Incidental pancreatic cysts: natural history and diagnostic accuracy of a limited serial pancreatic cyst MRI protocol.
Eur Radiol
; 24(5): 1020-9, 2014 May.
Article
en En
| MEDLINE
| ID: mdl-24569848
ABSTRACT
OBJECTIVES:
To examine the natural history of incidentally detected pancreatic cysts and whether a simplified MRI protocol without gadolinium is adequate for lesion follow-up.METHODS:
Over a 10-year period, 301-patients with asymptomatic pancreatic cysts underwent follow-up (45 months ± 30). The magnetic resonance imaging (MRI) protocol included axial, coronal T2-weighted images, MR cholangiopancreatographic and fat suppressed T1-weighted sequences before and after gadolinium. Three radiologists independently reviewed the initial MRI, the follow-up studies using first only unenhanced images, then secondly gadolinium-enhanced-sequences. Lesion changes during follow-up were recorded and the added value of gadolinium-enhanced sequences was determined by classifying the lesions into risk categories.RESULTS:
Three hundred and one patients (1,174 cysts) constituted the study population. Only 35/301 patients (12 %) showed significant lesion change on follow-up. Using multivariate analysis the only independent factor of lesion growth (OR = 2.4; 95 % CI, 1.7-3.3; P < 0.001) and mural nodule development (OR = 1.9; 95 % CI, 1.1-3.4, P = 0.03) during follow-up was initial lesion size. No patient with a lesion initial size less than 2 cm developed cancer during follow-up. Intra-observer agreement with and without gadolinium enhancement ranged from 0.86 to 0.97. After consensus review of discordant cases, gadolinium-enhanced sequences demonstrated no added value.CONCLUSION:
Most incidental pancreatic cystic lesions did not demonstrate change during follow-up. The addition of gadolinium-enhanced-sequences had no added-value for risk assignment on serial follow-up. KEY POINTS Significant growth of pancreatic cysts occurred in a minority of patients only. No lesion <2 cm demonstrated any change during the first year of follow-up. Intra-observer agreement between MR pancreatic protocols with and without gadolinium was excellent. Gadolinium application had limited value for follow-up of asymptomatic pancreatic cystic lesions.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Quiste Pancreático
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Gadolinio DTPA
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Hallazgos Incidentales
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Pancreatocolangiografía por Resonancia Magnética
Tipo de estudio:
Diagnostic_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Eur Radiol
Asunto de la revista:
RADIOLOGIA
Año:
2014
Tipo del documento:
Article