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Topic
Computer Tomography, Magnetic Resonance, Pancreas Benign Lesions, Pancreas Diffuse Disease, Pancreas Malignant Lesions
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{"type":2,"code":"6E32WM02n"}
[session]
[presentation]
[presenter]
SS 12.2 - Factors influencing the detection rate of transabdominal US for incidentally detected pancreatic cysts: a prospective multicenter study
Presentation Number
SS 12.2
Channel
On-demand channel 6
Purpose
To investigate the detection rate of transabdominal US (TAUS) for incidentally detected pancreatic cysts on CT or MRI as well as factors influencing detection rates.
Material and methods
Fifty-seven patients with incidentally detected pancreatic cysts (n = 77, 5mm to 3cm) on CT or MRI were prospectively enrolled at five institutions. TAUS was performed independently by two radiologists and assessed the detection of cysts, their location and size, and the diameter of the main pancreatic duct (MPD). Cyst detection rates according to size, location, multiplicity, and body mass index (BMI) were compared using the Mann-Whitney test. Kappa statistics and interclass correlation coefficient were used to evaluate the inter-observer agreement of cyst detection and consistency of size and diameter of MPD between TAUS and CT/MRI.
Results
Detection rate of pancreatic cysts was 81.8 % (63/77) and 83.1% (64/77) for each radiologist. Detection rate of larger (≥10mm) cysts was significantly higher than smaller cysts (89.0% vs 63.6% for R1; 89.0% vs 68.2% for R2, p< 0.05). Non tail location showed significantly higher detection rate than tail location (89.5% vs 65.0% for R2, p = 0.013) and detection rate was also significantly higher in single than in multiple cysts (90.9% vs 69.7 %, p = 0.018 for R1). However, BMI showed no significant difference. Inter-observer agreement was excellent for cyst size (0.963, 95% CI: 0.943-0.976) and diameter of MPD (0.930, 95% CI: 0.891- 0.956).
Conclusion
TAUS could be a useful surveillance imaging tool for incidentally detected pancreatic cysts on CT or MRI, especially, in single pancreatic cysts of larger (≥1cm) size and non-tail location.
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{"status_url":"https:\/\/cslide.ctimeetingtech.com\/play\/7E22WM06C\/status","status":20,"track_url":"https:\/\/cslide.ctimeetingtech.com\/play\/7E22WM06C\/track","track":60,"provider":"CTI","provider_live":0,"type":1,"code":"7E22WM06C"}
[session]
[presentation]
[presenter]
SS 12.4 - MDCT scan with model-based reconstruction algorithm in the detection and characterization of intraductal papillary mucinous neoplasm: comparison with MRCP
Presentation Number
SS 12.4
Channel
On-demand channel 6
Purpose
To compare the diagnostic accuracy of low-kV MDCT reconstructed with model-based iterative reconstruction algorithm (IMR) to MRI with MRCP sequences in the detection of intraductal papillary mucinous neoplasm (IPMN) and those features useful for their characterization.
Material and methods
We evaluated a total of 90 patients, with no history of pancreatitis, neoplasm and prior surgical procedures in the pancreas, who underwent both low-dose MDCT reconstructed with IMR and MRCP (time interval lower 90 days) for incidental pancreatic cystic lesions. Number of lesions detected in each patient and morphologic features (according to 2018 European Guidelines) of defined target lesion were recorded and analyzed to compare the diagnostic performance of MDCT with IMR algorithm and MRCP.
Results
A higher number of pancreatic cysts was identified on MRI than CT examinations (463 vs 227); however, high intraclass correlation coefficient (ICC) value of 0.76 was found, suggesting a good agreement. Very good agreement (ICC 0.98) was found regarding the diameter of target lesions (21.4 mm CT vs 21.8 mm MRI), location of the target lesion (κ=0.90), detection of MPD dilatation (κ=1.00), MPD communication (κ=0.73) and septa (κ=0.86). Fair agreement with calcifications (κ=0.22) was found.
Conclusion
Low-dose MDCT reconstructed with IMR can be considered equivalent to MRI with MRCP in the evaluation of IPMN, offering detailed morphologic features helpful for their characterization and those correlated with a high risk of malignancy.
