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Ohno E, Balduzzi A, Hijioka S, De Pastena M, Marchegiani G, Kato H, Takenaka M, Haba S, Salvia R. Association of high-risk stigmata and worrisome features with advanced neoplasia in intraductal papillary mucinous neoplasms (IPMN): A systematic review. Pancreatology 2024; 24:48-61. [PMID: 38161091 DOI: 10.1016/j.pan.2023.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND This systematic review aimed to assess the diagnostic accuracy of the International Consensus Fukuoka Guidelines (ICG2017) in identifying high-risk lesions of Intraductal Papillary Mucinous Neoplasms (IPMNs). METHODS The ICG2017 revision committee conducted a comprehensive literature review to establish evidence-based statements on IPMNs. The review focused on articles examining the diagnostic value of imaging features (e.g., cyst or main pancreatic duct diameter), clinical symptoms associated with IPMN, and serum biomarkers. Five clinical questions regarding high-risk stigmata (HRS) and worrisome features (WF) in the ICG2017 guidelines were addressed. RESULTS A total of 210 articles were reviewed. The findings revealed a significant association between the presence of mural nodules ≥5 mm in diameter or solid components with contrast enhancement and the diagnosis of high-grade dysplasia or invasive carcinoma. Contrast-enhanced diagnostic tools, such as CT, MRI, or EUS, demonstrated the highest prediction rate and were recommended. Positive cytology was identified as an HRS, while symptoms like acute pancreatitis and cyst diameter growth ≥2.5 mm per year were considered WFs. The use of nomograms and multiple diagnostic factors was recommended for optimal IPMN management. CONCLUSIONS This systematic review provides evidence supporting the improved diagnostic accuracy of ICG2017 in identifying high-risk lesions of IPMN. The multidisciplinary incorporation of HRS and WF based on imaging findings and clinical symptoms is crucial. These findings should inform the revision of ICG2017, enhancing the evaluation and management of IPMN patients. By implementing these recommendations, clinicians can make more informed decisions, leading to better diagnosis and treatment outcomes for high-risk IPMN cases.
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Affiliation(s)
- Eizaburo Ohno
- Fujita Health University, Department of Gastroenterology and Hepatology, Japan; Nagoya University Hospital, Department of Gastroenterology and Hepatology, Japan
| | - Alberto Balduzzi
- The Pancreas Institute Verona, Unit of General and Pancreatic Surgery Department of Surgery, Dentistry, Paediatrics and Gynaecology University of Verona, Italy
| | - Susumu Hijioka
- National Cancer Center Hospital, Department of Hepatobiliary and Pancreatic Oncology, Japan
| | - Matteo De Pastena
- The Pancreas Institute Verona, Unit of General and Pancreatic Surgery Department of Surgery, Dentistry, Paediatrics and Gynaecology University of Verona, Italy
| | - Giovanni Marchegiani
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy
| | - Hironari Kato
- Okayama University Hospital, Department of Gastroenterology and Hepatology, Japan
| | - Mamoru Takenaka
- Kindai University, Department of Gastroenterology and Hepatology, Japan
| | - Shin Haba
- Aichi Cancer Center Hospital, Department of Gastroenterology, Japan
| | - Roberto Salvia
- The Pancreas Institute Verona, Unit of General and Pancreatic Surgery Department of Surgery, Dentistry, Paediatrics and Gynaecology University of Verona, Italy.
