Imaging of Pancreatic Neoplasms Influences Outcome of Resection

Intraductal papillary mucinous neoplasms (IPMNs) can evolve through all biologic stages, from slight dysplasia to carcinoma. As one of the few surgically curable pancreatic tumors, accurate preoperative prediction of malignancy remains one of the major issues in the optimal treatment of IPMNs, and it also influences the outcome of the resection. A recent clinical study addressed the role of multidetector row computed tomography (MDCT) in predicting malignancy of IPMNs preoperatively.

The research team led by Prof. D.B. Wang from Ruijin Hospital of Shanghai Jiao Tong University School of Medicine (Shanghai, China) recruited 20 patients with pathologically confirmed IPMNs in their study. Axial MDCT images combined with CT angiography (CTA) and multiplanar volume or curved reformations (MPVR or CR) were preoperatively acquired. The investigators published their findings in the August 28, 2009, issue of the World Journal of Gastroenterology.

The pathologic study revealed 12 malignant IPMNs and 8 benign IPMNs. The diameters of the cystic lesions and main pancreatic ducts (MPDs) were significantly larger in malignant IPMNs compared with those of the benign IPMNs. The combined-type IPMNs had a higher rate of malignancy than the other two types of IPMNs. Tumors with mural nodules and thick septa had a significantly higher incidence of malignancy than tumors without these features. Communication of side-branch IPMNs with the MPD was present in nine cases at pathologic examination. Seven of them were identified from CTA and MPVR or CR images.

From comparison with the pathologic diagnosis, the sensitivity, specificity, and accuracy of MDCT in characterizing the malignancy of IPMN of the pancreas were determined to be 100%, 87.5%, and 95%, respectively. MDCT with CTA and MPVR or CR techniques can elucidate the imaging features of IPMNs and help predict the malignancy of these tumors, concluded the researchers.

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Ruijin Hospital of Shanghai Jiao Tong University School of Medicine