Recurrence patterns of intraductal papillary mucinous neoplasms of the pancreas on enhanced computed tomography

J Comput Assist Tomogr. Nov-Dec 2009;33(6):838-43. doi: 10.1097/RCT.0b013e3181a7e2a8.

Abstract

Objective: To characterize imaging features and findings in recurrent intraductal papillary mucinous neoplasms (IPMN); thereby reconciling the "field defect" theory with the appearance of recurrences distant from the resection margin.

Methods: Computed tomography findings were reviewed in 89 patients who were resected with IPMN. At follow-up, the appearance of the pancreatic duct, features of recurrent masses, evidence of enhancement, calcifications, lymphadenopathy, and metastases were recorded.

Results: Fourteen (16%) of the 89 patients had evidence of recurrence. Nine (64%) of the 14 patients demonstrated evidence for local recurrence. Ten recurrent lesions were noted in 9 patients. Patients with recurrence demonstrated an increase of pancreatic ductal dilatation of 3.3 mm, whereas patients without recurrence either had no dilatation or dilatation which then decreased over time.

Conclusions: Computed tomography findings suspicious for tumor recurrence include enlarging mass (either solid, cystic or both), progressive ductal dilatation, or extrapancreatic disease. There was a lack of correlation between margin status and location of recurrence within the pancreas consistent with the global field defect theory of IPMN.

MeSH terms

  • Adenocarcinoma, Mucinous / diagnostic imaging*
  • Adenocarcinoma, Mucinous / pathology
  • Adenocarcinoma, Mucinous / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Papillary / diagnostic imaging*
  • Carcinoma, Papillary / pathology
  • Carcinoma, Papillary / surgery
  • Contrast Media
  • Female
  • Humans
  • Iohexol
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging*
  • Pancreatic Neoplasms / diagnostic imaging*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery
  • Radiographic Image Interpretation, Computer-Assisted
  • Retrospective Studies
  • Tomography, X-Ray Computed / methods*

Substances

  • Contrast Media
  • Iohexol