MDCT of Intraductal Papillary Mucinous Neoplasm of the Pancreas: Evaluation of Features Predictive of Invasive Carcinoma

• Published in: American journal of roentgenology (1976) Vol. 186; no. 3; pp. 687 - 695
• Main Authors: Kawamoto, Satomi, Lawler, Leo P, Horton, Karen M, Eng, John, Hruban, Ralph H, Fishman, Elliot K
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.03.2006; American Roentgen Ray Society
• Subjects: Adenocarcinoma, Mucinous - diagnostic imaging; Adenocarcinoma, Mucinous - pathology; Adenocarcinoma, Mucinous - surgery; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Pancreatic Ductal - diagnostic imaging; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Contrast Media; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Nuclear medicine; Carcinoma; Carcinoma in situ; Helical computed tomography; Malignant tumor; Artery; Pancreatic duct; Multidetector scanner; Treatment; Surgery; Radiology; Medical imagery; Hepatic duct; Predictive factor; Pancreas; Vein; Main biliary tract; Contrast media
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.04.1820

The purpose of our study was to evaluate factors predictive of the presence of invasive carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT. Preoperative MDCT of 36 consecutive patients (23 men, 13 women; mean age, 66.6 years) who had undergone surgical resection and had a pathologic diagnosis of IPMN were retrospectively assessed. CT was performed with a 4-MDCT scanner with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Arterial and venous phase images were acquired at 25 and 50-60 sec from the start of IV contrast administration. Type of ductal involvement, location, tumor size in branch duct type and combined type lesions, caliber of the main pancreatic duct, caliber of the common bile duct or common hepatic duct, and solid appearance of the lesion were assessed on CT and correlated with pathologic findings for invasive carcinoma. Pathologic analysis revealed carcinoma in situ in seven patients (19%) and invasive carcinoma in 15 patients (42%) arising from the IPMN. With invasive carcinoma, the size of the tumor in branch duct type and combined type, and the caliber of the main pancreatic duct were significantly larger compared with the lesions without invasive carcinoma (4.7 +/- 1.7 cm vs 2.6 +/- 1.4 cm [p = 0.0007] and 9.3 +/- 5.5 mm vs 4.6 +/- 4.1 mm [p = 0.006], respectively). A solid mass (p < 0.001), dilatation of the common bile duct or common hepatic duct (> or = 15 mm), and the presence of a stent (p = 0.0004) were correlated with the presence of associated invasive carcinoma. MDCT helped to predict invasive carcinoma associated with IPMN.