BACKGROUND: While multiple cyst features are evaluated for stratifying pancreatic intraductal papillary mucinous neoplasms (IPMN), cyst size is an important factor that can influence treatment strategies. When magnetic resonance imaging (MRI) is used to evaluate IPMNs, no universally accepted sequence provides optimal size measurements. T2-weighted coronal/axial have been suggested as primary measurement sequences; however, it remains unknown how well these and maximum all-sequence diameter measurements correlate with pathology size. This study aims to compare agreement and bias between IPMN long-axis measurements on seven commonly obtained MRI sequences with pathologic size measurements. METHODS: This retrospective cohort included surgically resected IPMN cases with preoperative MRI exams. Long-axis diameter tumor measurements and the presence of worrisome features and/orhigh-risk stigmata were noted on all seven MRI sequences. MRI size and pathology agreement and MRI inter-observer agreement involved concordance correlation coefficient (CCC) and intraclass correlation coefficient (ICC), respectively. The presence of worrisome features and high-risk stigmata were compared to the tumor grade using kappa analysis. The Bland-Altman analysis assessed the systematic bias between MRI-size and pathology. RESULTS: In 52 patients (age 68 ± 13 years, 22 males), MRI sequences produced mean long-axis tumor measurements from 2.45–2.65 cm. The maximum MRI lesion size had a strong agreement with pathology (CCC = 0.82 (95% CI: 0.71–0.89)). The maximum IPMN size was typically observed on the axial T1 arterial post-contrast and MRCP coronal series and overestimated size versus pathology with bias +0.34 cm. The radiologist interobserver agreement reached ICCs 0.74 to 0.91 on the MRI sequences. CONCLUSION: The maximum MRI IPMN size strongly correlated with but tended to overestimate the length compared to the pathology, potentially related to formalin tissue shrinkage during tissue processing.
背景：虽然评估胰腺导管内乳头状黏液性肿瘤（IPMN）需综合考量多种囊肿特征，但囊肿大小是影响治疗策略的重要因素。当使用磁共振成像（MRI）评估IPMN时，目前尚无公认的序列能提供最佳尺寸测量。T2加权冠状位/轴位序列已被建议作为主要测量序列，但这些序列及全序列最大直径测量与病理学尺寸的相关性仍不明确。本研究旨在比较七种常用MRI序列上IPMN长轴测量值与病理学尺寸测量之间的一致性和偏差。 方法：本回顾性队列研究纳入经手术切除且术前接受MRI检查的IPMN病例。在所有七种MRI序列上记录肿瘤长轴直径测量值、令人担忧特征和/或高风险征象的存在情况。MRI尺寸与病理学的一致性采用一致性相关系数（CCC）评估，MRI观察者间一致性采用组内相关系数（ICC）评估。通过Kappa分析比较令人担忧特征和高风险征象与肿瘤分级的关系。采用Bland-Altman分析评估MRI测量尺寸与病理学尺寸之间的系统偏差。 结果：在52例患者（年龄68±13岁，男性22例）中，各MRI序列测得的肿瘤长轴平均值为2.45–2.65厘米。MRI最大病灶尺寸与病理学测量值高度一致（CCC=0.82，95%置信区间：0.71–0.89）。最大IPMN尺寸通常在轴位T1动脉期增强和MRCP冠状位序列上观察到，与病理学尺寸相比存在+0.34厘米的高估偏差。不同放射科医师在MRI序列上的观察者间一致性达到ICC 0.74至0.91。 结论：MRI测量的IPMN最大尺寸与病理学长度高度相关，但倾向于高估实际尺寸，这可能与组织处理过程中福尔马林引起的组织收缩有关。
Pancreatic Cyst Size Measurement on Magnetic Resonance Imaging Compared to Pathology
肿瘤(癌症)患者之家