scholarly journals The Diagnostic Accuracy of Magnetic Resonance Imaging for Maternal Acute Adnexal Torsion during Pregnancy: Single-Institution Clinical Performance Review

2020 ◽  
Vol 9 (7) ◽  
pp. 2209
Author(s):  
Jong Hwa Lee ◽  
Hyun Jin Roh ◽  
Jun Woo Ahn ◽  
Jeong Sook Kim ◽  
Jin Young Choi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Ovarian Cysts ◽  
Adnexal Torsion ◽  
Resonance Imaging ◽  
Hemorrhagic Infarction ◽  
Ovarian Cortex ◽  
Adc Values

Background: For acute adnexal torsion of pregnant women, appropriate treatment based on an accurate diagnosis is especially important for fertility preservation and timely treatment. The 2017 American College of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 723 announced its practice-changing guidelines to ensure that diagnostic magnetic resonance imaging (MRI) conducted during the first trimester and gadolinium exposure at any time during pregnancy are safe for fetal stability. Unfortunately, few studies have been performed to evaluate the usefulness of the diagnostic accuracy of MRI for acute adnexal torsion during pregnancy. Objective: We sought to determine the efficacy of diagnostic MRI modality using multiparameter for maternal adnexal torsion during pregnancy. Methods: From 1 January 2007 to 31 January 2019, 131 pregnant with MRI tests were reviewed. In this retrospective cohort study, 94 women were excluded due to conditions other than an adnexal mass, and 37 were identified through MRI analyses conducted before surgery for suspected adnexal torsion. The primary outcome was the diagnostic accuracy of sonography and MRI, and the secondary outcome was the usefulness of Apparent diffusion coefficient (ADC) values for predicting the severity of hemorrhagic infarction between the medulla and cortex of the torsed ovarian parenchyma. Results: Our study demonstrates that in the diagnosis of adnexal torsion during pregnancy, the sensitivity, specificity, positive predictive value, and negative predictive value are 62.5%, 83.3%, 90.9%, and 45.5% for sonography and 100%, 77.8%, 90.5%, and 100% for MRI. MRI results in surgical-proven adnexal torsion patients revealed unilocular ovarian cysts (36.8% (7/19)), multilocular ovarian cysts (31.6% (6/19)), and near normal-appearing ovaries (31.6% (6/19)). Pathology in adnexal torsion revealed a corpus luteal ovarian cyst (63.2% (12/19)) and underlying adnexal pathology (46.8% (7/19)). Maternal adnexal torsion during pregnancy was more likely to occur in corpus luteal ovarian cysts than in underlying adnexal masses (odds ratio, 2.14; 95% confidence interval (CI), 0.428–10.738). MRI features for adnexal torsion were as follows: tubal wall thickness, 100% (19/19); ovarian stromal (medullary) edema, 100% (19/19); symmetrical or asymmetrical ovarian cystic wall, 100%(19/19); prominent follicles in the ovarian parenchyma periphery, 57.9% (11/19); periadenxal fat stranding, 84.2% (16/19); uterine deviation to the twisted side, 21.1% (4/19); and peritoneal fluid, 42.1% (8/19). The signal intensity of the ADC values of the ovarian medulla and cortex were compared between the cystectomy and detorsion (CD) and salpingo-oophorectomy (SO) groups. The ADC values of the CD and SO groups were 1.81 ± 0.09 × 10−3 mm2/s and 1.91 ± 0.18 × 10−3 mm2/s, respectively (P = 0.209), in the ovarian medulla and 1.37 ± 0.32 × 10−3 mm2/s and 0.96 ± 0.36 × 10−3 mm2/s, respectively (P = 0.022), in the ovarian cortex. The optimal cut-off value of ADC values for predictable total necrosis in the torsed ovarian cortex was ≤ 1.31 × 10−3 mm2/s (area under the curve (AUC) = 0.81; 95% CI 0.611–1.0; P = 0.028). Conclusion: Our data showed that maternal adnexal torsion during pregnancy occurred in most corpus luteal cystic ovary cases and some normal-appearing ovary during the 1st and 2nd trimesters of gestation. Therefore, this study is the first study to elaborate on the existence or usefulness of the diagnostic MRI for acute maternal adnexal torsion during pregnancy and to provide a predictive diagnosis of the severity of hemorrhagic infarction for deciding surgical radicality.

