Representative example of CT findings and impact on the remnant pancreas of HG PanIN in a 62-year-old woman with malignant IPMN.

A. On the portal phase axial CT image obtained preoperatively, the MPD is dilated up to 8 mm in diameter in the pancreatic body (arrowheads), suggestive of main duct-type IPMN. B-C. The portal phase axial (B) and coronal (C) preoperative CT images show a 9-mm enhancing mural nodule (arrow) within the MPD, and both the downstream and upstream ducts are dilated (arrowheads). The patient underwent central pancreatectomy for the lesion. D. The portal phase axial CT image obtained 5 years after the surgery shows an enhancing soft tissue lesion at the pancreaticogastrostomy site of the remnant pancreas (arrows), which had grown in size on the recent serial follow-up CT. E. On the axial 18F-fluoro-deoxy-glucose (FDG) positron emission tomography (PET)/ MR image obtained three weeks later, the soft tissue lesion at the resection margin of the remnant pancreas shows FDG uptake (arrow). The patient underwent completion distal pancreatectomy, and the lesion was confirmed as a recurrent adenocarcinoma.</p

Comparison of preoperative CT imaging findings according to IPMN and PanIN grades.

Comparison of preoperative CT imaging findings according to IPMN and PanIN grades.</p

Summary of the used CT scanners.

PurposeTo investigate the common CT findings of high-grade (HG) PanIN and clinical effects in the remnant pancreas in patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Materials and methodsTwo hundred fifty-one patients with surgically confirmed IPMNs (118 malignant [invasive carcinoma/high-grade dysplasia] and 133 benign [low-grade dysplasia]) were retrospectively enrolled. The grade of PanIN (233 absent/low-grade and 18 high-grade) was recorded, and all patients underwent serial CT follow-up before and after surgery. Two radiologists analyzed CT findings of high-risk stigmata or worrisome features according to 2017 international consensus guidelines. They also analyzed tumor recurrence on serial follow-up CT after surgery. Statistical analyses were performed to identify significant predictors and clinical impact on postoperative outcomes of HG PanIN.ResultsPanIN grade showed a significant association with IPMN grade (p = 0.012). Enhancing mural nodules ≥5 mm, abrupt main pancreatic duct (MPD) changes with distal pancreatic atrophy, increased mural nodule size and MPD diameter were common findings in HG PanIN (PConclusionCT can be useful for predicting HG PanIN using common features, such as abrupt MPD changes and mural nodules. In HG PanIN, extra caution is needed to monitor postoperative recurrence during follow-up.</div

A flow chart of patient enrolment.

IPMN = intraductal papillary mucinous neoplasm, PanIN = pancreatic intraepithelial neoplasia, CT = computed tomography, S/P = status post.</p

Human participants research checklist.

PurposeTo investigate the common CT findings of high-grade (HG) PanIN and clinical effects in the remnant pancreas in patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Materials and methodsTwo hundred fifty-one patients with surgically confirmed IPMNs (118 malignant [invasive carcinoma/high-grade dysplasia] and 133 benign [low-grade dysplasia]) were retrospectively enrolled. The grade of PanIN (233 absent/low-grade and 18 high-grade) was recorded, and all patients underwent serial CT follow-up before and after surgery. Two radiologists analyzed CT findings of high-risk stigmata or worrisome features according to 2017 international consensus guidelines. They also analyzed tumor recurrence on serial follow-up CT after surgery. Statistical analyses were performed to identify significant predictors and clinical impact on postoperative outcomes of HG PanIN.ResultsPanIN grade showed a significant association with IPMN grade (p = 0.012). Enhancing mural nodules ≥5 mm, abrupt main pancreatic duct (MPD) changes with distal pancreatic atrophy, increased mural nodule size and MPD diameter were common findings in HG PanIN (PConclusionCT can be useful for predicting HG PanIN using common features, such as abrupt MPD changes and mural nodules. In HG PanIN, extra caution is needed to monitor postoperative recurrence during follow-up.</div

Comparison of postoperative follow-up CT imaging findings according to IPMN and PanIN grades.

Comparison of postoperative follow-up CT imaging findings according to IPMN and PanIN grades.</p

S3 File -

PurposeTo investigate the common CT findings of high-grade (HG) PanIN and clinical effects in the remnant pancreas in patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Materials and methodsTwo hundred fifty-one patients with surgically confirmed IPMNs (118 malignant [invasive carcinoma/high-grade dysplasia] and 133 benign [low-grade dysplasia]) were retrospectively enrolled. The grade of PanIN (233 absent/low-grade and 18 high-grade) was recorded, and all patients underwent serial CT follow-up before and after surgery. Two radiologists analyzed CT findings of high-risk stigmata or worrisome features according to 2017 international consensus guidelines. They also analyzed tumor recurrence on serial follow-up CT after surgery. Statistical analyses were performed to identify significant predictors and clinical impact on postoperative outcomes of HG PanIN.ResultsPanIN grade showed a significant association with IPMN grade (p = 0.012). Enhancing mural nodules ≥5 mm, abrupt main pancreatic duct (MPD) changes with distal pancreatic atrophy, increased mural nodule size and MPD diameter were common findings in HG PanIN (PConclusionCT can be useful for predicting HG PanIN using common features, such as abrupt MPD changes and mural nodules. In HG PanIN, extra caution is needed to monitor postoperative recurrence during follow-up.</div

CT scanning parameters.

PurposeTo investigate the common CT findings of high-grade (HG) PanIN and clinical effects in the remnant pancreas in patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Materials and methodsTwo hundred fifty-one patients with surgically confirmed IPMNs (118 malignant [invasive carcinoma/high-grade dysplasia] and 133 benign [low-grade dysplasia]) were retrospectively enrolled. The grade of PanIN (233 absent/low-grade and 18 high-grade) was recorded, and all patients underwent serial CT follow-up before and after surgery. Two radiologists analyzed CT findings of high-risk stigmata or worrisome features according to 2017 international consensus guidelines. They also analyzed tumor recurrence on serial follow-up CT after surgery. Statistical analyses were performed to identify significant predictors and clinical impact on postoperative outcomes of HG PanIN.ResultsPanIN grade showed a significant association with IPMN grade (p = 0.012). Enhancing mural nodules ≥5 mm, abrupt main pancreatic duct (MPD) changes with distal pancreatic atrophy, increased mural nodule size and MPD diameter were common findings in HG PanIN (PConclusionCT can be useful for predicting HG PanIN using common features, such as abrupt MPD changes and mural nodules. In HG PanIN, extra caution is needed to monitor postoperative recurrence during follow-up.</div

Summary of pathologic findings of 12 patients with tumor recurrence in the remnant pancreas.

Summary of pathologic findings of 12 patients with tumor recurrence in the remnant pancreas.</p

Summary of study population demographics and clinical characteristics.

Summary of study population demographics and clinical characteristics.</p