Pancreatic Cyst Size Measurement on Magnetic Resonance Imaging Compared to Pathology

Daniel Jeong; Brian Morse; Stuart Lane Polk; Dung Tsa Chen; Jiannong Li; Pamela Hodul; Barbara A. Centeno; James Costello; Kun Jiang; Sebastian Machado; Issam El Naqa; Paola T. Farah; Tri Huynh; Natarajan Raghunand; Shaffer Mok; Aamir Dam; Mokenge Malafa; Aliya Qayyum; Jason B. Fleming; Jennifer B. Permuth

doi:10.3390/cancers16010206

Pancreatic Cyst Size Measurement on Magnetic Resonance Imaging Compared to Pathology

Daniel Jeong, Brian Morse, Stuart Lane Polk, Dung Tsa Chen, Jiannong Li, Pamela Hodul, Barbara A. Centeno, James Costello, Kun Jiang, Sebastian Machado, Issam El Naqa, Paola T. Farah, Tri Huynh, Natarajan Raghunand, Shaffer Mok, Aamir Dam, Mokenge Malafa, Aliya Qayyum, Jason B. Fleming, Jennifer B. Permuth

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

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.

Original language	English (US)
Article number	206
Journal	Cancers
Volume	16
Issue number	1
DOIs	https://doi.org/10.3390/cancers16010206
State	Published - Jan 2024
Externally published	Yes

Keywords

intraductal papillary mucinous neoplasm
magnetic resonance imaging
size measurement

ASJC Scopus subject areas

Oncology
Cancer Research

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10.3390/cancers16010206

Cite this

Jeong, D., Morse, B., Polk, S. L., Chen, D. T., Li, J., Hodul, P., Centeno, B. A., Costello, J., Jiang, K., Machado, S., El Naqa, I., Farah, P. T., Huynh, T., Raghunand, N., Mok, S., Dam, A., Malafa, M., Qayyum, A., Fleming, J. B., & Permuth, J. B. (2024). Pancreatic Cyst Size Measurement on Magnetic Resonance Imaging Compared to Pathology. Cancers, 16(1), Article 206. https://doi.org/10.3390/cancers16010206

Jeong, D, Morse, B, Polk, SL, Chen, DT, Li, J, Hodul, P, Centeno, BA, Costello, J, Jiang, K, Machado, S, El Naqa, I, Farah, PT, Huynh, T, Raghunand, N, Mok, S, Dam, A, Malafa, M, Qayyum, A, Fleming, JB & Permuth, JB 2024, 'Pancreatic Cyst Size Measurement on Magnetic Resonance Imaging Compared to Pathology', Cancers, vol. 16, no. 1, 206. https://doi.org/10.3390/cancers16010206

@article{f32b68592d1c484d95e20c89bf2284cd,

title = "Pancreatic Cyst Size Measurement on Magnetic Resonance Imaging Compared to Pathology",

abstract = "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.",

keywords = "intraductal papillary mucinous neoplasm, magnetic resonance imaging, size measurement",

author = "Daniel Jeong and Brian Morse and Polk, {Stuart Lane} and Chen, {Dung Tsa} and Jiannong Li and Pamela Hodul and Centeno, {Barbara A.} and James Costello and Kun Jiang and Sebastian Machado and {El Naqa}, Issam and Farah, {Paola T.} and Tri Huynh and Natarajan Raghunand and Shaffer Mok and Aamir Dam and Mokenge Malafa and Aliya Qayyum and Fleming, {Jason B.} and Permuth, {Jennifer B.}",

note = "Publisher Copyright: {\textcopyright} 2024 by the authors.",

year = "2024",

month = jan,

doi = "10.3390/cancers16010206",

language = "English (US)",

volume = "16",

journal = "Cancers",

issn = "2072-6694",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "1",

}

TY - JOUR

T1 - Pancreatic Cyst Size Measurement on Magnetic Resonance Imaging Compared to Pathology

AU - Jeong, Daniel

AU - Morse, Brian

AU - Polk, Stuart Lane

AU - Chen, Dung Tsa

AU - Li, Jiannong

AU - Hodul, Pamela

AU - Centeno, Barbara A.

AU - Costello, James

AU - Jiang, Kun

AU - Machado, Sebastian

AU - El Naqa, Issam

AU - Farah, Paola T.

AU - Huynh, Tri

AU - Raghunand, Natarajan

AU - Mok, Shaffer

AU - Dam, Aamir

AU - Malafa, Mokenge

AU - Qayyum, Aliya

AU - Fleming, Jason B.

AU - Permuth, Jennifer B.

PY - 2024/1

Y1 - 2024/1

N2 - 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.

AB - 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.

KW - intraductal papillary mucinous neoplasm

KW - magnetic resonance imaging

KW - size measurement

UR - http://www.scopus.com/inward/record.url?scp=85182214895&partnerID=8YFLogxK

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U2 - 10.3390/cancers16010206

DO - 10.3390/cancers16010206

M3 - Article

C2 - 38201633

AN - SCOPUS:85182214895

SN - 2072-6694

VL - 16

JO - Cancers

JF - Cancers

IS - 1

M1 - 206

ER -

Pancreatic Cyst Size Measurement on Magnetic Resonance Imaging Compared to Pathology

Abstract

Keywords

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