Diagnostic Accuracy of Magnetic Resonance Imaging in Endometrial Cancer

2012 ◽  
Vol 22 (6) ◽  
pp. 1020-1025 ◽  
Author(s):  
Mark H. McComiskey ◽  
W. Glenn McCluggage ◽  
Arthur Grey ◽  
Ian Harley ◽  
Stephen Dobbs ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Endometrial Cancer ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Myometrial Invasion ◽  
Preoperative Assessment ◽  
Tumor Board ◽  
Resonance Imaging ◽  
Outer Half

ObjectivesThe objectives of this study were to investigate the accuracy of magnetic resonance imaging (MRI) in predicting the depth of myometrial invasion in the preoperative assessment of women with endometrial cancer and to quantify the impact of MRI as an adjunct to predicting patients requiring full surgical staging.MethodsThis was a diagnostic accuracy study of prospective cases in conjunction with STARD guidelines using collected data from a tumor board within a cancer network. Consecutive series of all endometrial cancers in Northern Ireland over a 21-month period was discussed at the Gynaecological Oncology Multidisciplinary Team/tumor board meeting. This study concerns 183 women who met all the inclusion criteria. Main outcome measure was the correlation between the depth of myometrial invasion suggested by preoperative MRI study and the subsequent histopathological findings following examination of the hysterectomy specimen. Secondary end point was how MRI changed management of women who required surgery to be performed at a central cancer center.ResultsFor the detection of outer-half myometrial invasion, overall sensitivity of MRI was 0.73 (95% confidence interval [CI], 0.59–0.83), and specificity was 0.83 (95% CI, 0.76–0.89). The positive predictive value was 0.63 (95% CI, 0.50–0.74), and negative predictive value was 0.89 (95% CI, 0.82–0.93). Positive likelihood ratio was 4.35 (95% CI, 2.87–6.61), and negative likelihood ratio was 0.33 (95% CI, 0.21–0.52). Magnetic resonance imaging improved the sensitivity and negative predictive value of endometrial biopsy alone in predicting women with endometrial cancer who require full surgical staging (0.73 vs 0.65 and 0.80 vs 0.78, respectively).ConclusionsPreoperative pelvic MRI is a moderately sensitive and specific method of identifying invasion to the outer half of myometrium in endometrial cancer. Addition of MRI to preoperative assessment leads to improved preoperative assessment, triage, and treatment.

Magnetic resonance imaging versus lymphoscintigraphy for the assessment of focal lymphatic transport disorders of the lower limb

2014 ◽  
Vol 53 (05) ◽  
pp. 190-196 ◽  
Author(s):  
C. Burgard ◽  
R. Baumeister ◽  
F. Strobl ◽  
A. Rominger ◽  
P. Bartenstein ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Lower Limb ◽  
Predictive Value ◽  
Lower Limbs ◽  
Lymphatic Transport ◽  
Imaging Method ◽  
Resonance Imaging ◽  
Focal Lesions

SummaryPurpose: To compare the diagnostic accuracy of magnetic resonance imaging (MR-lym- phangiography) and lymphoscintigraphy for assessment of focal lesions of the peripheral lymphatic system. Patients with focal lymphatic transport disorders might benefit from surgi-cal interventions. Patients, methods: We examined by lymphoscintigraphy and MR- lymphangiography a total of 85 lower limbs in 46 consecutive patients (33 women; mean age 41 years; range 9-79 years) presenting with uni- or bilateral lymphedema. MR-lym- phangiographies were obtained at isotropic sub-millimeter resolution with a 3.0 Tesla magnet after injection of gadolinium contrast medium. MR-lymphangiography was reviewed by radiologists, whereas lymp- hoscintigraphy was reviewed by nuclear medicine physicians. The images were examined for localization and distribution of any focal lesions of the lymphatic vessel system. Diagnostic accuracy of the MR-approach was calculated relative to the lymphoscintigraphy gold standard. Results: There was substantial correlation of results by the two modalities (κ = 0.62). MR-lymphangiography had sensitivity of 68%, specificity of 91%, positive predictive value of 82%, and negative predictive value of 83%. Conclusions: Imaging findings of both lymphoscintigraphy and MR-lymph- angiography showed good diagnostic accuracy. MR-lymphangiography proved more information about anatomic location of focal lesions of the lymphatic vessels, but use of MR-lymphangiography is currently constrained due to the requirement for off-label subcutaneous injection of gadolinium che- lates. Consequently, and due to its superior sensitivity lymphoscintigraphy remains the most common imaging method to assess functional lymphatic disorders of the lower limb.

