Eur Radiol: MR texture analysis to identify the malignant possibility of pancreatic ductal papillary mucinous tumors!

With the application and improvement of abdominal imaging technology, incidental findings of pancreatic cystic lesions, including intraductal papillary myxomas (IPMNs), are also increasing.

As a small part of pancreatic cystic lesions will develop into aggressive tumors, it may be important to accurately predict the malignancy of pancreatic cystic lesions on imaging images.

In recent years, texture analysis as a quantitative imaging biomarker has received extensive attention in tumor imaging.
Because it can quantify tissue heterogeneity, it provides important information for tumor characterization and prognosis.

Recently, a study published in the journal European Radiology explored the application value of MR performance and texture analysis in predicting the malignant potential of intrapancreatic papillary mucinous tumors (IPMN), providing a noninvasive imaging method for clinical assessment of the malignant potential of IPMN means.

A total of 248 patients with surgically confirmed IPMNs were included in this study (106 cases of malignant [invasive cancer/high-grade dysplasia], and 142 cases of benign [low/moderate dysplasia]), and each patient underwent MRI cholangiopancreatography (MRCP) check.

According to the recommendations of the 2017 International Consensus Guidelines, two reviewers conducted an independent analysis of MR performance.

At the same time, the texture analysis of MRCP was carried out.

Multivariate logistic regression analysis was used to determine predictors of malignant IPMNs.

Use receiver operating curve to analyze diagnostic performance.

In MR findings, enhanced mural nodules ≥5 mm, main pancreatic duct (MPD) ≥10 mm or MPD 5-9 mm, and MPD mutations were significant predictors of malignant IPMNs (p <0.
05).

Among texture variables, effective diameter, surface area, sphericity, compactness, entropy and gray-level co-occurrence matrix entropy are significant predictors (p <0.
05). In multivariate analysis, enhanced wall nodules ≥ 5 mm (odds ratios (ORs), 6.
697 and 6.
968 for reviewers 1 and 2, respectively), MPD ≥ 10 mm or MPD 5 to 9 mm (ORs of 4.
098 and 4.
215, respectively) 2.
517 and 3.
055), greater entropy (ORs, 1.
485 and 1.
515) and smaller compactness (ORs, 0.
981 and 0.
977) are important predictors of malignant IPMNs (p <0.
05).

When texture variables were added to the MR performance, the diagnostic power of the two reviewers for malignant IPMNs increased from 0.
80 and 0.
78 to 0.
85 and 0.
85, respectively (p <0.
05).

Comparison of MR imaging findings of benign and malignant IPMN.
Comparison of texture variables of benign and malignant IPMN.
A 64-year-old male with intraductal papillary mucinous tumor (IPMN) with invasive carcinoma.

The MIP reconstructed image of MRCP showed a pleomorphic cyst (arrow) with a diameter of about 3 cm in the head of the pancreas without obvious pancreatic duct dilation (less than 5 mm).

T1-weighted MRI in the portal vein showed no clear enhancement of wall nodules or thickened septa (arrows) in the cyst.

MR texture analysis shows that the entropy is high and the density is low (arrow).
MRCP-based texture features can be used to predict malignant IPMNs.
Adding texture analysis to MR features can improve the diagnostic performance of predicting malignant IPMNs.

Original source: Sun Kyung Jeon, Jung Hoon Kim, Jeongin Yoo, et al.
Assessment of malignant potential in intraductal papillary mucinous neoplasms of the pancreas using MR findings and texture analysis.
DOI:10.
1007/s00330-020-07425-0