Brief Articles
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World J Gastroenterol. Jun 14, 2009; 15(22): 2739-2747
Published online Jun 14, 2009. doi: 10.3748/wjg.15.2739
Predictive value of multi-detector computed tomography for accurate diagnosis of serous cystadenoma: Radiologic-pathologic correlation
Anjuli A Shah, Nisha I Sainani, Avinash Kambadakone Ramesh, Zarine K Shah, Vikram Deshpande, Peter F Hahn, Dushyant V Sahani
Anjuli A Shah, Nisha I Sainani, Avinash Kambadakone Ramesh, Zarine K Shah, Peter F Hahn, Dushyant V Sahani, Department of Radiology, Division of Abdominal Imaging and Interventional Radiology, White Bldg. 270, Massachusetts General Hospital, 55 Fruit St., Boston MA 02114, United States
Vikram Deshpande, Department of Pathology, Massachusetts General Hospital, 55 Fruit St., Boston MA 02114, United States
Author contributions: Shah AA, Sainani NI, Kambadakone AR, Shah ZK, Deshpande V, Hahn PF and Sahani DV contributed equally to this work; Sahani DV designed research and intellectual content; Shah AA, Sainani NI, Kambadakone AR, Shah ZK, Deshpande V and Sahani DV performed research; Shah AA, Kambadakone AR, Sainani NI, Deshpande V, Hahn PF and Sahani DV analyzed the data; Shah AA, Kambadakone AR, Deshpande V, Hahn PF and Sahani DV contributed to preparing the manuscript, editing and final approval.
Correspondence to: Dushyant V Sahani, MD, Director of CT, Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit street, White 270, Boston MA 02114, United States. dsahani@partners.org
Telephone: +1-617-7268396
Fax: +1-617-7264891
Received: July 1, 2008
Revised: August 26, 2008
Accepted: September 3, 2008
Published online: June 14, 2009
Abstract

AIM: To identify multi-detector computed tomography (MDCT) features most predictive of serous cystadenomas (SCAs), correlating with histopathology, and to study the impact of cyst size and MDCT technique on reader performance.

METHODS: The MDCT scans of 164 patients with surgically verified pancreatic cystic lesions were reviewed by two readers to study the predictive value of various morphological features for establishing a diagnosis of SCAs. Accuracy in lesion characterization and reader confidence were correlated with lesion size (≤ 3 cm or ≥ 3 cm) and scanning protocols (dedicated vs routine).

RESULTS: 28/164 cysts (mean size, 39 mm; range, 8-92 mm) were diagnosed as SCA on pathology. The MDCT features predictive of diagnosis of SCA were microcystic appearance (22/28, 78.6%), surface lobulations (25/28, 89.3%) and central scar (9/28, 32.4%). Stepwise logistic regression analysis showed that only microcystic appearance was significant for CT diagnosis of SCA (P = 0.0001). The sensitivity, specificity and PPV of central scar and of combined microcystic appearance and lobulations were 32.4%/100%/100% and 68%/100%/100%, respectively. The reader confidence was higher for lesions > 3 cm (P = 0.02) and for MDCT scans performed using thin collimation (1.25-2.5 mm) compared to routine 5 mm collimation exams (P > 0.05).

CONCLUSION: Central scar on MDCT is diagnostic of SCA but is seen in only one third of SCAs. Microcystic morphology is the most significant CT feature in diagnosis of SCA. A combination of microcystic appearance and surface lobulations offers accuracy comparable to central scar with higher sensitivity.

Keywords: Pancreas; Serous cystadenoma; Multi-detector computed tomography; Central scar; Lobulations; Microcystic