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Holmes TW, Yu Z, Thompson R, Oshinski JN, Pourmorteza A. Cardiac-induced motion of the pancreas and its effect on image quality of ultrahigh-resolution CT. Eur Radiol Exp 2024; 8:4. [PMID: 38172486 PMCID: PMC10764702 DOI: 10.1186/s41747-023-00401-5] [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: 07/14/2023] [Accepted: 10/16/2023] [Indexed: 01/05/2024] Open
Abstract
Recent advancements in diagnostic CT detector technology have made it possible to resolve anatomical features smaller than 20 LP/cm, referred to as ultra-high-resolution (UHR) CT. Subtle biological motions that did not affect standard-resolution (SR) CT may not be neglected in UHR. This study aimed to quantify the cardiac-induced motion of the pancreas and simulate its impact on the image quality of UHR-CT. We measured the displacement of the head of the pancreas in three healthy volunteers using Displacement Encoding with Stimulated Echoes (DENSE) MRI. The results were used to simulate SR- and UHR-CT acquisitions affected by pancreatic motion.We found pancreatic displacement in the 0.24-1.59 mm range during one cardiac cycle across the subjects. The greatest displacement was observed in the anterior-posterior direction. The time to peak displacement varied across subjects. Both SR and UHR images showed reduced image quality, as measured by radial modulation transfer function, due to cardiac-induced motion, but the motion artifacts caused more severe degradation in UHR acquisitions. Our investigation of cardiac-induced pancreatic displacement reveals its potential to degrade both standard and UHR-CT scans. To fully utilize the improvement in spatial resolution offered by UHR-CT, the effects of cardiac-induced motion in the abdomen need to be understood and corrected.Relevance statement Advancements in CT detector technology have enhanced CT scanner spatial resolution to approximately 100 µm. Consequently, previously ignored biological motions such as the cardiac-induced motion of the pancreas now demand attention to fully utilize this improved resolution.
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Affiliation(s)
- Thomas Wesley Holmes
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Zhou Yu
- Canon Medical Research USA, Inc, 706 N. Deerpath Drive, Vernon Hills, IL, 60061, USA
| | - Richard Thompson
- Canon Medical Research USA, Inc, 706 N. Deerpath Drive, Vernon Hills, IL, 60061, USA
| | - John N Oshinski
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
- Department of Biomedical Engineering, Emory University - Georgia Institute of Technology, 201 Dowman Drive, Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, 1701 Uppergate Dr, Suite 5018A, Atlanta, GA, 30322, USA
| | - Amir Pourmorteza
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
- Department of Biomedical Engineering, Emory University - Georgia Institute of Technology, 201 Dowman Drive, Atlanta, GA, 30322, USA.
- Winship Cancer Institute, Emory University, 1701 Uppergate Dr, Suite 5018A, Atlanta, GA, 30322, USA.
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Minelli C, Balducci F, Cavalleri C, Milanetto AC, Ferrara F, Crimì F, Quaia E, Vernuccio F. Intraductal papillary mucinous neoplasms of the pancreas: Uncommon imaging presentation, evolution and comparison of guidelines. Eur J Radiol Open 2023; 11:100531. [PMID: 37920680 PMCID: PMC10618428 DOI: 10.1016/j.ejro.2023.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023] Open
Abstract
Pancreatic cystic lesions are often asymptomatic, incidentally detected and include a range of entities with varying degrees of concern for malignancy. Among these, intraductal papillary mucinous neoplasms (IPMN) are considered premalignant pancreatic lesions, with a broad pathological spectrum ranging from lesions without dysplasia, which can be managed conservatively, to malignant lesions that require surgical resection. The increasing use of CT and MRI has led to increased recognition of this entity incidentally, with branch-duct IPMN representing the most common subtype and the most challenging lesions in terms of patient management. The main imaging modality involved in diagnosis and surveillance of IPMN is MRI. Radiologists play an important role in the management of patients with IPMN, including lesion detection, characterization, follow-up and prognostication, allowing early MRI identification of features that are concerning for malignancy. The main aim of this pictorial review is to illustrate MRI features of IPMN and to discuss risk stratification scores based on different guidelines, with a main focus on branch-duct IPMN. The secondary aims include the presentation of common and uncommon imaging evolution of BD-IPMN as well as the discussion on current controversies on the appropriate management of IPMN.
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Affiliation(s)
- Chiara Minelli
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Federico Balducci
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Cristina Cavalleri
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Anna Caterina Milanetto
- Chirurgia Generale 3, Department of Surgery, Oncology and Gastroenterology - University of Padova, 35128, Padova, Italy
| | - Francesco Ferrara
- Gastroenterology Unit - University Hospital of Padova, 35128 Padova, Italy
| | - Filippo Crimì
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, 35128 Padova, Italy
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Ryoo DY, Koehler B, Rath J, Shah ZK, Chen W, Esnakula AK, Hart PA, Krishna SG. A Comparison of Single Dimension and Volume Measurements in the Risk Stratification of Pancreatic Cystic Lesions. J Clin Med 2023; 12:5871. [PMID: 37762812 PMCID: PMC10531933 DOI: 10.3390/jcm12185871] [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: 07/24/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
The incidence of pancreatic cystic lesions (PCLs) has been rising due to improvements in imaging. Of these, intraductal papillary mucinous neoplasms (IPMNs) are the most common and are thought to contribute to almost 20% of pancreatic adenocarcinomas. All major society guidelines for the management of IPMNs use size defined by maximum diameter as the primary determinant of whether surveillance or surgical resection is recommended. However, there is no consensus on how these measurements should be obtained or whether a single imaging modality is superior. Furthermore, the largest diameter may fail to capture the complexity of PCLs, as most are not perfectly spherical. This article reviews current PCL measurement techniques in CT, MRI, and EUS and posits volume as a possible alternative to the largest diameter.
