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Differential diagnosis of benign and malignant intraductal papillary mucinous tumors of the pancreas: MR cholangiopancreatography and MR angiography.

Choi BS, Kim TK, Kim AY, Kim KW, Park SW, Kim PN, Ha HK, Lee MG, Kim SC - Korean J Radiol (2003 Jul-Sep)

Bottom Line: Combined-type IPMTs were more frequently malignant (78%) than benign (42%) (p < 0.05).Compared with benign lesions, malignant lesions were larger, and the caliber of the communicating channel was also larger (p < 0.05).Their dilated MPD was more extensive and of greater diameter (p < 0.05), and the presence of mural nodules was more frequent (p < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. tkkim@amc.seoul.kr

ABSTRACT

Objective: To compare the usefulness of magnetic resonance cholangiopancreatography (MRCP) and MR angiography (MRA) in differentiating malignant from benign intraductal papillary mucinous tumors of the pancreas (IPMTs), and to determine the findings which suggest malignancy.

Materials and methods: During a 6-year period, 46 patients with IPMT underwent MRCP. Morphologically, tumor type was classified as main duct, branch duct, or combined. The diameter of the main pancreatic duct (MPD), the extent of the dilated MPD, and the location and size of the cystic lesion, septum, and communicating channel were assessed. For all types of IPMTs, enhanced mural nodules and portal vein narrowing were evaluated at MRA.

Results: Combined-type IPMTs were more frequently malignant (78%) than benign (42%) (p < 0.05). Compared with benign lesions, malignant lesions were larger, and the caliber of the communicating channel was also larger (p < 0.05). Their dilated MPD was more extensive and of greater diameter (p < 0.05), and the presence of mural nodules was more frequent (p < 0.001).

Conclusion: Combined MRCP and MRA might be useful for the differential diagnosis of malignant and benign IPMTs of the pancreas.

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A 44-year-old man with malignant combined duct-type IPMT of the pancreas. The MRA source image (TR/TE, 4.6/1.8) shows an enhancing mural nodule (arrow) and a thick irregular septum in the multilocular cystic lesion (arrowheads) of the pancreatic head.
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Figure 6: A 44-year-old man with malignant combined duct-type IPMT of the pancreas. The MRA source image (TR/TE, 4.6/1.8) shows an enhancing mural nodule (arrow) and a thick irregular septum in the multilocular cystic lesion (arrowheads) of the pancreatic head.

Mentions: Mural nodules were observed in 85% (23/27) of malignant IPMTs (Fig. 6), but in only 21% (4/19) of benign IPMTs (p < 0.001). With regard to the presence or absence of portal vein narrowing, however, the difference was not statistically significant (p = 1.6). Only one of 15 benign multilocular branch duct-type lesions had a thick irregular septum, but this was present in 13 of 23 malignant multilocular lesions (57%) (p < 0.001). The mean diameter of mural nodules was 16 ± 11 mm in malignant IPMTs and 6 ± 2 mm in benign IPMTs, representing a statistically significant difference (p < 0.001) (Fig. 7).


Differential diagnosis of benign and malignant intraductal papillary mucinous tumors of the pancreas: MR cholangiopancreatography and MR angiography.

Choi BS, Kim TK, Kim AY, Kim KW, Park SW, Kim PN, Ha HK, Lee MG, Kim SC - Korean J Radiol (2003 Jul-Sep)

A 44-year-old man with malignant combined duct-type IPMT of the pancreas. The MRA source image (TR/TE, 4.6/1.8) shows an enhancing mural nodule (arrow) and a thick irregular septum in the multilocular cystic lesion (arrowheads) of the pancreatic head.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698082&req=5

Figure 6: A 44-year-old man with malignant combined duct-type IPMT of the pancreas. The MRA source image (TR/TE, 4.6/1.8) shows an enhancing mural nodule (arrow) and a thick irregular septum in the multilocular cystic lesion (arrowheads) of the pancreatic head.
Mentions: Mural nodules were observed in 85% (23/27) of malignant IPMTs (Fig. 6), but in only 21% (4/19) of benign IPMTs (p < 0.001). With regard to the presence or absence of portal vein narrowing, however, the difference was not statistically significant (p = 1.6). Only one of 15 benign multilocular branch duct-type lesions had a thick irregular septum, but this was present in 13 of 23 malignant multilocular lesions (57%) (p < 0.001). The mean diameter of mural nodules was 16 ± 11 mm in malignant IPMTs and 6 ± 2 mm in benign IPMTs, representing a statistically significant difference (p < 0.001) (Fig. 7).

Bottom Line: Combined-type IPMTs were more frequently malignant (78%) than benign (42%) (p < 0.05).Compared with benign lesions, malignant lesions were larger, and the caliber of the communicating channel was also larger (p < 0.05).Their dilated MPD was more extensive and of greater diameter (p < 0.05), and the presence of mural nodules was more frequent (p < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. tkkim@amc.seoul.kr

ABSTRACT

Objective: To compare the usefulness of magnetic resonance cholangiopancreatography (MRCP) and MR angiography (MRA) in differentiating malignant from benign intraductal papillary mucinous tumors of the pancreas (IPMTs), and to determine the findings which suggest malignancy.

Materials and methods: During a 6-year period, 46 patients with IPMT underwent MRCP. Morphologically, tumor type was classified as main duct, branch duct, or combined. The diameter of the main pancreatic duct (MPD), the extent of the dilated MPD, and the location and size of the cystic lesion, septum, and communicating channel were assessed. For all types of IPMTs, enhanced mural nodules and portal vein narrowing were evaluated at MRA.

Results: Combined-type IPMTs were more frequently malignant (78%) than benign (42%) (p < 0.05). Compared with benign lesions, malignant lesions were larger, and the caliber of the communicating channel was also larger (p < 0.05). Their dilated MPD was more extensive and of greater diameter (p < 0.05), and the presence of mural nodules was more frequent (p < 0.001).

Conclusion: Combined MRCP and MRA might be useful for the differential diagnosis of malignant and benign IPMTs of the pancreas.

Show MeSH
Related in: MedlinePlus