Pancreatic CT density is an optimal imaging biomarker for earlier detection of malignancy in the pancreas with intraductal papillary mucinous neoplasm |
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| Affiliation: | 1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan;2. Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan;3. Department of Surgery, Osaka Police Hospital, Tennoji-ku Kitayamacho 10-31, Osaka, 543-0035, Japan;4. Department of Gastroenterological Surgery, Rinku General Medical Center, Rinku-Ourai-Kita 2-23, Izumisano, Osaka, 598-8577, Japan;1. Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan;2. Department of Advanced Medicine, Hiroshima University, Hiroshima, Japan;1. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;2. Department of Statistics, Korea University, Seoul, Republic of Korea;3. Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea;4. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;5. Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;6. Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;1. Department of Surgery, University of North Carolina, Chapel Hill, NC, USA;2. Department of Radiology, University of North Carolina, Chapel Hill, NC, USA;3. Department of Endocrinology, University of North Carolina, Chapel Hill, NC, USA;4. Department of Gastroenterology, University of North Carolina, Chapel Hill, NC, USA |
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| Abstract: | BackgroundIntraductal papillary mucinous neoplasms (IPMNs) are typically detected as incidental findings by computed tomography (CT); however, the conventional surveillance is not valid for the early detection of concomitant pancreatic cancer. The pancreas of IPMN is often accompanied by fatty infiltration in the parenchyma, and pancreatic fatty infiltration could be evaluated by pancreatic CT density (pancreatic index, PI). We aimed to investigate whether PI could be an imaging biomarker for the early prediction of malignancies in the pancreas with IPMN.MethodsTwo different cohorts were investigated. (Investigation cohort): A total of 1137 patients with initially low-risk IPMN were compensated by initial IPMN findings, and 2 groups (malignancy/possible benign, 50 cases each) were investigated for yearly changes in PI and for the cutoff value of PI indicating the development of malignancies. (Validation cohort): To validate the cutoff value, 256 patients radiologically suspected of having IPMNs were investigated.Results(Investigation-cohort): The malignancy group showed a gradual decrease in PI every year, and PI significantly differed among the 2 groups 1 year prior to the last investigation. The cutoff value of PI was set at 0.65. (Validation-cohort): A total of 55% of the patients with a PI below the cutoff value had malignancy in the pancreas, including concomitant pancreatic cancer, and the cutoff value was the most significant risk factors for the development of malignancies in the pancreas compared to the conventional risk factors for IPMN.ConclusionsDecreasing PI would be an optimal imaging biomarker for earlier detection of malignancies in the pancreas with IPMN. |
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| Keywords: | IPMN surveillance Pancreatic CT density Pancreatic fatty infiltration Concomitant PDAC |
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