MRI diagnosis pancreas cystics neoplasms at the stages of a medical examination

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Abstract

The use of modern imaging techniques in clinical practice is accompanied by a steady increase in the detection of pancreatic cystic neoplasms, many of which are an accidental finding due to asymptomatic course. At the same time, the absence of early clinical manifestations in conjunction with the different malignant potential of cystic neoplasia of the pancreas, the difficulties of differential diagnosis, determine the extreme relevance of this clinical problem.

Purpose of the study. To evaluate the possibilities and advantages of magnetic resonance imaging (MRI) in the differential diagnosis of pancreatic cystic neoplasms.

Materials and methods. The analysis of clinical and radiographic data of 75 patients with cystic neoplasms of the pancreas was carried out. All patients underwent MRI, in the amount or combination of the MR-protocol, magnetic resonance diffusion, magnetic resonance cholangiopancreatography, dynamic contrast enhancement. Computed tomography (n=7), endosonography (n=45) were also performed.

Results and conclusions. Tissue contrast, the use of various modalities of magnetic resonance imaging provides a number of advantages in the visualization of cystic neoplasms of the pancreas and the assessment of relationships with the ductal system, which allows us to consider it as the most effective method in the algorithm for radiological diagnosis of cystic neoplasms of the pancreas. During the study, the sensitivity of MRI in the diagnosis of cystic neoplasms was 96%, the specificity was 90%. The most frequent cystic neoplasms were intraductal papillary mucinous neoplasm type II – 34.5%. Serous cystic neoplasm (16%), mucinous cystic neoplasm (12%), and intraductal papillary mucinous neoplasm type I (10.5%) were also identified. Timely use of MRI at the stages of primary and differential diagnosis of cystic neoplasms of the pancreas will allow not only the necessary surgical treatment, but also to avoid unreasonable intervention. MRI is the method of choice for non-invasive differential diagnosis of pancreatic cystic neoplasms and the method of their dynamic monitoring.

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About the authors

S. K. Skulskiy

ICDC of PAO «Gazprom»; L.G. Sokolov North-Western district scientific and clinical center, Federal Medical and Biological Agency

Author for correspondence.
Email: skulsky@mail.ru

Candidate of Medical Sciences, Professor

Russian Federation, Moscow; Saint Petersburg

V. A. Ratnikov

L.G. Sokolov North-Western district scientific and clinical center, Federal Medical and Biological Agency; Saint Petersburg State University

Email: skulsky@mail.ru

MD, Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Ya. A. Lubashev

ICDC of PAO «Gazprom»

Email: skulsky@mail.ru

MD

Russian Federation, Moscow

E. V. Sevryukova

ICDC of PAO «Gazprom»

Email: skulsky@mail.ru

Candidate of Medical Sciences

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. MRI in Patient V., aged 45 years, pancreatic pseudocysts: a – T2-weighted image (WI); б – Т1fs-WI, contrast enhancement. Single-chamber cysts with a clearly differentiated capsule with a low signal intensity are visualized above the pancreatic isthmus and tail

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3. Fig. 2. MRI in Patient R., aged 67 years, serous cystic neoplasia: a, б – T2-WI; в – magnetic resonance cholangiopancreatography (MRCP), 1-mm thin section; г – MIP reconstruction. The microcystic type of pancreatic serous cystic neoplasia (SCN). The fine-mesh structure of neoplasia, the septa of which converge to the central scar (arrow) is visualized

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4. Fig. 3. Patient M., aged 60 years, SCN. Computed tomography (CT): a – native image; б – contrast enhancement; в – contrast enhancement, reconstruction – there is liquid pancreatic body neoplasm (arrow), in the presence of single septa, with no connection with the main pancreatic duct, does not accumulate a contrast agent. Endoscopic ultrasonography (EUS; г–е) shows a cystic pancreatic body neoplasm (arrow) with a thin capsule, with internal septa (г), with anechoic contents, with no connection with the main pancreatic duct (д). A fine-needle aspiration biopsy (e), 22 G puncture needle (arrow). Conclusion: SCN

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5. Fig. 4. Patient M., aged 40 years, mucinous cystic neoplasia. MRI: a – T2-WI, a large cystic neoplasm is visualized in the area of the pancreatic body and tail in the presence of internal parietal septa (arrow); б – T1fs-WI, contrast enhancement, there is contrast agent accumulation along the capsule and neoplasia septa (arrow). There is no connection between the formation and the main pancreatic duct. EUS (в): The pancreatic tail area shows a unilobular cystic mass with a thick echo-dense wall, with multiple echo-dense septa around the periphery (arrows), without a solid component; the liquid content of the cyst is homogeneous and has a somewhat higher echo density. Operative treatment. Microscopic description: the cyst wall is shown by an ovary-like stroma with focal hemorrhages, the inner surface is lined by mucin-producing columnar epithelium with basal nuclei, with micropapillary structures in places, with signs of low-grade focal intraepithelial neoplasia (mucinous cystic neoplasia)

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6. Fig. 5. Patient D., aged 55 years, the lateral type of intraductal papillary mucinous neoplasia. MRI: a – MRCP; б – T2-WI; в – MRCP, reconstruction. Multiple pancreatic cystic changes are visualized. One of the cystic components with a tissue component (arrow)

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7. Fig. 6. Patient A., aged 68 years, the lateral type of intraductal papillary mucinous neoplasia. MRI: a – MRCP, reconstruction; б – MRCP, 1 mm; в – T2-WI. EUS: г – a pancreatic body cystic mass of up to 1.7 cm in size is visualized, which communicates with the main pancreatic duct (arrow), without the presence of an internal tissue mass; д – control study after 1 year, there is appearance of a parietal tissue mass (arrow)

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