Skip to main content

Advertisement

SpringerLink
Log in

MRI is useful to suggest and exclude malignancy in mucinous cystic neoplasms of the pancreas

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the value of MRI in differentiating benign (b-MCN) and malignant (m-MCN) MCN. European guidelines suggest that certain mucinous cystic neoplasms (MCN) of the pancreas can be conservatively managed.

Methods

A retrospective single-center study of consecutive patients with resected MCN. MRIs were independently reviewed by two readers blinded to the pathological results. The authors compared b-MCN (i.e., mucinous-cystadenoma comprising high-grade dysplasia (HGD)) and m-MCN (i.e., cystadenocarcinoma).

Results

Sixty-three patients (62 women [98%]) with 63 MCN (6 m-MCN, 2 HGD) were included. m-MCN tumors had a tendency to be larger than b-MCN (median 86 [25–103] vs. 45 [17–130] mm, p = .055). The combination of signal heterogeneity on T2-weighted imaging, wall thickness ≥ 5 mm, the presence of mural nodules ≥ 9 mm, and enhancing septa had an area under the ROC curve of 0.97 (95% CI 0.91–1.00) for the diagnosis of m-MCN. A total of 24 (37%), 20 (32%), 10 (16%), 5 (8%), and 4 (6%) out of 63 MCNs showed 0, 1, 2, 3, and 4 of these features, respectively. The corresponding rate of m-MCN was 0%, 0%, 10%, 20%, and 100%, respectively, with a good-to-excellent inter-reader agreement. Patterns with a high NPV for m-MCN included an absence of enhancing septa or walls (NPV 97% and 100%, respectively), wall thickness < 3 mm (NPV 100%), and no mural nodules (NPV 100%).

Conclusions

A combination of 4 imaging features suggests malignant MCN on MRI. On the other hand, visualization of a thin non-enhancing wall with no mural nodules suggests benign MCN.

Key Points

• A heterogenous signal on T2-weighted MRI, a ≥ 5-mm-thick wall, mural nodules ≥ 9 mm, and/or enhancing septa suggest malignant MCNs.

• A thin non-enhancing wall with no mural nodules suggests benign MCNs.

• MRI should be performed in the pre-therapeutic evaluation of MCN to help determine the therapeutic strategy in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

b-MCN:

Benign mucinous cystic neoplasm

HGD:

High-grade dysplasia

MCN:

Mucinous cystic neoplasms

m-MCN:

Malignant mucinous cystic neoplasm

References

  1. Nagtegaal ID, Odze RD, Klimstra D et al (2020) The 2019 WHO classification of tumours of the digestive system. Histopathology 76:182–188

    Article  Google Scholar 

  2. Zamboni G, Scarpa A, Bogina G et al (1999) Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 23:410–422

    Article  CAS  Google Scholar 

  3. Nilsson LN, Keane MG, Shamali A et al (2016) Nature and management of pancreatic mucinous cystic neoplasm (MCN): a systematic review of the literature. Pancreatology 16:1028–1036

    Article  Google Scholar 

  4. Hui L, Rashid A, Foo WC et al (2018) Significance of T1a and T1b carcinoma arising in mucinous cystic neoplasm of pancreas. Am J Surg Pathol 42:578

    Article  Google Scholar 

  5. O'Toole D, Palazzo L, Hammel P et al (2004) Macrocystic pancreatic cystadenoma: the role of EUS and cyst fluid analysis in distinguishing mucinous and serous lesions. Gastrointest Endosc 59:823–829

    Article  Google Scholar 

  6. Cizginer S, Turner B, Bilge AR, Karaca C, Pitman MB, Brugge WR (2011) Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas 40:1024–1028

    Article  CAS  Google Scholar 

  7. Zhong N, Zhang L, Takahashi N et al (2012) Histologic and imaging features of mural nodules in mucinous pancreatic cysts. Clin Gastroenterol Hepatol 10:192–198. e192

    Article  Google Scholar 

  8. Genevay M, Mino-Kenudson M, Yaeger K et al (2011) Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts. Ann Surg 254

  9. The European Study Group on Cystic Tumours of the Pancreas (2018) European evidence-based guidelines on pancreatic cystic neoplasms. Gut 67:789–804

  10. Park JW, Jang J-Y, Kang MJ, Kwon W, Chang YR, Kim S-W (2014) Mucinous cystic neoplasm of the pancreas: is surgical resection recommended for all surgically fit patients? Pancreatology 14:131–136

    Article  Google Scholar 

  11. Crippa S, Salvia R, Warshaw AL et al (2008) Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg 247:571

    Article  Google Scholar 

  12. Yamao K, Yanagisawa A, Takahashi K et al (2011) Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan Pancreas Society. Pancreas 40:67–71

    Article  CAS  Google Scholar 

  13. Kosmahl M, Egawa N, Schröder S, Carneiro F, Lüttges J, Klöppel G (2002) Mucinous nonneoplastic cyst of the pancreas: a novel nonneoplastic cystic change? Mod Pathol 15:154–158

