Three Dimensional Contrast Enhanced Ultrasonography vs. Magnetic Resonance Imaging in The Diagnosis of IPMN of the Pancreas
Carla Serra1, Lucia Calculli2, Andrea Imbrogno1, Davide Fabbri1, Fabio Ferroni2, Alexandro Paccapelo1, Riccardo Casadei3, Raffaele Pezzilli1
1Pancreas Unit, Department of Digestive Diseases and Internal Medicine, 2Department of Radiology and 3Department of Surgery; Sant’Orsola-Malpighi Hospital, University of Bologna. Bologna, Italy
Context The IPMNs of the pancreas represent a challenge for the imaging. Objective To prospectively compare the diagnostic accuracy of three-dimensional contrast enhanced ultrasonography (3D-CEUS) vs. magnetic resonance imaging plus RM cholangiopancreatography (MRI) in the diagnosis of IPMNs. Methods Thirty consecutive IPMN patients (22 F, 8 M, age 67.1±12.2 years, mean±SD; MRI lesion size 13.8±8.3 mm, mean±SD) were studied. The kappa, McNemar and Wilcoxon matched-pairs statistics were applied. Results Three patients (10.0%) had no diagnostic 3D-CEUS for technical problems. 3D-CEUS was judged to improve the two-dimensional ultrasonography (2D-US) findings in evaluating the pancreatic lesions in 14 patients (51.9%). Twelve (44.4%) main duct IPMN cases were identified by 3D-CEUS vs. no cases by MRI (P<0.001). IPMN localization showed a poor agreement between 3D-CEUS and MRI (kappa=0.058), whereas a good agreement was found in detecting the presence of calcifications (kappa=1.000). Significant differences between 3D-CEUS and MRI were found regarding the number of lesions detected (1.4±0.8 vs. 3.8±3.6; P<0.001), the detection of mucinous plugs (3.7% vs. 50.0%; P<0.001), chronic pancreatitis (7.4% vs. 29.6%; P=0.031), pancreatic atrophy (0% vs. 48.1%; P<0.001), high thick septa (22.2% vs. 55.6%; P=0.004) and mural nodules (25.9% vs. 3.3%; P=0.016), while presence of dilation of both the Wirsung duct (40.7% vs. 18.5%; P=0.070) and the secondary duct communicating with the main pancreatic duct (0% vs. 3.3%; P=1.000) were not significant. Conclusions The 3D-CEUS compared to 2D-US improves the IPMN diagnosis. It may be utilized to better evaluate these patients after 2D-US examination. MRI remains the gold standard technique.