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Magnetic resonance imaging short protocols for intraductal papillary mucinous neoplasm (IPMN) surveillance: The time
Mirko D'Onofrio1, Luca Geraci1, Riccardo Lombardi De Robertis1
1Department of Radiology - G.B. Rossi University Hospital, AOUI Verona, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
Background/Objectives:
To analyze the diagnostic performance of three short magnetic resonance imaging (MRI) protocols for the follow-up of pancratic intraductal papillary mucinous neoplasms (IPMN).
Methods:
Follow-up MRI examinations of 287 patients with IPMN performed in two centers were retrospectively retrieved. Four MRI protocols were identified as follows: T1-weighted (T1w), T2-weighted (T2w), and MRCP sequences (protocol 1); T1w, T2w, MRCP, and diffusion-weighted (DWI) sequences (protocol 2); T1w, T2w, MRCP, and post-contrast T1w-sequences (protocol 3); and a comprehensive protocol including all previous sequences (protocol 4). Three radiologists with different experience in abdominal imaging expressed their opinion upon the optimal patient's management upon the evaluation of each protocol. Intra-and inter-observer agreement and concordance with the clinical decision expressed by a pancreatic surgeon were calculated with Cohen's kappa test.
Results:
223 patients were included (66±10 years; 92 men, 131 women). 143 patients had branch-duct-IPMNs, 25 main-duct-IPMNs and 55 mixed-type-IPMNs. 79 patients underwent surgery, resulting in 52 high-grade dysplasia (HGD) and 27 low-grade dysplasia (LGD). Concordance for the expert reader between protocols 1, 2 and 3 and the actual clinical decision were 0.63, 0.72, and 0.74 respectively (95% CI, 0.53-0.73, 0.63-0.81, and 0.65-0.83). Inter-observer agreement between reader 1 and reader 2, reader 1 and reader 3, and reader 2 and reader 3 were: 0.71, 0.50, and 0.75 for protocol 1 (95% CI, 0.63-0.81, 0.40-0.60, and 0.66-0.84);0.68, 0.54, and 0.84 for protocol 2 (95% CI, 0.59-0.77, 0.44-0.64, and 0.76-0.91); and 0.77, 0.65, and 0.86 for protocol 3 (95% CI, 0.69-0.86, 0.55-0.74, and 0.80-0.93).
Conclusions:
Short MRI protocol is suitable for IPMN surveillance.
Insights
Short magnetic resonance imaging (MRI) protocols are effective for monitoring pancreatic intraductal papillary mucinous neoplasms (IPMN). These concise MRI approaches provide reliable diagnostic performance for IPMN surveillance, aiding clinical management decisions.
Area of Science:
- Gastroenterology
- Radiology
- Oncology
Background:
- Pancreatic intraductal papillary mucinous neoplasms (IPMN) require regular surveillance.
- Optimizing magnetic resonance imaging (MRI) protocols can improve diagnostic efficiency.
- Short MRI protocols may offer a balance between diagnostic accuracy and patient convenience.
Purpose of the Study:
- To evaluate the diagnostic performance of three distinct short MRI protocols for IPMN follow-up.
- To compare the effectiveness of different MRI sequence combinations in assessing IPMN.
- To determine the suitability of abbreviated MRI protocols for routine IPMN surveillance.
Main Methods:
- Retrospective analysis of 287 patients with IPMN across two institutions.
- Evaluation of four MRI protocols: Protocol 1 (T1w, T2w, MRCP), Protocol 2 (T1w, T2w, MRCP, DWI), Protocol 3 (T1w, T2w, MRCP, post-contrast T1w).
- Assessment of diagnostic performance by three radiologists and comparison with clinical decisions by a pancreatic surgeon, utilizing Cohen's kappa for agreement analysis.
Main Results:
- Concordance rates for the expert reader between protocols 1, 2, and 3 and clinical decisions were 0.63, 0.72, and 0.74, respectively.
- Inter-observer agreement varied across protocols, with Protocol 3 showing higher agreement (0.77, 0.65, 0.86) compared to Protocols 1 and 2.
- The study included 223 patients, with varying IPMN subtypes and dysplasia grades.
Conclusions:
- Short MRI protocols demonstrate suitability for IPMN surveillance.
- The evaluated short MRI protocols offer reliable diagnostic performance for monitoring IPMN.
- These findings support the use of abbreviated MRI protocols in clinical practice for IPMN management.
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