• Nieun Seo, Jae Ho Byun, Jin Hee Kim, Hyoung Jung Kim, Seung Soo Lee, Ki Byung Song, Song-Cheol Kim, Duck Jong Han, Seung-Mo Hong, and Moon-Gyu Lee.
• *Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea †Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea ‡Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
• Ann. Surg. 2016 Mar 1; 263 (3): 557-64.

ObjectiveTo validate the 2012 guidelines for intraductal papillary mucinous neoplasm (IPMN) of the pancreas and to compare diagnostic performances of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiating malignant from benign IPMN.BackgroundAs IPMN has variable risks of malignancy and management of this entity is closely related to its malignant potential, it is important to predict risks of IPMN malignancy.MethodsThis retrospective study included 158 patients with surgically confirmed IPMN of the pancreas who underwent both preoperative CT and MRI. Two radiologists evaluated the "high-risk stigmata" and "worrisome features" of the 2012 guidelines for branch duct (BD)-IPMN and main duct (MD)-IPMN. Univariate and multivariable analyses were used to identify significant predictors of malignancy in IPMN. The diagnostic performance was compared between CT and MRI.ResultsMalignant IPMN was seen in 8 of 60 patients (13.3%) with BD-IPMN and 44 of 98 patients (44.9%) with MD-IPMN. Presence of mural nodule was the most important predictor in BD-IPMN and MD-IPMN (odds ratios, 9.2 and 7.6, respectively, P = 0.01 on CT; and odds ratios, 5.7 and 13.3, respectively, P ≤ 0.04 on MRI), whereas mural nodule size and lymphadenopathy were significant only in MD-IPMN (P < 0.05). The diagnostic performance of CT and MRI for significant findings was not statistically different in both types of IPMN (P > 0.34).ConclusionsThe presence of mural nodule was the most important predictor of malignancy in both types of IPMN. Mural nodule size and lymphadenopathy were also significant predictors in MD-IPMN. Computed tomography and MRI showed similar diagnostic performances for differentiating malignant from benign IPMN.

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