{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T19:06:41Z","timestamp":1788116801673,"version":"build-2803163510"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T00:00:00Z","timestamp":1646956800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T00:00:00Z","timestamp":1646956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Region Stockholm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>Current guidelines base the management of intraductal papillary mucinous neoplasms (IPMN) on several well-established resection criteria (RC), including cyst size. However, malignancy may occur in small cysts. Since branch-duct (BD) IPMN are not perfect spheres, volumetric and morphologic analysis might better correlate with mucin production and grade of dysplasia. Nonetheless, their role in malignancy (high-grade dysplasia\/invasive cancer) prediction has been poorly investigated. Previous studies evaluating RC also included patients with solid-mass-forming pancreatic cancer (PC), which may affect the RC yield. This study aimed to assess the role of volume, morphology, and other well-established RC in malignancy prediction in patients with BD- and mixed-type IPMN after excluding solid masses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Retrospective ethical review-board-approved study of 106 patients (2008\u20132019) with histopathological diagnosis of BD- and mixed-type IPMN (without solid masses) and preoperative MRI available. Standard imaging and clinical features were collected, and the novel imaging features cyst-volume and elongation value [EV = 1 \u2212 (width\/length)] calculated on T2-weighted images. Logistic regression analysis was performed. Statistical significance set at two-tails, <jats:italic>p<\/jats:italic> &lt; 0.05.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Neither volume (odds ratio (OR) = 1.01, 95% CI: 0.99\u20131.02, <jats:italic>p<\/jats:italic> = 0.12) nor EV (OR = 0.38, 95% CI: 0.02\u20135.93, <jats:italic>p<\/jats:italic> = 0.49) was associated with malignancy. Contrast-enhancing mural nodules (MN), main pancreatic duct (MPD) \u2265 5 mm, and elevated carbohydrate antigen (CA) 19-9 serum levels (&gt; 37 \u03bcmol\/L) were associated with malignancy (MN OR: 4.32, 95% CI: 1.18\u201315.76, <jats:italic>p<\/jats:italic> = 0.02; MPD \u2265 5 mm OR: 4.2, 95% CI: 1.34\u201313.1, <jats:italic>p<\/jats:italic> = 0.01; CA19-9 OR: 6.72; 95% CI: 1.89 \u2013 23.89, <jats:italic>p<\/jats:italic> = 0.003).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Volume and elongation value cannot predict malignancy in BD- and\/or mixed-type IPMN. Mural nodules, MPD \u2265 5 mm and elevated CA19-9 serum levels are associated with higher malignancy risk even after the exclusion of solid masses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p><jats:italic>\u2022 Novel and well-established resection criteria for IPMN have been evaluated after excluding solid masses.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 BD-IPMN volume and elongation value cannot predict malignancy.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 Main pancreatic duct \u2265 5 mm, mural nodules, and elevated carbohydrate antigen 19-9 levels are associated with malignancy.<\/jats:italic><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-022-08650-5","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T11:05:04Z","timestamp":1646996704000},"page":"5144-5155","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Branch-duct intraductal papillary mucinous neoplasm (IPMN): Are cyst volumetry and other novel imaging features able to improve malignancy prediction compared to well-established resection criteria?"],"prefix":"10.1007","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7668-0394","authenticated-orcid":false,"given":"Raffaella M.","family":"Pozzi Mucelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Fern\u00e1ndez","family":"Moro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Del Chiaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Valente","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lennart","family":"Blomqvist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Papanikolaou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes-Matthias","family":"L\u00f6hr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Kartalis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,11]]},"reference":[{"key":"8650_CR1","doi-asserted-by":"publisher","unstructured":"Ren B, Liu X, Suriawinata AA (2019) Pancreatic ductal adenocarcinoma and its precursor lesions: histopathology, cytopathology, and molecular pathology. 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Nikolaos Papanikolaou is the owner of MRIcons LTD company. Marco del Chiaro has been awarded an industry grant (Haemonetics, Inc) to conduct a multi-center study to evaluate the prognostic implications of TEG in pancreas cancer. Further, he is a co-PI of a sponsored Boston Scientific study on the use of intra-operative pancreatoscopy in IPMN patients. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"Nicola Orsini, associate professor of Medical Statistics, head of the Biostatistics Team, Department of Global Public Health, kindly provided statistical advice for this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and Biometry"}},{"value":"Written informed consent was waived by the Regional Review Board.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}},{"value":"Regional Review Board approval was obtained (EPN 2015\/1544\u201331\/4).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"The final population of our study overlaps with two previously published papers.Twenty-nine patients out of 106 (27%) (operated on in the period 2008\u20132015) were part of the patient cohort in a previously published study by our group [reference nr. 5: Ateeb Z, Valente R, Pozzi-Mucelli RM, et al (2019) Main pancreatic duct dilation greater than 6 mm is associated with an increased risk of high-grade dysplasia and cancer in IPMN patients. Langenbecks Arch Surg].Fifty out of 106 patients (47%) (operated on in the period 2008\u20132017) were part of the patient cohort in the study by Del Chiaro M. et al [reference nr. 6: del Chiaro M, Beckman R, Ateeb Z, et al (2019) Main duct dilatation is the best predictor of high-grade dysplasia or invasion in intraductal papillary mucinous neoplasms of the pancreas. Ann Surg].Our study differs from the previous paper from Ateeb Z et al and del Chiaro et al as we only included patients with a preoperative pancreatic MRI, who had at least one histologically proven BD-IPMN detectable on the T2-weighted images. Moreover, the main aim of our current study was to assess the role of cystic volume, morphological features such as elongation value and other well-established resection criteria after (1) excluding subjects with solid-mass-forming IPMN\u2013associated or concomitant pancreatic cancer, and (2) patients with main-duct diameter \u2265 5 mm without a BD-IPMN clearly identifiable at preoperative MRI.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}