Criteria for determining malignancy in pancreatic intraductal papillary mucinous neoplasm based on computed tomography

Abstract

$\textit {Introduction:}$ Determining the dignity of intraductal papillary mucinous neoplasms (IPMNs) by imaging procedures is challenging. Various CT-based criteria were evaluated. $\textit {Patients and Methods:}$ Preoperative CT scans from 47 patients with IPMN were analyzed. Predefined criteria of malignancy were compared between patients with benign (bIPMN; $\it n$ = 28) and malignant (mIPMN; $\it n$ = 19) tumors, and a summation score was determined. $\textit {Results:}$ Preoperative carbohydrate-antigen 19-9 levels were higher in patients with mIPMN ($\it p$ = 0.013). The diameter of the main pancreatic duct was greater in patients with mIPMN (($\it p$ < 0.0001). More patients with mIPMN showed bile duct obstruction (($\it p$ = 0.0076), solid tumor components (($\it p$ = 0.0076), contrast enhancement in cystic walls (($\it p$ = 0.0086), peripancreatic lymph nodes (($\it p$ = 0.0076), and abrupt diameter changes of the main pancreatic duct (($\it p$ = 0.0008). The CT density of the cysts was higher in mIPMN (($\it p$ = 0.0063). The diagnostic accuracy of the summation score (sensitivity: 0.84, specificity: 0.96) was greater when compared to each individual CT parameter. $\textit {Conclusions:}$ The prevalence and extent of various CT-based abnormalities are greater in patients with mIPMN, but the wide overlap limits the diagnostic value of each individual parameter. A simple summation score largely enhances the diagnostic accuracy