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Vullierme MP, Gregory J, Rebours V, Cros J, Abelhady-Attia Y, Vilgrain V, Aguilera-Munoz L, Laurent L, Levy P, Sauvanet A, Ronot M. MRI is useful to suggest and exclude malignancy in mucinous cystic neoplasms of the pancreas. Eur Radiol 2021; 32:1297-1307. [PMID: 34374801 DOI: 10.1007/s00330-021-08091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/21/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the value of MRI in differentiating benign (b-MCN) and malignant (m-MCN) MCN. European guidelines suggest that certain mucinous cystic neoplasms (MCN) of the pancreas can be conservatively managed. METHODS A retrospective single-center study of consecutive patients with resected MCN. MRIs were independently reviewed by two readers blinded to the pathological results. The authors compared b-MCN (i.e., mucinous-cystadenoma comprising high-grade dysplasia (HGD)) and m-MCN (i.e., cystadenocarcinoma). RESULTS Sixty-three patients (62 women [98%]) with 63 MCN (6 m-MCN, 2 HGD) were included. m-MCN tumors had a tendency to be larger than b-MCN (median 86 [25-103] vs. 45 [17-130] mm, p = .055). The combination of signal heterogeneity on T2-weighted imaging, wall thickness ≥ 5 mm, the presence of mural nodules ≥ 9 mm, and enhancing septa had an area under the ROC curve of 0.97 (95% CI 0.91-1.00) for the diagnosis of m-MCN. A total of 24 (37%), 20 (32%), 10 (16%), 5 (8%), and 4 (6%) out of 63 MCNs showed 0, 1, 2, 3, and 4 of these features, respectively. The corresponding rate of m-MCN was 0%, 0%, 10%, 20%, and 100%, respectively, with a good-to-excellent inter-reader agreement. Patterns with a high NPV for m-MCN included an absence of enhancing septa or walls (NPV 97% and 100%, respectively), wall thickness < 3 mm (NPV 100%), and no mural nodules (NPV 100%). CONCLUSIONS A combination of 4 imaging features suggests malignant MCN on MRI. On the other hand, visualization of a thin non-enhancing wall with no mural nodules suggests benign MCN. KEY POINTS • A heterogenous signal on T2-weighted MRI, a ≥ 5-mm-thick wall, mural nodules ≥ 9 mm, and/or enhancing septa suggest malignant MCNs. • A thin non-enhancing wall with no mural nodules suggests benign MCNs. • MRI should be performed in the pre-therapeutic evaluation of MCN to help determine the therapeutic strategy in these patients.
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Affiliation(s)
- Marie-Pierre Vullierme
- Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Radiology, Beaujon University Hospital, 100 bd general Leclerc, 92110, Clichy, France. .,Université Paris Diderot-Paris 7, Université de Paris, F-75018, Paris, France.
| | - Jules Gregory
- Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Radiology, Beaujon University Hospital, 100 bd general Leclerc, 92110, Clichy, France
| | - Vinciane Rebours
- Université Paris Diderot-Paris 7, Université de Paris, F-75018, Paris, France.,Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Pancreatology, Beaujon Hospital, 100 bd general Leclerc, 92110, Clichy, France
| | - Jerome Cros
- Université Paris Diderot-Paris 7, Université de Paris, F-75018, Paris, France.,Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Pathology, Beaujon University Hospital, 100 bd general Leclerc, 92110, Clichy, France
| | - Yasser Abelhady-Attia
- Department of Radiology, Benha University Hospital, Fareed Nada Street, Benha, Qalubiya Governorate, 13511, Egypt
| | - Valerie Vilgrain
- Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Radiology, Beaujon University Hospital, 100 bd general Leclerc, 92110, Clichy, France.,Centre de Recherche de l'Inflammation (CRI), INSERM U1149, Université de Paris, F-75018, Paris, France
| | - Lina Aguilera-Munoz
- Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Pancreatology, Beaujon Hospital, 100 bd general Leclerc, 92110, Clichy, France
| | - Lucie Laurent
- Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Pancreatology, Beaujon Hospital, 100 bd general Leclerc, 92110, Clichy, France
| | - Philippe Levy
- Université Paris Diderot-Paris 7, Université de Paris, F-75018, Paris, France.,Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Pancreatology, Beaujon Hospital, 100 bd general Leclerc, 92110, Clichy, France
| | - Alain Sauvanet
- Université Paris Diderot-Paris 7, Université de Paris, F-75018, Paris, France.,Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Hepato Pancreato Biliary Surgery, Beaujon University Hospital, 100 bd general Leclerc, 92110, Clichy, France
| | - Maxime Ronot
- Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Radiology, Beaujon University Hospital, 100 bd general Leclerc, 92110, Clichy, France.,Université Paris Diderot-Paris 7, Université de Paris, F-75018, Paris, France
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