracy 0.91 (0.85-0.95). Using the full protocol, respective values were 0.98 (0.93-1.00), 0.85 (0.70-0.93), and 0.95 (0.90-0.97), not significantly different compared with the short protocol. Similar trends were seen with detecting deep extension. Interobserver agreement was similar between protocols. However, readers had higher confidence in diagnosing abscesses using the full protocol. CONCLUSIONS Short MRI protocol showed good-to-excellent accuracy for tonsillar abscesses. Contrast-enhanced images improved reader confidence but did not affect diagnostic accuracy or interobserver agreement. RELEVANCE STATEMENT Short protocol consisting only of T2-weighted Dixon and DWI sequences can accurately image tonsillar abscesses, which may improve feasibility of emergency neck MRI. KEY POINTS • The short 3-T MRI protocol (T2-weighted images and DWI) was faster (5 min) than the full protocol including T1-weighted contrast-enhanced images (24 min). • The short 3-T MRI protocol showed good diagnostic accuracy for pharyngotonsillar abscesses. • Contrast-enhanced sequences improved reader confidence but did not impact diagnostic accuracy or interobserver agreement.
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Affiliation(s)
| | - Janne Nurminen
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Ville Jussila
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Mikko Nyman
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Jaakko Heikkinen
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Bernd Pape
- Department of Biostatistics, Turku University Hospital, Turku, Finland
- School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Kaarlo Sorvettula
- Medical Imaging Center, Department of Radiology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kimmo Mattila
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital, Turku, Finland
- Medical Imaging Center, Department of Radiology, Tampere University and Tampere University Hospital, Tampere, Finland
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Grabowska S, Hitnarowicz A, Barczyk-Gutkowska A, Gruszczyńska K, Steinhof-Radwańska K, Winder M. Abbreviated magnetic resonance imaging protocols in oncology: improving accessibility in precise diagnostics. Pol J Radiol 2023; 88:e415-e422. [PMID: 37808176 PMCID: PMC10551741 DOI: 10.5114/pjr.2023.131213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/26/2023] [Indexed: 10/10/2023] Open
Abstract
Cancer, as the second leading cause of death in the world, is one of the major public health concerns today. Accurate diagnosis and prompt initiation of adequate treatment are of key importance for prognosis. Abbreviated magnetic resonance protocols (AMRI) are promising techniques based on magnetic resonance imaging (MRI) protocols that shorten acquisition time without significant loss of examination quality. Faster protocols that focus on detection of suspicious lesions with most precise sequences, can contribute to comparable diagnostic performance of a full MRI protocol. The purpose of this article was to review the current application of AMRI protocols in several oncological diseases.
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Affiliation(s)
- Sylwia Grabowska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Anna Hitnarowicz
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Anna Barczyk-Gutkowska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Gruszczyńska
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
| | | | - Mateusz Winder
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
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Standardization of MRI Screening and Reporting in Individuals With Elevated Risk of Pancreatic Ductal Adenocarcinoma: Consensus Statement of the PRECEDE Consortium. AJR Am J Roentgenol 2022; 219:903-914. [PMID: 35856454 DOI: 10.2214/ajr.22.27859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies, with a dismal survival rate. Screening the general population for early detection of PDAC is not recommended, but because early detection improves survival, high-risk individuals, defined as those meeting criteria based on a family history of PDAC and/or the presence of known pathogenic germline variant genes with PDAC risk, are recommended to undergo screening with MRI and/or endoscopic ultrasound at regular intervals. The Pancreatic Cancer Early Detection (PRECEDE) Consortium was formed in 2018 and is composed of gastroenterologists, geneticists, pancreatic surgeons, radiologists, statisticians, and researchers from 40 sites in North America, Europe, and Asia. The overarching goal of the PRECEDE Consortium is to facilitate earlier diagnosis of PDAC for high-risk individuals to increase survival of the disease. A standardized MRI protocol and reporting template are needed to enhance the quality of screening examinations, improve consistency of clinical management, and facilitate multiinstitutional research. We present a consensus statement to standardize MRI screening and reporting for individuals with elevated risk of pancreatic cancer.
