IPMN (Intraductal Papillary Mucinous Neoplasm)
Intraductal papillary mucinous neoplasms (IPMN) are intraductal mucin-producing neoplasms with tall columnar, mucin-containing epithelium, with or without papillary projections, involving the main pancreatic duct and/or major side branches. They account for approximately 25 % of all cystic neoplasms and can be subdivided into benign lesions, borderline lesions, and carcinoma.
F18-FDG-PET/CT seems to be an useful technique for preoperative work-up of patients with suspected IPMN and is an improvement over conventional imaging in distinguishing benign from malignant lesions, especially for selecting patients for surgical treatment or for long-term follow-up (1).
PET/CT was superior to MDCT in diagnosing malignant IPMN. All 22 concordant results gave accurate diagnoses. Of 9 discordant results, MDCT misdiagnosed 7 IPMNs, whereas PET/CT misinterpreted 2. Malignant IPMNs showed significantly higher maximal standardized uptake values (mean ± standard deviation, 6.7 ± 3.6) than benign IPMNs (mean ± standard deviation, 2.1 ± 1.0) (P < 0.001) (2).
Despite the yield of F18-FDG-PET/CT, it is not recommended in the guidelines 2012 (3).
References:
1 Francesco Bertagna, Giorgio Treglia, Gian Luca Baiocchi, Raffaele Giubbini. F18-FDG-PET/CT for evaluation of intraductal papillary mucinous neoplasms (IPMN): a review of the literature. Jpn J Radiol (2013) 31:229–236.
2 Hong HS, Yun M, Cho A, Choi JY, Kim MJ, Kim KW, Choi YJ, Lee JD. The utility of F-18 FDG PET/CT in the evaluation of pancreatic intraductal papillary mucinous neoplasm. Clin Nucl Med. 2010 Oct;35(10):776-9.
3 Masao Tanaka, Carlos Fernández-del Castillo, Volkan Adsay, Suresh Chari, Massimo Falconi, Jin-Young Jang, Wataru Kimura, Philippe Levy, Martha Bishop Pitman, C. Max Schmidt, Michio Shimizu, Christopher L. Wolfgang, Koji Yamaguchim, Kenji Yamao. Department of International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12 (2012) 183-197.