scholarly journals Diagnostic accuracy of magnetic resonance imaging in detecting anterior cruciate ligament injuries

2017 ◽  
Vol 26 (3) ◽  
pp. 218-23
Author(s):  
Ashfaq Ahmed ◽  
Muhammad A. Razzaque ◽  
Muhammad Kaleem ◽  
Atiq U. Zaman ◽  
Rizwan Akram ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Ligament Injury ◽  
Resonance Imaging ◽  
Anterior Cruciate

Background: The anterior cruciate ligament (ACL) stabilizes the joint during hyperextension and prevents anterior translation over femur. The objective of this study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting ACL injury by taking arthroscopy as gold standard in patients with traumatic knee injury.Methods: Patients fulfilling the study criteria were treated with clinical examination, MRI and then arthroscopy at the Department of Orthopedics and Spine in the Ghurki Trust Teaching Hospital, Lahore. The accuracy, sensitivity and specificity of MRI in diagnosing  the anterior cruciate ligament injury were calculated based on arthroscopic findings. All the data were analyzed using SPSS 17.0 version.Results: A total 185 patients were included. 91.1% were males and 8.9% were females with Mean age of 28.25±0.433. The accuracy of MRI in diagnosing the anterior cruciate ligament was 91.89%, with sensitivity of 93.33%, specificity of 85.71%, positive predictive value of 96.55% and the negative predictive value  of 75%.Conclusion: MRI is accurate and non-invasive modality for the assessment of ligamentous injuries. It can be used as a first line investigation to patients with suspicion of ACL injury.

scholarly journals ADNEXAL MASSES;

2019 ◽  
Vol 26 (02) ◽  
Author(s):  
Nasira Sultana ◽  
Faran Nasrullah ◽  
Shahlisa Hameedi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Resonance Imaging ◽  
Transabdominal Ultrasonography ◽  
Adnexal Masses ◽  
Contrast Enhanced ◽  
Contrast Enhanced Mri

Objectives: To compare the diagnostic accuracy of transabdominal ultrasonography and contrast enhanced magnetic resonance imaging, in the differentiation of benign and malignant adnexal masses. Study Design: A prospective comparative study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi from 16 Jun 2015 to 15Jun 2016. Methodology: 61 female patients with adnexal masses, irrespective of age, were evaluated with transabdominal ultrasonography and contrast enhanced magnetic resonance imaging (MRI). This was followed by surgery (either laporotomy or laproscopy) or ultrasound guided biopsy and then histopathology to characterize them as benign or malignant masses. Results: Diagnostic accuracy of contrast enhanced MRI for characterization of adnexal masses was 90.1%, while that of transabdominal ultrasonography was 72.1 %. Sensitivity and specificity of transabdominal ultrasonography was 100 % and 54 % respectively while positive predictive value was 58.5 % and negative predictive value was 100 %. Sensitivity and specificity of MRI was 95.8 % and 86.4 % respectively while positive predictive value was 82.1% while negative predictive value was 96.9 %. Conclusion: Contrast enhanced MRI has a superior diagnostic accuracy as compared to transabdominal ultrasonography in the characterization of adnexal masses into benign and malignant, which influences the mode of treatment and clinical outcome.

scholarly journals ACOUSTIC NEUROMA;

2019 ◽  
Vol 26 (04) ◽  
Author(s):  
Nazish Hameed ◽  
Muhammad Tahir ◽  
Noureen Jahangir ◽  
Hassan Bukhari ◽  
Hira Bukhari
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Acoustic Neuroma ◽  
Predictive Value ◽  
Gold Standard ◽  
Imaging Modality ◽  
Whole Body ◽  
Resonance Imaging ◽  
Cross Sectional Survey

