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Gastrointest Endosc. 2010 May;71(6):945-50. doi: 10.1016/j.gie.2009.11.046. Epub 2010 Mar 15.

Variability in measurements of pancreatic cyst size among EUS, CT, and magnetic resonance imaging modalities.

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  • 1Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.

Abstract

BACKGROUND:

Cyst size is an important factor in the management of pancreatic cysts, both in predicting the need for surgery and the frequency of follow-up.

OBJECTIVE:

To determine agreement and precision of EUS, CT, and magnetic resonance imaging (MRI) modalities in the evaluation of pancreatic cyst diameter.

DESIGN:

Retrospective chart review.

SETTING:

Tertiary-care center, January 2000 to June 2009.

PATIENTS:

This study involved 175 patients presenting for EUS evaluation of pancreatic cysts, with size measured by at least two of the aforementioned imaging studies within a 90-day period.

MAIN OUTCOME MEASUREMENTS:

Largest cyst diameter from EUS, CT, MRI/MRCP, and surgical pathology.

RESULTS:

A total of 175 patients underwent EUS. Seventy-three had CT plus EUS, 33 had MRI/MRCP plus EUS, 23 had MRI/MRCP plus CT, and 15 had all imaging studies, occurring within 90 days of each other. Median size differences between studies: EUS and CT (ie, absolute value of size determined by EUS minus size determined by CT) = 4 mm (range 0-25 mm), EUS and MRI = 4 mm (range 0-17 mm), CT and MRI = 3 mm (range 2-20 mm). Median size differences for surgical pathology specimens compared with results of 12 EUS, 13 CT, and 8 MRI/MRCP studies were as follows: EUS and pathology = 9.5 mm (range 0-20 mm), CT and pathology = 5 mm (range 0-21 mm), MRI and pathology = 5.5 mm (range 2-44 mm).

LIMITATIONS:

Interobserver variability and small sample of surgical pathology cysts.

CONCLUSION:

There is considerable variation in size estimates of pancreatic cysts by different imaging modalities, which practitioners should take into account when making management decisions. Use of a single imaging modality is recommended during follow-up. The precision of imaging studies for measuring pancreatic cysts must be prospectively defined if change in size is to be reliably used for clinical management.

PMID:
20231021
DOI:
10.1016/j.gie.2009.11.046
[PubMed - indexed for MEDLINE]
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