Inclusion criteria: patients with EUS or pathological diagnosis of IPMN who underwent an MRI examination between July 2015 and December 2017 at Department of Radiology of University Hospital of Ancona,
Exclusion criteria: lack of MRI examination,
contraindication to contrast media administration and lack of EUS,
pathological and clinical data.
MRI studies were performed with a 1.5-T scanner (GE Signa HdXt,
WI) and an eight-channel phased-array body coil.
The examination protocol included axial and coronal fast spin-echo (FSE) T2-weighted sequences,
axial T1-weighted gradient echo (GRE) in- and opposite-phase,
diffusion-weighted imaging (DWI,
and 3D MR cholangiopancreatography (MRCP) with heavily T2-weighted fast recovery FSE.
A multiphasic post-contrast study was performed with a 3D fast spoiled GRE sequence (LAVA) and administration of Gd-DOTA,
0.1 mmol/Kg (Dotarem,
France) at 2 ml/s followed by a saline flush.
and delayed phase were obtained.
Three radiologists with different experience,
reader A (30 years),
reader B (10 years),
and reader C (1 year),
retrospectively reviewed in blind all the MRI.
MRI studies were evaluated as per Fukuoka guidelines v2017,
the presence of Worrisome Features (WF) and High-Risk Stigmata (HRS) was assessed .
WF included: pancreatitis (pancreatic edema); cyst ≥3cm; cystic mural thickening or enhancement; not-enhancing mural nodule <5 mm; main pancreatic duct (MPD) diameter between 5 and 9 mm; abrupt change in the MPD diameter with pancreatic atrophy; lymphadenopathy (short axis >10 mm).
HRS included: obstructive jaundice (choledochal diameter ≥8 mm); enhancing mural nodules or solid component; MPD ≥10 mm.
Quantitative variables were expressed as dichotomous following the thresholds in the previous paragraph.
The IRA was calculated with Intraclass Correlation Coefficient (ICC) and 95% confidence interval (95%CI).