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Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

The study aims were to evaluate: (1) whether a short-protocol (SP) MRI for the surveillance of pancreatic cystic neoplasms (PCN) provides equivalent clinical information as a comprehensive-protocol (CP), and (2) the cost reduction from substituting CP with SP for patient surveillance.

Methods

This retrospective study included 154 consecutive patients (median age: 66, 52 % men) with working-diagnosis of PCN and available contrast-enhanced MRI/MRCP. Three radiologists evaluated independently two imaging sets (SP/CP) per patient. The CP included: T2-weighted (HASTE/MRCP), DWI and T1-weighted (chemical-shift/pre-/post-contrast) images [acquisition time (AT) ≈ 35 min], whereas the SP included: T2-weighted HASTE and T1-weighted pre-contrast images (AT ≈ 8 min). Mean values of largest cyst/main pancreatic duct diameter (DC/DMPD) were compared. Agreement regarding presence/absence of cystic/MPD mural nodules (MNC/MNMPD), inter-observer agreement and cost differences between SP/CP were calculated.

Results

For DC and DMPD, mean values with SP/CP were 21.4/21.7 mm and 3.52/3.58 mm, while mean differences SP-CP were 0.3 mm (p = 0.02) and 0.06 mm (p = 0.12), respectively. For presence/absence of MNC and MNMPD, SP/CP coincided in 93 % and 98 % of cases, respectively. Inter-observer agreement was strong for SP/CP. SP-cost was 25 % of CP-cost.

Conclusions

For the surveillance of PCN, short-protocol MRI provides information equivalent to the more time-consuming and costly comprehensive-protocol.

Key Points

• Pancreatic cystic neoplasms (PCN) are increasingly diagnosed in the general population.

• Multiple imaging controls are recommended for the surveillance of patients with PCN.

• Short and comprehensive MRI-protocols are equivalent for decision-making in PCN under surveillance.

• Evaluation of imaging risk factors in PCNs is comparable with both MRI-protocols.

• Use of the short MRI-protocol may rationalise healthcare resources.

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Abbreviations

AT:

Acquisition time

BD:

Branch duct

CARE:

Combined applications to reduce exposure

EECS:

European experts consensus statement

IPMN:

Intraductal papillary mucinous neoplasm

MCN:

Mucinous cystic neoplasm

MDT:

Multidisciplinary tumour board

MIP:

Maximum intensity projection

MPD:

Main pancreatic duct

NSF:

Nephrogenic systemic fibrosis

PCN:

Pancreatic cystic neoplasm

PDAC:

Pancreatic ductal adenocarcinoma

SCN:

Serous cystic neoplasm

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Acknowledgments

The scientific guarantor of this publication is Nikolaos Kartalis. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. The biostatistician Per Näsman (KTH Royal Institute of Technology, Stockholm, Sweden) kindly provided statistical advice for this manuscript. Region Ethics Review Board approval was obtained. Written informed consent was waived by the Region Ethics Review Board. Methodology:retrospective, observational, multicenter study.

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Authors and Affiliations

  1. Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Radiology, C1-46 Karolinska University Hospital, 14186, Stockholm, Sweden

    Raffaella Maria Pozzi-Mucelli & Nikolaos Kartalis

  2. Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland

    Irina Rinta-Kiikka

  3. Department of Radiology, St.Olavs University Hospital, Trondheim, Norway

    Katharina Wünsche

  4. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland

    Johanna Laukkarinen

  5. Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway

    Knut Jørgen Labori

  6. Department of Gastroenterology, Oslo University Hospital, Oslo, Norway

    Kim Ånonsen

  7. Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway

    Caroline Verbeke

  8. Department of Pathology, Karolinska University Hospital, Stockholm, Sweden

    Caroline Verbeke

  9. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden

    Marco Del Chiaro

Authors
  1. Raffaella Maria Pozzi-Mucelli
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  2. Irina Rinta-Kiikka
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  4. Johanna Laukkarinen
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  6. Kim Ånonsen
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  7. Caroline Verbeke
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  9. Nikolaos Kartalis
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Correspondence to Nikolaos Kartalis.

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Pozzi-Mucelli, R.M., Rinta-Kiikka, I., Wünsche, K. et al. Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol. Eur Radiol 27, 41–50 (2017). https://doi.org/10.1007/s00330-016-4377-4

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  • DOI: https://doi.org/10.1007/s00330-016-4377-4

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