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Incidental pancreatic cystic lesions: comparison between CT with model-based algorithm and MRI.

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  • 1Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy.

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Summary

Low-kilovolt CT with MBIR reconstruction shows good agreement with MRI for detecting pancreatic cystic lesion features. This CT technique is a useful first-line tool for identifying worrisome signs and high-risk stigmata.

Keywords:
Magnetic resonance cholangiopancreatographyMultidetector computed tomographyPancreatic intraductal neoplasmsPancreatic neoplasms

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Area of Science:

  • Radiology
  • Medical Imaging
  • Gastroenterology

Background:

  • Pancreatic cystic lesions require accurate characterization for risk stratification.
  • Magnetic Resonance Imaging (MRI) is the established standard for evaluating these lesions.
  • Computed Tomography (CT) offers an alternative imaging modality.

Purpose of the Study:

  • To compare low-kilovolt (kV) CT reconstructed with the Model-Based Iterative Reconstruction (MBIR) technique against MRI for detecting high-risk stigmata and worrisome features in pancreatic cystic lesions.
  • To assess the diagnostic performance of low-kV CT-MBIR in characterizing pancreatic cystic lesions.

Main Methods:

  • Retrospective enrollment of 75 patients who underwent low-kV CT with contrast and MRI with Magnetic Resonance Cholangiopancreatography (MRCP).
  • Blinded review of imaging data to record lesion characteristics including size, location, calcifications, septa, solid components, main pancreatic duct (MPD) communication, and MPD dilatation.
  • Statistical analysis using mean differences, 95% limits of agreement, Intraclass Correlation Coefficient (ICC), and Cohen's kappa (κ) statistics to compare CT and MRI findings.

Main Results:

  • MRI detected more pancreatic cystic lesions than CT, but a good overall agreement (ICC = 0.81) was observed.
  • Very good agreement was found for lesion diameter (ICC = 0.98), location (κ = 0.90), MPD dilatation (κ = 1), septa presence (κ = 0.86), and MPD communication (κ = 0.87).
  • Moderate agreement was noted for enhanced components (κ = 0.44), and fair agreement for calcifications (κ = 0.87).

Conclusions:

  • Multi-detector CT (MDCT) reconstructed with MBIR is nearly equivalent to MRI with MRCP for evaluating worrisome features and high-risk stigmata in pancreatic cystic lesions.
  • Low-kV CT-MBIR provides detailed morphological features beneficial for lesion characterization.
  • CT can serve as a valuable first-line imaging technique for identifying concerning features in pancreatic cystic lesions, complementing MRI's role.