gadoxetic-acid-disodium and Adenocarcinoma--Mucinous

Background It is debated whether diagnostic performance of diffusion-weighted imaging (DWI), which is widely used for detection and characterization of various malignant tumors, is comparable with high-risk stigmata of 2012 international consensus guidelines (ICG) for diagnosis of intraductal papillary mucinous neoplasms (IPMNs). Purpose To evaluate the diagnostic accuracy of diffusion restriction in IPMNs for prediction of malignancy and invasiveness in comparison with high-risk stigmata of 2012 ICG. Material and Methods This retrospective study was institutional review board approved and informed consent was waived. A total of 132 patients with surgically proven IPMNs (49 malignant, 83 benign) who underwent gadoxetic acid-enhanced magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and DWI with a b-value of 0, 100, and 800 s/mm

Topics: Adenocarcinoma, Mucinous; Adult; Aged; Carcinoma, Pancreatic Ductal; Carcinoma, Papillary; Cholangiopancreatography, Magnetic Resonance; Consensus; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Pancreas; Pancreatic Neoplasms; Practice Guidelines as Topic; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

The purpose of this study was to evaluate whether the use of diffusion-weighted MRI (DWI) increases diagnostic accuracy in the differentiation of malignant from benign intraductal papillary mucinous neoplasms (IPMNs) of the pancreas over the accuracy of contrast-enhanced MRI with MRCP.. A total of 61 patients with surgically resected IPMNs (19 malignant, 42 benign) who underwent gadoxetic acid-enhanced MRI, DWI, and MRCP were included. Two blinded observers evaluated two image sets, that is, conventional MRI with MRCP images versus combined conventional MRI with MRCP and DW images, and scored their confidence for malignancy of IPMNs. Qualitative analyses of the IPMNs were also conducted. Diagnostic performance (ROC curve analysis), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. The Fisher exact test was used to compare groups.. The diagnostic performance (area under the ROC curve [Az]) with respect to predicting malignancy of IPMNs improved significantly for both observers after additional review of DW images (p < 0.05). The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of combined conventional and DW images were higher than those of conventional MR images alone. Diffusion restriction was more often present in malignant IPMNs (78.9%) than in benign IPMNs (16.7%) (p < 0.001) with excellent interobserver agreement (ĸ = 0.965).. Compared with conventional MRI alone, adding DWI to conventional MRI improves diagnostic accuracy with increased specificity for differentiating malignant from benign IPMNs of the pancreas.

Topics: Adenocarcinoma, Mucinous; Adult; Aged; Aged, 80 and over; Carcinoma, Pancreatic Ductal; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Male; Observer Variation; Pancreatic Neoplasms; Reproducibility of Results; Sensitivity and Specificity

We report a 75-year-old man with radiological evidence of a 4.5 × 3.0 cm cystic mass and polypoid masses in the left hepatic lobe. Study of surgical specimens returned a definitive diagnosis of intraductal papillary mucinous neoplasm of the bile duct (IPMN-B). IPMN-B, thought to be the counterpart of intraductal papillary mucinous neoplasm of the pancreas (IPMN), is frequently associated with marked mucin production. We describe a rare case of IPMN-B in which gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance cholangiography was useful for detecting mucin retention in the bile ducts.

Topics: Adenocarcinoma, Mucinous; Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Papillary; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Gadolinium DTPA; Humans; Male