Skip to main content

Advertisement

Log in

Additional value of FDG PET/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms of the pancreas with mural nodules

  • Original article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objectives

This study aimed at determining the additional value of FDG PET/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with mural nodules.

Methods

This retrospective review of medical records was approved by our institutional review board. The preoperative PET/CT images of 16 non-diabetic patients with surgically proven IPMN, where mural nodules of 3 mm or larger were shown by preoperative contrast-enhanced CT, were retrospectively evaluated. The 16 patients were divided into two groups: 7 patients with benign IPMN [adenoma (n = 1) and borderline tumor (n = 6)] and 9 patients with malignant IPMN [carcinoma in situ (CIS) (n = 8) and invasive carcinoma (n = 1)]. Nuclear medicine physician blinded to the pathologic assessment of malignancy of IPMN set a spherical volume of interest (VOI) over the mural nodules on PET/CT images and recorded the peak standardized uptake value (SUVmax) in the VOI, referring the contrast-enhanced CT images. Statistical differences in the size of mural nodule, the diameter of main pancreatic duct (MPD), and SUVmax of the tumors between benign IPMNs and malignant IPMNs were compared using the Mann–Whitney U test. Statistical significance was set at p < 0.05. Additionally, the diagnostic accuracy of FDG PET for the detection of malignancy was calculated.

Results

The SUVmax of the malignant IPMNs with mural nodules of 3 mm or larger was higher than that of benign IPMNs (2.7 ± 0.6 vs. 1.9 ± 0.3, p < 0.01). Meanwhile, there was no significant difference in mural nodule diameter and MPD diameter between the two groups. FDG PET/CT showed an excellent diagnostic accuracy for the differentiation between malignant and benign IPMNs with mural nodules: the sensitivity, specificity, PPV, NPV, and accuracy in malignant IPMN with mural nodule of FDG PET/CT were 77.8, 100, 100, 77.8, and 87.5 for the cutoff value of 2.3; and 100, 57.1, 75.0, 100, and 81.3 for the cutoff value of 2.0, respectively.

Conclusions

The result of this study indicates that FDG PET/CT can provide additional information for the differentiation between benign and malignant IPMNs of the pancreas with mural nodules.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Bernard P, Scoazec JY, Joubert M, Kahn X, Le Borgne J, Berger F, et al. Intraductal papillary-mucinous tumors of the pancreas: predictive criteria of malignancy according to pathological examination of 53 cases. Arch Surg. 2002;137:1274–8.

    Article  PubMed  Google Scholar 

  2. Terris B, Ponsot P, Paye F, Hammel P, Sauvanet A, Molas G, et al. Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct. Am J Surg Pathol. 2000;24:1372–7.

    Article  PubMed  CAS  Google Scholar 

  3. Imdahl A, Nitzsche E, Krautmann F, Hogerle S, Boos S, Einert A, et al. Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-d-glucose for the differentiation of chronic pancreatitis and pancreatic cancer. Br J Surg. 1999;86:194–9.

    Article  PubMed  CAS  Google Scholar 

  4. Kloppel G, Solcia E, Longnecker D, Capella C, Sobin L. Histological typing of tumours of the exocrine pancreas. 2nd ed. Berlin: Springer; 1996.

    Google Scholar 

  5. Sugiyama M, Atomi Y, Kuroda A. Two types of mucin-producing cystic tumors of the pancreas: diagnosis and treatment. Surgery. 1997;122:617–25.

    Article  PubMed  CAS  Google Scholar 

  6. Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y. Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg. 2003;90:1244–9.

    Article  PubMed  CAS  Google Scholar 

  7. Kimura W, Sasahira N, Yoshikawa T, Muto T, Makuuchi M. Duct-ectatic type of mucin producing tumor of the pancreas—new concept of pancreatic neoplasia. Hepatogastroenterology. 1996;43:692–709.

    PubMed  CAS  Google Scholar 

  8. Sai JK, Suyama M, Kubokawa Y, Yamanaka K, Tadokoro H, Iida Y, et al. Management of branch duct-type intraductal papillary mucinous tumor of the pancreas based on magnetic resonance imaging. Abdom Imaging. 2003;28:694–9.

    Article  PubMed  CAS  Google Scholar 

  9. Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.

    Article  PubMed  Google Scholar 

  10. Ogawa H, Itoh S, Ikeda M, Suzuki K, Naganawa S. Intraductal papillary mucinous neoplasm of the pancreas: assessment of the likelihood of invasiveness with multisection CT. Radiology. 2008;248:876–86.

    Article  PubMed  Google Scholar 

  11. Vullierme MP, Giraud-Cohen M, Hammel P, Sauvanet A, Couvelard A, O’Toole D, et al. Malignant intraductal papillary mucinous neoplasm of the pancreas: in situ versus invasive carcinoma surgical resectability. Radiology. 2007;245:483–90.

    Article  PubMed  Google Scholar 

  12. Sperti C, Bissoli S, Pasquali C, Frison L, Liessi G, Chierichetti F, et al. 18-fluorodeoxyglucose positron emission tomography enhances computed tomography diagnosis of malignant intraductal papillary mucinous neoplasms of the pancreas. Ann Surg. 2007;246:932–7 (discussion 7–9).