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[session]
[presentation]
[presenter]
SS 12.8 - Inter-observer variability of radiologists for Cambridge Classification for Chronic Pancreatitis using CT and MRCP: results from a large multi-center study
Presentation Number
SS 12.8
Channel
On-demand channel 6
Purpose
To determine inter-observer variability among radiologists in assigning Cambridge Classification (CC) for chronic pancreatitis (CP) based on secretin-enhanced MRCP and contrast-enhanced CT.
Material and methods
This multi-institutional study included 39 subjects who were selected randomly without reference to their clinical data, from 422 participants enrolled in the PROCEED study (ClinicalTrials.gov ID NCT03099850) between June 2017 and August 2018. These subjects were categorized into three groups based on clinical data and review of imaging by local radiologist (LR) at the enrolling sites: controls (n = 8; CC of 0), suspected CP (n = 22; CC of 1 or 2) and definite CP (n = 9; CC = 3 or 4). Each study was scored by 3 radiologists, who were randomly selected from 5 blinded subspecialized radiologists. We compared the CC score by LRs and a consensus CC score by central radiologists (CRs). The weighted kappa statistic (wKappa) was used to estimate the inter-observer agreement.
Results
There was moderate agreement (63% and 67%, respectively) between CRs and LRs in both CT score (wKappa [95% CI] = 0.56 [0.34, 0.78]; p-value = 0.57) and MR score (wKappa [95% CI] = 0.68 [0.49, 0.86]; p-value = 0.72). The composite CT/MRCP score showed moderate agreement (wKappa [95% CI] = 0.62 [0.43, 0.81]; p-value = 0.80). For majority of subjects, the actual cohort assignment by the LR agreed with consensus composite CT/MRCP score by the CRs, with concordance ranging from 75% to 89%.
Conclusion
There is a high degree of concordance by radiologists for the assignment of CC using MRCP and CT.
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{"status_url":"https:\/\/cslide.ctimeetingtech.com\/play\/8E22WM0gd\/status","status":20,"track_url":"https:\/\/cslide.ctimeetingtech.com\/play\/8E22WM0gd\/track","track":60,"provider":"CTI","provider_live":0,"type":1,"code":"8E22WM0gd"}
[session]
[presentation]
[presenter]
SS 12.9 - Ultra-small superparamagnetic iron oxide-enhanced MRI for pre-operative lymph node staging in patients with pancreatic and periampullary carcinoma: a feasibility study
Presentation Number
SS 12.9
Channel
On-demand channel 6
Purpose
An important negative prognostic factor for adenocarcinomas of the pancreas and periampullary region is the presence of para-aortic lymph node (LN) metastases, which are regarded as distant metastases. Determining LN status is challenging but may be possible with MRI with ultra-small superparamagnetic iron oxide (USPIO) particles, which have proven valuable for detecting LN metastases of solid tumors. The aim is to validate USPIO-MRI for pathology in patients with pancreatic or periampullary cancer.
Material and methods
Analysis of an ongoing feasibility study in patients undergoing resection of pancreatic or periampullary adenocarcinoma (N=14). LNs are scored on MRI, divided between regional and distant, and matched to histopathology of resected specimens.
Results
One patient was excluded due to perioperative peritoneal metastases. In the remaining 13 patients, in total 307 LNs were detected on MRI. In total, 293 LNs were analyzed histopathologically. On MRI, 28/78 regional and 58/229 distant LNs were suspected for metastases. On histopathology, 35/260 regional and 3/33 distant LNs were positive for metastases. Not all suspected distant LNs were resected. The regional LNs were assessed on a per-patient basis. Five patients had suspicious LNs with positive LNs histopathologically, 4 patients had negative LNs on MRI, but positive LNs histopathologically and 4 patients had negative LNs on MRI with negative LNs histopathologically.
Conclusion
The preliminary results show that on patient basis it is possible to detect regional LN metastases with USPIO-MRI. Further analysis of the data, including node-to-node analysis and follow-up, will provide more insight into the value of USPIO-MRI in these patients.
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[session]
[presentation]
[presenter]
