Abbreviated versus comprehensive MRI protocols in the surveillance of branch-duct intraductal papillary mucinous neoplasms (BD-IPMN): an exploratory analysis of inter-reader agreement, management concordance, time and cost savings.

内容摘要

To compare abbreviated (APs) and comprehensive (CP) MRI protocols for branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) surveillance in terms of imaging findings, management recommendations and inter-reader agreement across readers with different levels of expertise, while assessing potential time and cost savings. This single-center retrospective study included patients with BD-IPMN undergoing baseline and follow-up MRI between January 2018 and April 2024. The CP included axial and coronal T2WI, axial fat-saturated T1-weighted images before and after contrast injection (T1WI), 2D- and 3D-MRCP and DWI images. Two APs were obtained from CP follow-up examinations: AP with DWI consisted of axial and coronal T2WI, 2D- 3D-MRCP, axial fat-saturated T1WI and DWI; AP without DWI consisted of the same AP sequences excluding DWI. A senior radiologist (>&#x2009;20 years of experience in pancreatic imaging) and a junior radiologist (4th-year-radiology resident), blinded to subsequent examinations, independently analysed each protocol according to Kyoto guidelines and management recommendations. Inter-reader and inter-protocol agreement were analysed using Cohen's and Fleiss' Kappa. Acquisition times and resource-saving were compared using national reimbursement rates (p&#x2009;<&#x2009;0.05 statistically significant). Overall, 40 patients (25 women and 15 men) with a median age of 67 years (range 48-87) were included. No statistically significant differences were observed among the 3 protocols in identifying worrisome features, including high-risk stigmata, cyst size, main pancreatic duct dilation and mural nodules. The inter-protocol agreement was almost perfect (Fleiss' Kappa&#x2009;=&#x2009;0.82). Substantial inter-reader agreement (Cohen's Kappa&#x2009;>&#x2009;0.6) was observed for all protocols, with almost perfect agreement (Cohen's Kappa&#x2009;>&#x2009;0.8) in some instances. APs demonstrated up to 48% reduction in acquisition time and a 27.4% resource-saving compared to CP. The addition of DWI did not significantly improve inter-reader and inter-protocol agreement or influence management recommendations. Abbreviated protocols, particularly without DWI, showed substantial agreement with CP and similar management recommendations, supporting their feasibility as resource-saving alternatives for BD-IPMN surveillance, even among less experienced radiologists.