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Characterization of Cystic Pancreatic Masses: Relative Accuracy of CT and MRI

Brendan C. Visser1, Benjamin M. Yeh2, Aliya Qayyum2, Lawrence W. Way1, Charles E. McCulloch3 and Fergus V. Coakley2

1 Department of Surgery, University of California at San Francisco, San Francisco, CA.
2 Department of Radiology, Division of Abdominal Imaging, University of California at San Francisco, 505 Parnassus Ave., Rm. M-372, Box 0628, San Francisco, CA 94143-0628.
3 Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA.


Figure 1
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  		Fig. 1A —CT versus MRI distinction of 58 surgically proven cystic pancreatic masses as benign or malignant. Graphs show receiver operating characteristic curves for CT (A) and MRI (B) by reviewer. Gray curve is data for reviewer 1 and black curve, for reviewer 2. Dashed line is reference line.

 

Figure 2
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  		Fig. 1B —CT versus MRI distinction of 58 surgically proven cystic pancreatic masses as benign or malignant. Graphs show receiver operating characteristic curves for CT (A) and MRI (B) by reviewer. Gray curve is data for reviewer 1 and black curve, for reviewer 2. Dashed line is reference line.

 

Figure 3
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  		Fig. 2 —Bar graph shows diagnostic accuracy for specific histopathologic diagnosis stratified by reviewer and level of certainty in leading diagnosis. Black bars show results for reviewer 1 and gray bars show results for reviewer 2.

 

Figure 4
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  		Fig. 3 —Axial contrast-enhanced CT image in 56-year-old woman with vague abdominal pain shows 2.5-cm thin-walled unilocular cyst in pancreatic tail. This benign-appearing lesion proved to be mucinous cystadenocarcinoma at final histopathology.

 

Figure 5
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  		Fig. 4A —41-year-old man with 2-month history of abdominal pain. Axial contrast-enhanced CT image shows 5-cm thin-walled multilocular cyst (arrow) in pancreatic tail.

 

Figure 6
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  		Fig. 4B —41-year-old man with 2-month history of abdominal pain. Axial contrast-enhanced CT image at more inferior level than A shows thin septations (arrow) and large locules. Both reviewers considered this likely to be mucinous cystic neoplasm. Final histopathologic diagnosis of lymphoepithelial cyst was established after distal pancreatectomy.

 

Figure 7
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  		Fig. 5 —Axial T2-weighted MR image in 54-year-old woman with chronic abdominal pain shows 3-cm unilocular cyst (asterisk) in pancreatic head that appears to communicate with dilated pancreatic duct side branch (arrow). Both reviewers considered this likely to be intraductal papillary mucinous neoplasm (mucinous ductal ectasia). Final histopathologic diagnosis was pseudocyst.

 

Figure 8
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  		Fig. 6 —Axial T2-weighted MR image in 6-year-old girl with presumptive clinical diagnosis of chronic pancreatitis based on 2-year history of episodic abdominal pain, intermittent mildly elevated serum amylase level, and apparent pseudocyst detected on serial sonograms obtained at another institution. A 2.5-cm thin-walled unilocular cyst (arrow) is seen in pancreatic tail. Both reviewers considered this likely to be pseudocyst. Final histopathologic diagnosis of gastric duplication cyst was established after distal pancreatectomy.

 

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