Volume 4, 2020

Medical Imaging

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS: RADIOLOGY METHODS IN THE DEFINITION OF TREATMENT TACTICS

Yulia A. Stepanova

Pages: 76–80

DOI: 10.21175/RadProc.2020.16

IPMN is a borderline malignant epithelial tumor that develops in the pancreatic duct and/or its lateral branches from mucin-producing cells. The aim is to evaluate the capabilities of radiology diagnostic methods in assessing IPMN, based on the analysis of literature data and personal experience. From 2004 to 2019, at A.V. Vishnevsky National Medical Research Center of Surgery (A.V. Vishnevsky NMRC of Surgery), 96 patients were examined and treated with morphologically verified IPMN, aged from 38 to 80, with a somewhat larger share of men (57.3%). Patients were subjected to the complete radiology examination: ultrasound (in B-mode and duplex scanning, with 3D reconstruction, if it’s necessary), multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) with contrast enhancement. The following types of IPMN have been diagnosed: MD-IPMN - 19 cases (19.8%), BD-IPMN - 46 cases (47.9%), combined-IPMN – 31 cases (32.3%). The criteria of radiology diagnostics of the IPMN are as follows: extended duct throughout its range; thickening of its walls; parietal papillary proliferations of varying degrees of severity; possible single expanded segmental ducts and tumor masses around the main pancreatic duct. The MRCP is the priority method of diagnostics. In accordance with the criteria of tumor malignancy, 56 (58.3%) patients were operated on, 40 (41.7%) were under observation: Type 1: operated on - 17 (89.5%); are under observation - 2 (10.5%); Type 2: operated on - 12 (26.1%); are under observation - 34 (73.9%); Type 3: operated on - 27 (87.1%); are under observation - 4 (12.9%). Thus, dynamic monitoring is carried out mainly for type II tumors. Despite the increase in the availability of radiological methods of examination, the diagnosis of IPMN can be difficult. Current guidelines provide indications for surgery and recommendations for surveillance, but management of IPMN is still challenging in routine clinical practice. Due to the high risk of tumor malignancy in types 1 and 3, timely correct diagnosis and determination of further treatment tactics are extremely important. MRI is a priority method for the diagnosis of IPMN, however, in some cases, the involvement of at least two methods of radiology diagnostics allows to establish the nature of the disease and determine the tactics of treatment.
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Yulia A. Stepanova, "Intraductal papillary mucinous neoplasms: Radiology methods in the definition of treatment tactics," RAD Conf. Proc, vol. 4, 2020, pp. 76–80, http://doi.org/10.21175/RadProc.2020.16