Objectives: To determine the diagnostic accuracy of magnetic resonance imaging in the detection of acoustic neuroma taking histopathology as gold standard. Study Design: Cross-sectional survey. Setting: This study was carried out at the Department of Diagnostic Radiology, Lahore General Hospital, Lahore. Duration of Study with Dates: Study was completed in six months after approval of synopsis from 14-07-2009 to 14-01-2010. Subjects & Methods: This study comprised of 55 patients with clinical suspicion acoustic neuroma. Magnetic resonance imaging on a 1.5-T Philips whole body magnetic resonance system was performed. The cases were operated and histopathological results were recorded. The results of magnetic resonance imaging and histopathology were compared taking histopathology as gold standard. Results: Out of 55 patients, 43 patients (78.2%) had acoustic neuroma on magnetic resonance imaging. After comparison of results of magnetic resonance imaging with histopathology, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of magnetic resonance imaging were 97.7%, 91.7%, 97.7%, 91.7% and 96.4% respectively. Conclusion: Magnetic resonance imaging is a highly accurate, non-invasive, safe and convenient imaging modality for the evaluation of acoustic neuromas and is valuable for guiding surgical biopsies thereby decreasing unnecessary intervention. It allows detection of small tumours which is very useful in tumour characterization and plays an integral role in early detection, planning management and estimating patient’s prognosis.

scholarly journals Multiparametric Magnetic Resonance Imaging in Evaluation of Clinically Significant Prostate Cancer

2021 ◽  
Author(s):  
Sarang M. Ingole ◽  
Rajeev U. Mehta ◽  
Zubair N. Kazi ◽  
Rutuja V. Bhuyar
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Predictive Value ◽  
Chronic Prostatitis ◽  
Resonance Imaging ◽  
Multiparametric Magnetic Resonance Imaging ◽  
Adc Values ◽  
The Mean ◽  
Clinically Significant

Abstract Aim In this prospective study, we evaluate the role of multiparametric magnetic resonance imaging (mp-MRI) in the assessment of clinically significant prostate cancer at 1.5 T without endorectal coil (ERC). Materials and Methods Forty-five men with clinical suspicion of prostate cancer (prostate-specific antigen [PSA] level > 4 ng/mL, hard prostate on digital rectal examination, and suspicious area at transrectal ultrasound [TRUS]) were evaluated using the mp-MRI protocol over a period of 24 months. All cases were interpreted using the Prostate Imaging Reporting and Data System (PI-RADS) version 2 guidelines and correlated with histopathology. Statistical Analysis Used A chi-squared test was used for analysis of nominal/categorical variables and receiver operating characteristic (ROC) curve and one-way analysis of variance (ANOVA) test for continuous variables. Results The mean age was 67 years and the mean PSA was 38.2 ng/mL. Eighty percent had prostate cancer and 20% were benign (11% benign prostatic hyperplasia [BPH] and 9% chronic prostatitis). Eighty-six percent of all malignancies were in the peripheral zone. The PI-RADS score for T2-weighted (T2W) imaging showed good sensitivity (81%) but low specificity (67%). The PI-RADS score for diffusion weighted imaging (DWI) with sensitivity of 92% and specificity of 78% had a better accuracy overall than T2W imaging alone. The mean apparent diffusion coefficient (ADC) value (×10–6 mm2/s) was 732 ± 160 in prostate cancer, 1,009 ± 161 in chronic prostatitis, 1,142 ± 82 in BPH, and 663 in a single case of granulomatous prostatitis. Low ADC values (<936) have shown good correlation (area under curve [AUC]: 0.87) with the presence of cancer foci. Inverse correlation was observed between Gleason scores and ADC values. Dynamic contrast-enhanced (DCE) imaging has shown 100% sensitivity/negative predictive value (NPV), but moderate specificity (67%) in predicting malignancy. The final PI-RADS score had 100% sensitivity and NPV with good overall positive predictive value (PPV) of 95%. Conclusions T2W imaging and DWI remain the mainstays in diagnosis of prostate cancer with mp-MRI. DCE-MRI can be a problem-solving tool in case of equivocal findings. Because assessment with mp-MRI can be subjective, use of the newly developed PI-RADS version 2 scoring system is helpful in accurate interpretation.

scholarly journals Magnetic resonance imaging-guided biopsies in children

2021 ◽  
Vol 10 (11) ◽  
pp. 205846012110538
Author(s):  
Mika Hirvonen ◽  
Juha-Jaakko Sinikumpu ◽  
Osmo Tervonen ◽  
Roberto Blanco Sequeiros
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Needle Aspiration ◽  
Late Complications ◽  
Resonance Imaging ◽  
Chi Square ◽  
Bone Biopsies ◽  
Chi Square Test

