Abdominal Radiology

, Volume 44, Issue 7, pp 2448–2458 | Cite as

Differentiation of aggressive from non-aggressive pancreatic solid pseudopapillary neoplasms using computed tomography

  • Jianhua Wang
  • Xiao Chen
  • Cheng Wang
  • Wenjing Cui
  • Shuai Ren
  • Zhonglan Wang
  • Hui Li
  • Zhongqiu WangEmail author



Microscopic aggressive behaviors may be related with the prognosis of solid pseudopapillary neoplasms (SPNs). In this study, we investigate computed tomography (CT) features and differential diagnosis of aggressive and non-aggressive SPNs in pancreas.

Materials and methods

122 patients with pathologically proven SPNs in pancreas were included. Patients’ age, tumor site, texture, shape, margins, exophytic growth, capsule, calcification, hemorrhage, pancreatic duct dilatation or pancreatic parenchyma atrophy, peripancreatic infiltration or metastases, vascular encasement, and enhancement pattern were assessed. The diagnostic accuracy was analyzed by using the receiver operating characteristic curve (ROC).


There were 30 aggressive SPNs and 92 non-aggressive SPNs. Aggressive SPNs showed significantly higher frequencies of an ill-defined margin, patient age > 40.5 years, and tumor size < 42.1 mm, but lower frequencies of complete capsule, hemorrhage compared with non-aggressive SPNs (p < 0.05). Lack of complete capsule and age > 40.5 years were independent risk factors of aggressive SPNs (odd ratio 7.08 and 3.1, respectively). When we applied the two predictors in the logistic regression model, the area under the curve (AUC) was 0.77 with sensitivity of 86.7% and specificity of 55.4%.


Size less than 42.1 mm, lack of complete capsule, ill-defined, and absent bleeding are useful CT imaging features for predicating aggressive SPNs. Patient age > 40.5 years and lack of complete capsule showed acceptable diagnostic performance for discriminating aggressive from non-aggressive SPNs.


Solid pseudopapillary neoplasm Pancreas Aggressive Computed tomography 



We thank all authors for their continuous and excellent support with patient data collection, imaging analysis, statistical analysis, and valuable suggestions for the article.


This study was supported by the Key Program of Research and Development of Jiangsu Province (BE2017772) and the Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX18_1651).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed content

Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to CECT examinations by written consent.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
  2. 2.Department of PathologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina

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