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Multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: magnetic resonance (MR) imaging pattern and evolution over time

Tumori intraduttali papillari mucino-secernenti (IPMN) dei dotti pancreatici secondari: aspetti RM ed evoluzione nel tempo

  • Abdominal Radiology / Radiologia Addominale
  • Published:
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Abstract

Purpose

The aim of our study was to follow the evolution over time of multifocal intraductal papillary mucinous neoplasms (IPMN) of the pancreatic duct side branches by means of magnetic resonance imaging (MRI).

Materials and methods

A total of 155 patients with multifocal IPMN of the side branches were examined with MRI and MR cholangiopancreatography (MRI/MRCP). Inclusion criteria were patients with ≥2 dilated side branches involving any site of the parenchyma; presence of communication with the main pancreatic duct and previous investigations by MRI/MRCP within at least six months. Median follow-up was 25.8 months (range, 12–217). Patients with a follow-up period shorter than 12 months (n=33) and those with a diagnosis of multifocal IPMN of the side branches without any follow-up (n=14) were excluded from the study. The final study population thus comprised 108 patients. A double, quantitative and qualitative, analysis was carried out. The quantitative image analysis included: number of dilated side branches in the head-uncinate process and body-tail; maximum diameter of lesions in the head-uncinate process; maximum diameter in the body-tail; maximum diameter of the main pancreatic duct in the head and body-tail. The qualitative image analysis included: presence of malformations or anatomical variants of the pancreatic ductal system; site of the lesions (head-uncinate process, body-tail, ubiquitous, bridge morphology); presence of gravity-dependent intraluminal filling defects; presence of enhancing mural nodules.

Results

At diagnosis, the mean number of cystic lesions of the side branches was 7.09. The mean diameter of the cystic lesions was 13.7 mm. The mean diameter of the main pancreatic duct was 3.6 mm. At follow-up, the mean number of cystic lesions was 7.76. The mean diameter of the cystic lesions was 13.9 mm. The mean diameter of the main pancreatic duct was 3.7 mm. Intraluminal filling defects in the side branches were seen in 18/108 patients (16.6%); enhancing mural nodules were seen in 3/108 patients (2.7%).

Conclusions

Multifocal IPMN of the branch ducts shows a very slow growth and evolution over time. In our study, only 3/108 patients showed mural nodules which, however, did not require any surgical procedure, indicating that careful nonoperative management may be safe and effective in asymptomatic patients.

Riassunto

Obiettivo

L’obiettivo che il nostro studio si propone è quello di seguire l’evoluzione nel tempo delle neoplasie multifocali mucinose intraduttali papillari (IPMN) dei rami collaterali per mezzo della risonanza magnetica (RM).

Materiali e metodi

Sono stati valutati 155 pazienti con IPMN multifocali dei dotti secondari esaminati con RM e con colangiopancreatografia RM (CPRM). Criteri di inclusione: pazienti con ≥2 rami collaterali dilatati che coinvolgono qualunque sito del parenchima pancreatico; presenza di comunicazione con il dotto pancreatico principale, ≥2 esami precedenti RM/CPRM a distanza di almeno sei mesi. La mediana del monitoraggio è stata 25,8 (range 12–217) mesi. Criteri di esclusione: pazienti con un periodo di osservazione inferiore ai 12 mesi (n=33), ed i pazienti con diagnosi di IPMN multifocale dei dotti di II ordine che non hanno un follow-up (n=14). La popolazione considerata è quindi di 108 pazienti. è stata effettuata una duplice analisi, quantitativa e qualitativa. L’analisi quantitativa comprendeva: numero delle ectasie cistiche dei dotti collaterali nella testa-processo uncinato e nel corpo-coda; diametro massimo delle lesioni nella testa-processo-uncinato; diametro massimo nel corpocoda, diametro massimo del dotto pancreatico principale nella testa e nel corpo-coda. L’analisi qualitativa comprendeva: presenza/assenza di malformazioni/varianti anatomiche del sistema duttale pancreatico, localizzazione delle lesioni nel parenchima pancreatico, presenza di difetti endoluminali declivi, presenza di noduli parietali con impregnazione di mezzo di contrasto.

Risultati

Alla diagnosi il numero medio di ectasie cistiche dei rami collaterali è stato 7,09. Il diametro medio delle ectasie cistiche era di 13,7 mm. Il diametro medio del dotto pancreatico principale era di 3,6 mm. Al follow-up il numero medio di ectasie cistiche era di 7,76. Il diametro medio delle lesioni cistiche era di 13,9. Il diametro medio del dotto pancreatico principale era di 3,7 mm. In 18/108 pazienti (16,6%) sono stati osservati difetti di riempimento intraluminali nei dotti pancreatici secondari, mentre sono stati riscontrati noduli murali in 3/108 pazienti (2,7%).

Conclusioni

Gli IPMN multifocali dei dotti pancreatici secondari mostrano una crescita molto lenta. Nel nostro studio solo 3/108 pazienti hanno mostrato noduli murali, che comunque non sono stati sottoposti ad intervento chirurgico.

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Authors and Affiliations

  1. Istituto di Radiologia, Azienda Ospedaliero Universitaria Integrata - Policlinico “G.B. Rossi”, P.le L.A. Scuro 10, 37134, Verona, Italy

    Federica Castelli, Davide Bosetti, Riccardo Negrelli, Valerio Di Paola, Lisa Zantedeschi, Anna Ventriglia, Riccardo Manfredi & Roberto Pozzi Mucelli

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  1. Federica Castelli
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  2. Davide Bosetti
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  3. Riccardo Negrelli
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  4. Valerio Di Paola
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  5. Lisa Zantedeschi
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Correspondence to Riccardo Manfredi.

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Castelli, F., Bosetti, D., Negrelli, R. et al. Multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: magnetic resonance (MR) imaging pattern and evolution over time. Radiol med 118, 917–929 (2013). https://doi.org/10.1007/s11547-013-0945-8

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