    Article  Google Scholar 

  14. Jais B, Rebours V, Malleo G et al (2016) Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). Gut 65(2):305–312

    Article  CAS  Google Scholar 

  15. Le Baleur Y, Couvelard A, Vullierme MP et al (2011) Mucinous cystic neoplasms of the pancreas: definition of preoperative imaging criteria for high-risk lesions. Pancreatology 11:495–499

    Article  Google Scholar 

  16. Di Paola V, Manfredi R, Mehrabi S et al (2016) Pancreatic mucinous cystoadenomas and cystoadenocarcinomas: differential diagnosis by means of MRI. Br J Radiol 89:20150536

    Article  Google Scholar 

  17. Falconi M, Mantovani W, Crippa S, Mascetta G, Salvia R, Pederzoli P (2008) Pancreatic insufficiency after different resections for benign tumours. Br J Surg 95:85–91

    Article  CAS  Google Scholar 

  18. Regi P, Salvia R, Cena C, Girelli R, Frigerio I, Bassi C (2013) Cystic “feminine” pancreatic neoplasms in men. Do any clinical alterations correlate with these uncommon entities? Int J Surg 11:157–160

    Article  CAS  Google Scholar 

  19. Procacci C, Carbognin G, Accordini S et al (2001) CT features of malignant mucinous cystic tumors of the pancreas. Eur Radiol 11:1626–1630

    Article  CAS  Google Scholar 

  20. Garces-Descovich A, Beker K, Castillo-Angeles M et al (2018) Mucinous cystic neoplasms of the pancreas: high-resolution cross-sectional imaging features with clinico-pathologic correlation. Abdom Radiol (NY) 43:1413–1422

    Article  Google Scholar 

  21. Postlewait LM, Ethun CG, McInnis MR et al (2017) Association of preoperative risk factors with malignancy in pancreatic mucinous cystic neoplasms: a multicenter study. JAMA Surg 152:19–25

    Article  Google Scholar 

  22. Keane MG, Shamali A, Nilsson LN et al (2018) Risk of malignancy in resected pancreatic mucinous cystic neoplasms. Br J Surg 105:439–446

    Article  CAS  Google Scholar 

  23. Goh BK, Tan Y-M, Chung Y-FA et al (2006) A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg 30:2236–2245

    Article  Google Scholar 

  24. Manfredi R, Ventriglia A, Mantovani W et al (2015) Mucinous cystic neoplasms and serous cystadenomas arising in the body-tail of the pancreas: MR imaging characterization. Eur Radiol 25:940–949

    Article  Google Scholar 

  25. Mamone G, Barresi L, Tropea A, Di Piazza A, Miraglia R (2020) MRI of mucinous pancreatic cystic lesions: a new updated morphological approach for the differential diagnosis. Updates Surg 72:617–637

    Article  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Radiology, Beaujon University Hospital, 100 bd general Leclerc, 92110, Clichy, France

    Marie-Pierre Vullierme, Jules Gregory, Valerie Vilgrain & Maxime Ronot

  2. Université Paris Diderot-Paris 7, Université de Paris, F-75018, Paris, France

    Marie-Pierre Vullierme, Vinciane Rebours, Jerome Cros, Philippe Levy, Alain Sauvanet & Maxime Ronot

  3. Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Pancreatology, Beaujon Hospital, 100 bd general Leclerc, 92110, Clichy, France

    Vinciane Rebours, Lina Aguilera-Munoz, Lucie Laurent & Philippe Levy

  4. Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Pathology, Beaujon University Hospital, 100 bd general Leclerc, 92110, Clichy, France

    Jerome Cros

  5. Department of Radiology, Benha University Hospital, Fareed Nada Street, Benha, Qalubiya Governorate, 13511, Egypt

    Yasser Abelhady-Attia

  6. Centre de Recherche de l’Inflammation (CRI), INSERM U1149, Université de Paris, F-75018, Paris, France

    Valerie Vilgrain

  7. Assistance Publique-Hôpitaux de Paris, APHP.Nord, Department of Hepato Pancreato Biliary Surgery, Beaujon University Hospital, 100 bd general Leclerc, 92110, Clichy, France

    Alain Sauvanet

Authors
  1. Marie-Pierre Vullierme
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jules Gregory
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vinciane Rebours
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jerome Cros
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasser Abelhady-Attia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Valerie Vilgrain
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lina Aguilera-Munoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lucie Laurent
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Philippe Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alain Sauvanet
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Maxime Ronot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie-Pierre Vullierme.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr. Marie-Pierre Vullierme, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Maxime Ronot and Dr. Jules Gregory kindly provided statistical advice for this manuscript. Both authors have significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because the study was retrospective upon preoperative MRI.

Ethical approval

Institutional Review Board approval was obtained, Board -IRB 00006477- of HUPNVS, Paris 7 University, AP-HP.

Methodology

• retrospective

• case-control study

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vullierme, MP., Gregory, J., Rebours, V. et al. MRI is useful to suggest and exclude malignancy in mucinous cystic neoplasms of the pancreas. Eur Radiol 32, 1297–1307 (2022). https://doi.org/10.1007/s00330-021-08091-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-08091-6

Keywords

Search

Navigation