Background Magnetic resonance imaging (MRI) is used far less as an imaging-guided method for percutaneous biopsies than computed tomography (CT) and ultrasound (US), despite its imaging benefits, particularly in children. Purpose To evaluate the feasibility, accuracy and safety of MRI-guided biopsies in paediatric patient population. Material and Methods The retrospective study included 57 consecutive paediatric patients (<18 years old). A percutaneous core needle biopsy (PCNB) or trephine biopsy was performed in 53 cases, and an additional fine-needle aspiration biopsy (FNAB) in 26 cases. In 4 cases, a stand-alone FNAB was taken. Biopsies were performed with 0.23 T open and 1.5 T closed MRI scanners. Statistical methods used for confidence intervals and p-values were Wilson score method and chi-square test. Results The overall diagnostic accuracy of histologic biopsy was 0.94, with sensitivity 0.82, specificity 1.00, positive predictive value (PPV) 1.00 and negative predictive value (NPV) 0.92. In histological bone biopsies, diagnostic accuracy was 0.96, with sensitivity 0.86, specificity 1.00, PPV 1.00 and NPV 0.94. The FNAB sample diagnosis was associated with the histological diagnosis in 79% of cases. There were no major primary complications and only a few late complications. After biopsy, 83% of the children were ambulatory in 6 h. Anti-inflammatory drugs and paracetamol provided satisfactory pain relief in 96% of the patients after biopsy. Most outpatients (71%) were discharged from hospital either on the same day or 1 day later. Conclusion MRI is a technically feasible, accurate and safe guidance tool for performing percutaneous biopsies in children.

scholarly journals AB1086 POWER DOPPLER AND SPECTRAL DOPPLER ULTRASOUND IN SUSPECTED ACTIVE SACROILIITIS: A COMPARISON WITH MAGNETIC RESONANCE IMAGING AS GOLD STANDARD

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1832.1-1832
Author(s):  
P. Falsetti ◽  
E. Conticini ◽  
C. Baldi ◽  
M. Bardelli ◽  
S. Gentileschi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Diagnostic Accuracy ◽  
Doppler Ultrasound ◽  
Gold Standard ◽  
Clinical Characteristics ◽  
Power Doppler ◽  
Resonance Imaging ◽  
Asas Criteria ◽  
Spectral Doppler

Background:SIJ involvement is a characteristic feature of Spondylarthritis (SpA). Magnetic Resonance imaging (MRI) has been included in the new Assessment of SpA International Society (ASAS) criteria for the classification of Axial SpA. Gray scale US, Color Doppler ultrasound (CDUS), contrast-enhanced CDUS, and spectral Doppler (SD) US has been used in few works to evaluate the inflammatory activity of the SIJ with not conclusive results. Power Doppler ultrasound (PDUS) was not yet applied to the study of SIJ with active SI.Objectives:The aim of this work was to study with PDUS and SD US the SIJ of patients with suspected active SI, to describe inflammatory flows with spectral wave analysis (SWA) in duplex Doppler US, and to correlate US data with clinical characteristics and the presence of bone marrow edema (BME) in MRI.Methods:22 patients (18 females and 4 males, mean age 35 years) with new onset of inflammatory back pain (IBP), were included. Every patient underwent an US examination in prone position. The sonographers were blinded to the clinical data of the patient. A Esaote Twice US machine, equipped with a convex multifrequency 1-8 MHz probe, was used, with standardized parameters: 1-5 MHz for gray scale, 1.9-2.3 MHz frequency for Doppler with Pulse Repetition Frequency (PRF) of 1.0 KHz and a color gain just under the artifact limit. SIJ was located as the hypoechoic triangle delimited between the sacrum and iliac bone, and the posterior SI ligament as the upper margin. The first sacral foramen was always localized to avoid measurement of the normal pre-sacral arteries. The PDUS was applied, and if any signals were detected in the SIJ, they were scored with a 3-points scale: 0= absence of signals, 1= isolate vessels, 2= more than one vessel. The signals were also classified as intra-articular or peri-articular. The same vessels were also evaluated using quantitative SD calculating the Resistive Index (RI=peak of systolic flow- end diastolic flow/peak systolic flow), ranging between 0 and 1. Every patient underwent MRI of SIJ within the same week, before treatment. A statistical analysis was performed, estimating the sensitivity and specificity against the gold standard (presence of BME in the same SIJ according to ASAS criteria). The Spearman rank not-parametric test was applied to correlate the presence and grading of BME with PDUS grading and RI. A regression analysis was applied between PDUS results and clinical characteristics.Results:In 14/22 SIJ MRI revealed BME. In 13 of them, PDUS confirmed abnormal hypervascularisation in the intrarticular portion of SI, and in 3 in the periarticular site too. Two SIJ showed hypervascularisation at PD with no BME in MRI. A significant correlation was demonstrated between positivity and grading of PD and presence of BME in MRI (p=0.0005). SD analysis demonstrated low Resistance Index (RI) values in 14 SIJ (mean 0.57). An inverse correlation was demonstrated between RI and grading of BME in MRI (r= -0,6229, p= 0,044). The diagnostic accuracy of SD for detection of active SI varied on the basis of RI cut-off value. The best values of sensitivity (62,5%) and specificity (61,5%) were obtained with a RI cut-off values of 0.60. A multiple regression model demonstrated a significant relationship between PDUS signals and ASDAS (p=0.0382), but not with inflammatory reactants.Conclusion:PDUS and SD US of SIJ can be useful as first imaging assessment in suspected active SI, demonstrating a good diagnostic accuracy compared with MRI. Intra-articular low RI values (<0.60) on SD indicate active SI with good accuracy. Moreover, PDUS signals into the SIJ correlate with clinical symptoms but not with inflammation reactants.Figure 1.Doppler US in SI.Right SIJ with a Doppler signal along the posterior SIJ ligament, and another Doppler signal into the joint, where SD analysis gave a RI of 0,62.Disclosure of Interests:None declared

