Criteria for Determining Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasm Based on Computed Tomography

Digestion. 2016;94(4):230-239. doi: 10.1159/000452738. Epub 2016 Dec 29.


Introduction: Determining the dignity of intraductal papillary mucinous neoplasms (IPMNs) by imaging procedures is challenging. Various CT-based criteria were evaluated.

Patients and methods: Preoperative CT scans from 47 patients with IPMN were analyzed. Predefined criteria of malignancy were compared between patients with benign (bIPMN; n = 28) and malignant (mIPMN; n = 19) tumors, and a summation score was determined.

Results: Preoperative carbohydrate-antigen 19-9 levels were higher in patients with mIPMN (p = 0.013). The diameter of the main pancreatic duct was greater in patients with mIPMN (p < 0.0001). More patients with mIPMN showed bile duct obstruction (p = 0.0076), solid tumor components (p = 0.0076), contrast enhancement in cystic walls (p = 0.0086), peripancreatic lymph nodes (p = 0.0076), and abrupt diameter changes of the main pancreatic duct (p = 0.0008). The CT density of the cysts was higher in mIPMN (p = 0.0063). The diagnostic accuracy of the summation score (sensitivity: 0.84, specificity: 0.96) was greater when compared to each individual CT parameter.

Conclusions: The prevalence and extent of various CT-based abnormalities are greater in patients with mIPMN, but the wide overlap limits the diagnostic value of each individual parameter. A simple summation score largely enhances the diagnostic accuracy.

MeSH terms

  • Adenocarcinoma, Mucinous / blood
  • Adenocarcinoma, Mucinous / diagnostic imaging*
  • Aged
  • CA-19-9 Antigen / blood*
  • Carcinoma, Pancreatic Ductal / blood
  • Carcinoma, Pancreatic Ductal / diagnostic imaging*
  • Carcinoma, Papillary / blood
  • Carcinoma, Papillary / diagnostic imaging*
  • Female
  • Germany
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Ducts / pathology*
  • Pancreatic Neoplasms / blood
  • Pancreatic Neoplasms / diagnostic imaging*
  • Pancreatic Neoplasms / pathology
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed


  • CA-19-9 Antigen