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Affiliation(s)
- Da Yeon Ryoo
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (D.Y.R.); (B.K.)
| | - Bryn Koehler
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (D.Y.R.); (B.K.)
| | - Jennifer Rath
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (J.R.); (Z.K.S.)
| | - Zarine K. Shah
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (J.R.); (Z.K.S.)
| | - Wei Chen
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (W.C.); (A.K.E.)
| | - Ashwini K. Esnakula
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (W.C.); (A.K.E.)
| | - Phil A. Hart
- Division of Gastroenterology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Somashekar G. Krishna
- Division of Gastroenterology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
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Xu Y, Xie C, Gao Z, Zhang M, Zhan M. Nomogram to predict malignancy in branch duct type intraductal papillary mucinous neoplasms. Medicine (Baltimore) 2022; 101:e30627. [PMID: 36197166 PMCID: PMC9509101 DOI: 10.1097/md.0000000000030627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Prediction of malignancy in branch duct (BD)-type intraductal papillary mucinous neoplasms (BD-IPMNs) is difficult. In this retrospective study, we showed the performance of imaging biomarker and biochemical biomarker in identifying the malignant BD-IPMNs. A total of 97 patients with pathological proved BD-IPMNs were included in this study. Imaging data were collected from magnetic resonance imaging (MRI). Malignant BD-IPMNs were defined as those with high grade dysplasia and invasive carcinoma. There were 10 patients with malignant BD-IPMNs (10.3%). Significant difference was found in prevalence of mural nodule and tumor size >3.0 cm between patients with and without malignant BD-IPMNs (44.4% vs 3.1%, P < .01; 80.0% vs 33.3%, P < .01). Significant differences were observed in mural nodule and elevated carbohydrate antigen 19-9 (CA19-9) between patients with and without invasive carcinoma (40.0% vs 7.6, P = .05; 60% vs 15.3%, P = .04). Mural nodule and tumor size >3.0 cm were the independent associated factor for malignant BD-IPMNs. The odds ratio (OR) was 5.22 (95% confidence interval [CI]: 1.04-31.16) for mural nodule and was 6.80 (95% CI: 1.16-39.71) for cyst size >3.0 cm. The combined model of mural nodule and tumor size showed good performance in identifying malignant BD-IPMNs (area under the curve [AUC] = 0.82, 95%CI: 0.67-0.97). Our data show that mural nodule and cystic size can be used as predictor of malignancy in BD-IPMN. The predictive performance is acceptable.
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Affiliation(s)
- Yisheng Xu
- Department of Radiology, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou Zhenjiang, China
| | - Chunmei Xie
- Department of Radiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou Zhenjiang, China
| | - Zhiqin Gao
- Department of Radiology, Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou Zhenjiang, China
| | - Meihua Zhang
- Department of Radiology, Hangzhou Ninth People’s Hospital, Hangzhou Zhenjiang, China
| | - Ming Zhan
- Department of Radiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou Zhenjiang, China
- *Correspondence: Ming Zhan, Department of Radiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, No. 728 Yucai North Road, Xiaoshan District, Hangzhou Zhenjiang 311201, China (e-mail: )
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6
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Zhao W, Zhao Y. ASO Author Reflections: Imaging Predictors of High-Grade Dysplasia or Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2021; 29:1313-1314. [PMID: 34553303 DOI: 10.1245/s10434-021-10746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Wenjing Zhao
- Central Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 1 Shuai Fu Yuan Hu Tong, Beijing, 100730, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 1 Shuai Fu Yuan Hu Tong, Beijing, 100730, China.
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