scholarly journals A243 A RETROSPECTIVE REVIEW OF THE RADIOGRAPHIC DIAGNOSIS AND SURGICAL RESECTION RATES OF PANCREATIC SEROUS CYSTS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 300-301
Author(s):  
M Monachese ◽  
S Li ◽  
M Salim ◽  
L Guimaraes ◽  
P D James
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Surgical Resection ◽  
Predictive Value ◽  
Resected Specimen ◽  
Cystic Lesions ◽  
Resonance Imaging ◽  
Guided Biopsy ◽  
Magnetic Resonance Imaging Mri

Abstract Background Pancreatic cystic lesions are increasingly identified in persons undergoing abdominal imaging. Serous cystic neoplasms (SCNs) have a very low risk of malignant transformation. Resection of SCNs is not recommended in the absence of related symptoms. The accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) to identify SCNs is not known and may impact clinical care. Aims To evaluate the accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for the diagnosis of SCN. To see how this can impact the decision to resect suspected SCNs. Methods Retrospective cohort study of patients from the University Health Network with suspected SCNs from 2017–2020 who underwent either a CT or MRI of the abdomen. Reports noting pancreatic cystic lesions were identified and reviewed. Only cases with suspected SCNs were included. Clinical (age, sex, symptoms, treatment) and radiographic (type of imaging, reported cyst characteristics) data was collected. Pathology was reviewed for all cases where the cysts was biopsied or resected during follow-up. The gold standard for the diagnosis for SCN was pathology of resected specimen or EUS-guided biopsy cytopathology showing no evidence of a mucinous lesion, CEA level below 10ug per L and amylase level below 50 U/L. Results 163 patients were included in the study. 99 (61%) were female and 98 (60%) underwent CT scan. EUS-guided biopsy was performed in 24 (15%) of patients and 8 (5%) had surgical resection. Multidisciplinary review was performed in 6 of the 8 cases that went to surgery. Of the resected specimens, 5 (63%) were SCN, 1 was a mucinous cystic lesion, 1 was a neuroendocrine tumor and 1 was a carcinoma. Two patients underwent EUS evaluation prior to surgical resection. In one case SCN was resected when EUS reported an undetermined cyst type. Reasons for surgical resection were: the diagnosis of serous cyst was not definitive (n=5), symptoms (n=2), and high-risk mucinous cystic neoplasm identified on EUS (n=1). Of 30 patients with pathology available, 15 (50%) were confirmed to have a SCN. CT and MRI had a sensitivity, specificity, positive predictive value and negative predictive value of 93%, 25%, 52% and 80%, respectively. Conclusions Surgical resection for SCN lesions is driven by diagnostic uncertainty after cross-sectional imaging. Multidisciplinary review and EUS evaluation may improve diagnostic accuracy and should be considered prior to surgical resection of possible SCN lesions. Funding Agencies None

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