    Google Scholar 

  13. Hong HS, Yun M, Cho A, Choi JY, Kim MJ, Kim KW, et al. The utility of F-18 FDG PET/CT in the evaluation of pancreatic intraductal papillary mucinous neoplasm. Clin Nucl Med. 2010;35:776–9.

    Article  PubMed  Google Scholar 

  14. Perkins NJ, Schisterman EF. The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006;163:670–5.

    Article  PubMed  Google Scholar 

  15. Goh BK, Chung YF, Ng DC, Selvarajan S, Soo KC. Positron emission tomography with 2-deoxy-2-[18f] fluoro-d-glucose in the detection of malignancy in intraductal papillary mucinous neoplasms of the pancreas. JOP. 2007;8:350–4.

    PubMed  Google Scholar 

  16. Yoshioka M, Sato T, Furuya T, Shibata S, Andoh H, Asanuma Y, et al. Positron emission tomography with 2-deoxy-2-[(18)F] fluoro-d-glucose for diagnosis of intraductal papillary mucinous tumor of the pancreas with parenchymal invasion. J Gastroenterol. 2003;38:1189–93.

    Article  PubMed  Google Scholar 

  17. Baiocchi GL, Portolani N, Bertagna F, Gheza F, Pizzocaro C, Giubbini R, et al. Possible additional value of 18FDG-PET in managing pancreas intraductal papillary mucinous neoplasms: preliminary results. J Exp Clin Cancer Res. 2008;27:10.

    Google Scholar 

  18. Hoffman EJ, Huang SC, Phelps ME. Quantitation in positron emission computed tomography: 1 effect of object size. J Comput Assist Tomogr. 1979;3:299–308.

    Article  PubMed  CAS  Google Scholar 

  19. Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med. 2007;48:932–45.

    Article  PubMed  Google Scholar 

  20. Nakayama Y, Yamashita Y, Kadota M, Takahashi M, Kanemitsu K, Hiraoka T, et al. Vascular encasement by pancreatic cancer: correlation of CT findings with surgical and pathologic results. J Comput Assist Tomogr. 2001;25:337–42.

    Article  PubMed  CAS  Google Scholar 

  21. Irie H, Honda H, Aibe H, Kuroiwa T, Yoshimitsu K, Shinozaki K, et al. MR cholangiopancreatographic differentiation of benign and malignant intraductal mucin-producing tumors of the pancreas. AJR Am J Roentgenol. 2000;174:1403–8.

    PubMed  CAS  Google Scholar 

  22. Pilleul F, Rochette A, Partensky C, Scoazec JY, Bernard P, Valette PJ. Preoperative evaluation of intraductal papillary mucinous tumors performed by pancreatic magnetic resonance imaging and correlated with surgical and histopathologic findings. J Magn Reson Imaging. 2005;21:237–44.

    Article  PubMed  Google Scholar 

  23. Song SJ, Lee JM, Kim YJ, Kim SH, Lee JY, Han JK, et al. Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. J Magn Reson Imaging. 2007;26:86–93.

    Article  PubMed  Google Scholar 

  24. Waters JA, Schmidt CM, Pinchot JW, White PB, Cummings OW, Pitt HA, et al. CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg. 2008;12:101–9.

    Article  PubMed  Google Scholar 

  25. Sahani DV, Kadavigere R, Blake M, Fernandez-Del Castillo C, Lauwers GY, Hahn PF. Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations—correlation with MRCP. Radiology. 2006;238:560–9.

    Article  PubMed  Google Scholar 

  26. Mera K, Tajiri H, Muto M, Ohtsu A, Furuse J, Maru Y, et al. Clinical significance of magnetic resonance cholangiopancreatography for the diagnosis of cystic tumor of the pancreas compared with endoscopic retrograde cholangiopancreatography and computed tomography. Jpn J Clin Oncol. 1999;29:294–8.

    Article  PubMed  CAS  Google Scholar 

  27. Ahmad NA, Kochman ML, Brensinger C, Brugge WR, Faigel DO, Gress FG, et al. Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions. Gastrointest Endosc. 2003;58:59–64.

    Article  PubMed  Google Scholar 

  28. Carbognin G, Zamboni G, Pinali L, Chiara ED, Girardi V, Salvia R, et al. Branch duct IPMTs: value of cross-sectional imaging in the assessment of biological behavior and follow-up. Abdom Imaging. 2006;31:320–5.

    Article  PubMed  CAS  Google Scholar 

  29. Cellier C, Cuillerier E, Palazzo L, Rickaert F, Flejou JF, Napoleon B, et al. Intraductal papillary and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series. Gastrointest Endosc. 1998;47:42–9.

    Article  PubMed  CAS  Google Scholar 

  30. Sakorafas GH, Sarr MG. Cystic neoplasms of the pancreas; what a clinician should know. Cancer Treat Rev. 2005;31:507–35.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kentaro Takanami.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Takanami, K., Hiraide, T., Tsuda, M. et al. Additional value of FDG PET/CT to contrast-enhanced CT in the differentiation between benign and malignant intraductal papillary mucinous neoplasms of the pancreas with mural nodules. Ann Nucl Med 25, 501–510 (2011). https://doi.org/10.1007/s12149-011-0494-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-011-0494-y

Keywords

Navigation