Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol

Raffaella Maria Pozzi-Mucelli; Irina Rinta-Kiikka; Katharina Wünsche; Johanna Laukkarinen; Knut Jørgen Labori; Kim Ånonsen; Caroline Verbeke; Marco Del Chiaro; Nikolaos Kartalis

doi:10.1007/s00330-016-4377-4

Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol

Eur Radiol. 2017 Jan;27(1):41-50. doi: 10.1007/s00330-016-4377-4. Epub 2016 May 31.

Authors

Raffaella Maria Pozzi-Mucelli¹, Irina Rinta-Kiikka², Katharina Wünsche³, Johanna Laukkarinen⁴, Knut Jørgen Labori⁵, Kim Ånonsen⁶, Caroline Verbeke^{7

8}, Marco Del Chiaro⁹, Nikolaos Kartalis¹⁰

Affiliations

¹ Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Radiology, C1-46 Karolinska University Hospital, 14186, Stockholm, Sweden.
² Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland.
³ Department of Radiology, St.Olavs University Hospital, Trondheim, Norway.
⁴ Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
⁵ Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.
⁶ Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
⁷ Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway.
⁸ Department of Pathology, Karolinska University Hospital, Stockholm, Sweden.
⁹ Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
¹⁰ Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Department of Radiology, C1-46 Karolinska University Hospital, 14186, Stockholm, Sweden. nikolaos.kartalis@karolinska.se.

PMID: 27246720
DOI: 10.1007/s00330-016-4377-4

Abstract

Objectives: The study aims were to evaluate: (1) whether a short-protocol (SP) MRI for the surveillance of pancreatic cystic neoplasms (PCN) provides equivalent clinical information as a comprehensive-protocol (CP), and (2) the cost reduction from substituting CP with SP for patient surveillance.

Methods: This retrospective study included 154 consecutive patients (median age: 66, 52 % men) with working-diagnosis of PCN and available contrast-enhanced MRI/MRCP. Three radiologists evaluated independently two imaging sets (SP/CP) per patient. The CP included: T2-weighted (HASTE/MRCP), DWI and T1-weighted (chemical-shift/pre-/post-contrast) images [acquisition time (AT) ≈ 35 min], whereas the SP included: T2-weighted HASTE and T1-weighted pre-contrast images (AT ≈ 8 min). Mean values of largest cyst/main pancreatic duct diameter (D_C/D_MPD) were compared. Agreement regarding presence/absence of cystic/MPD mural nodules (MN_C/MN_MPD), inter-observer agreement and cost differences between SP/CP were calculated.

Results: For D_C and D_MPD, mean values with SP/CP were 21.4/21.7 mm and 3.52/3.58 mm, while mean differences SP-CP were 0.3 mm (p = 0.02) and 0.06 mm (p = 0.12), respectively. For presence/absence of MN_C and MN_MPD, SP/CP coincided in 93 % and 98 % of cases, respectively. Inter-observer agreement was strong for SP/CP. SP-cost was 25 % of CP-cost.

Conclusions: For the surveillance of PCN, short-protocol MRI provides information equivalent to the more time-consuming and costly comprehensive-protocol.

Key points: • Pancreatic cystic neoplasms (PCN) are increasingly diagnosed in the general population. • Multiple imaging controls are recommended for the surveillance of patients with PCN. • Short and comprehensive MRI-protocols are equivalent for decision-making in PCN under surveillance. • Evaluation of imaging risk factors in PCNs is comparable with both MRI-protocols. • Use of the short MRI-protocol may rationalise healthcare resources.

Keywords: Cysts; Interdisciplinary communication; Magnetic Resonance Imaging; Neoplasms; Pancreas.

Publication types

Comparative Study

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Cholangiopancreatography, Magnetic Resonance / methods*
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Pancreas / diagnostic imaging*
Pancreatic Neoplasms / diagnosis*
Retrospective Studies
Young Adult