Application of the 2024 International Association of Pancreatology Guidelines for Identifying (Pre)Malignancy Among Presumed Intraductal Papillary Mucinous Neoplasms via CT and MRI.
IF 3.9 2区 医学Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
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引用次数: 0
Abstract
Rationale and objectives: To evaluate the diagnostic performance of the 2024 International Association of Pancreatology (IAP) guidelines for presumed intraductal papillary mucinous neoplasms (IPMNs).
Materials and methods: We retrospectively analyzed 181 presumed IPMNs with preoperative contrast-enhanced CT and 129 presumed IPMNs with preoperative contrast-enhanced MRI. All high-risk stigmata (HRS) and worrisome features (WF) in the 2024 IAP guidelines were assessed. Multivariable logistic regression analysis developed nomograms for identifying (pre)malignancy among presumed IPMNs via CT and MRI. The diagnostic performance of nomograms was validated and compared with the 2017 IAP guidelines in independent testing cohorts.
Results: Elevated serum carbohydrate antigen 19-9, main pancreatic duct (MPD) ≥ 10 mm, thickened enhancing cyst wall, enhanced mural nodule or solid component, and lymphadenopathy were associated with (pre)malignancy via CT and MRI. MPD ≥ 5 mm and abrupt MPD caliber changes with distal atrophy were also related to (pre)malignancy via CT. Both the CT and MRI nomograms demonstrated satisfactory and improved diagnostic performance compared to HRS in the 2017 IAP guidelines (accuracy: 77.9% vs 67.7%, p = 0.039 for CT and 75.5% vs 59.2%, p = 0.021 for MRI) and the six-point scale based on the 2017 version (AUC: 0.808 vs 0.726, p = 0.039 for CT and 0.865 vs 0.631, p < 0.001 for MRI) in the testing cohorts. The intermodality agreement between CT and MRI was moderate to excellent, except for thickened enhancing cyst wall.
Conclusion: The nomograms based on the 2024 IAP guidelines effectively identified (pre)malignant lesions among presumed IPMNs and demonstrated improvement over the 2017 version when evaluated via both CT and MRI in the testing cohorts.
期刊介绍：
Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.
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