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Johansson K, Mustonen H, Seppänen H, Lehtimäki TE. Anatomical pancreatic variants in intraductal papillary mucinous neoplasm patients: a cross-sectional study. BMC Gastroenterol 2022; 22:394. [PMID: 35989322 PMCID: PMC9394057 DOI: 10.1186/s12876-022-02465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background No previous studies have examined the possible relationship between intraductal papillary mucinous neoplasm (IPMN) and the developmental ductal variations of the pancreas, such as an ansa pancreatica and a meandering main pancreatic duct (MMPD). Methods This retrospective cross-sectional study enrolled 214 patients, 108 with IPMN disease and 106 subjects from a community at the tertiary care unit. The main pancreatic duct (MPD) was evaluated in the head of the pancreas by its course, which were non-MMPD: descending, vertical, and sigmoid, or MMPD including loop types, reverse-Z subtypes, and an N-shape, which was identified for the first time in this study. IPMN patients were also evaluated for worrisome features (WF) or high-risk stigmata (HRS), and the extent of IPMN cysts. Results Among IPMN patients, 18.4% had MMPD, which we observed in only 3.0% of the control group (P < 0.001). Patients with MMPD were more likely to belong to the IPMN group compared with non-MMPD patients [odds ratio (OR) 6.4, 95% confidence interval (CI) 2.2–24.9]. Compared with a descending shape MPD, IPMN patients with an N-shaped MPD were more likely to have a cystic mural nodule (OR 5.9, 95% CI 1.02–36.0). The presence of ansa pancreatica associated with more extent IPMN disease (OR 12.8, 95% CI 2.6–127.7). Conclusions IPMN patients exhibited an MMPD more often than control patients. Ansa pancreatica associated with multiple cysts. Furthermore, an N-shape in IPMN patients associated with cystic mural nodules, suggesting that this shape serves as a risk factor for more severe IPMN. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02465-w.
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Faccioli N, Santi E, Foti G, Curti P, D'Onofrio M. Cost-effectiveness analysis of short biparametric magnetic resonance imaging protocol in men at risk of prostate cancer. Arch Ital Urol Androl 2022; 94:160-165. [PMID: 35775339 DOI: 10.4081/aiua.2022.2.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare the cost-effectiveness of a short biparametric MRI (BP-MRI) with that of contrast-enhanced multiparametric MRI (MP-MRI) for the detection of prostate cancer in men with elevated prostatespecific antigen (PSA) levels. MATERIALS AND METHODS We compared two diagnostic procedures for detection of prostate cancer (Pca), BP-MRI and MP-MRI, in terms of quality-adjusted life years (QALY), incremental costeffectiveness ratio (ICER) and net monetary benefit (NMB) for a hypothetical cohort of 10,000 patients. We compared two scenarios in which different protocols would be used for the early diagnosis of prostate cancer in relation to PSA values. Scenario 1. BP-MRI/MP-MRI yearly if > 3.0 ng/ml, every 2 years otherwise; Scenario 2. BP-MRI/MP-MRI yearly with age-dependent threshold 3.5 ng/ml (50-59 years), 4.5 ng/ml (60-69 years), 6.5 ng/ml (70-79 years). RESULTS BP-MRI was more effective than the comparator in terms of cost (160.10 € vs 249.99€) QALYs (a mean of 9.12 vs 8.46), ICER (a mean of 232.45) and NMB (a mean of 273.439 vs 251.863). BP-MRI was dominant, being more effective and less expensive, with a lower social cost. Scenario 2 was more cost-effective compared to scenario 1. CONCLUSIONS Our results confirmed the hypothesis that a short bi-parametric MRI protocol represents a cost-efficient procedure, optimizing resources in a policy perspective.
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Affiliation(s)
- Niccolò Faccioli
- Department of Radiology, G.B. Rossi Hospital, Università di Verona, Verona.
| | - Elena Santi
- Department of Radiology, Mater Salutis Hospital, Legnago, Verona.
| | - Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona.
| | - Pierpaolo Curti
- Department of Radiology, Mater Salutis Hospital, Legnago, Verona.
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi Hospital, Università di Verona, Verona.
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