ACR logo

Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Buerke B, Domagk D, Heindel W, Wessling J. Diagnostic and radiological management of cystic pancreatic lesions: important features for radiologists. [Review]. Clin Radiol. 67(8):727-37, 2012 Aug. Review/Other-Dx N/A To develop a broader understanding of the pathological and radiological characteristics of cystic pancreatic neoplasms, and provide a guideline for everyday practice based on current concepts in the radiological management of the given lesions. No results stated in abstract 4
2. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol. 191(3):802-7, 2008 Sep. Observational-Dx 2832 patients To determine the prevalence of findings of unsuspected pancreatic cysts on 16-MDCT in a population of adult out-patients imaged for disease unrelated to the pancreas. A total of 73 patients had pancreatic cysts, representing a prevalence of 2.6 per 100 patients (95% CI, 2.0–3.2). Cysts ranged in size from 2 to 38 mm (mean, 8.9 mm) and were solitary in 85% of cases. Analysis of demographic information showed a strong correlation between pancreatic cysts and age, with no cysts identified among patients under 40 years and a prevalence of 8.7 per 100 (95% CI, 4.6–12.9) in individuals from 80 to 89 years. After controlling for age, cystswere more common in individuals of the Asian race than all other race categories, with an odds ratio of 3.57 (95% CI, 1.05–12.13). There was no difference by sex in the prevalence of cysts (p = 0.527); however, cysts were on average 3.6 mm larger (p = 0.014) in men than women. 3
3. Zaheer A, Pokharel SS, Wolfgang C, Fishman EK, Horton KM. Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions. [Review]. Abdom Imaging. 38(2):331-41, 2013 Apr. Review/Other-Dx N/A To facilitate a better understanding of incidentally noted cystic pancreatic lesions, since these lesions often pose a challenge regarding appropriate management. Diagnostic benign lesions can be left alone. Cross-sectional imaging can be used to follow-up benign appearing lesions and to stage more aggressive ones.Endoscopic ultrasound with fine needle aspiration and cyst fluid analysis can be performed on certain indeterminate lesions. Lesions with high malignant potentialshould undergo resection. 4
4. Freeny PC, Saunders MD. Moving beyond morphology: new insights into the characterization and management of cystic pancreatic lesions. [Review]. Radiology. 272(2):345-63, 2014 Aug. Observational-Dx N/A To present the limitations of cross-sectional imaging in patients with cystic pancreatic lesions, detail advances in knowledge of thegenomic and epigenomic changes that lead to progression of carcinogenesis, outline the current understanding of the natural history of mucinous cystic lesions, and include the current use and future potential of novel tumor markers and molecular analysis to characterize cystic pancreatic lesions more precisely. No results stated in abstract 4
5. Moris M, Bridges MD, Pooley RA, et al. Association Between Advances in High-Resolution Cross-Section Imaging Technologies and Increase in Prevalence of Pancreatic Cysts From 2005 to 2014. Clin Gastroenterol Hepatol. 14(4):585-593.e3, 2016 Apr. Observational-Dx 500 patients To determine the prevalence of incidental pancreatic cysts in patients undergoing magnetic resonance imaging (MRI) for nonpancreatic indications on successive,increasingly sophisticated MRI systems and to compare prevalence based on the demographic characteristics of the patients. Of the 500 patients analyzed, 208 patients (41.6%) were found to have an incidental cyst. A significant relationship was observed between pancreatic cysts and patient age (P < .0001), diabetes mellitus (P = .001), and nonpancreatic cancer (P = .01), specifically nonmelanoma skin cancer (P=.03) or hepatocellular carcinoma (P=.02). The multivariable model showed a strong association between hardware and software versions and detection of cysts (P < .0001); the old hardware detected pancreatic cysts in 30.3% of patients, whereas the newest hardware detected cysts in 56.3% of patients. 3
6. Pinho DF, Rofsky NM, Pedrosa I. Incidental pancreatic cysts: role of magnetic resonance imaging. [Review]. Top Magn Reson Imaging. 23(2):117-28, 2014 Apr. Review/Other-Dx N/A To review the role of magnetic resonance imaging (MRI) in evaluation of incidental pancreatic cysts No results stated in abstract 4
7. Megibow AJ, Baker ME, Morgan DE, et al. Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. Journal of the American College of Radiology. 14(7):911-923, 2017 Jul. Review/Other-Dx N/A Guidance document on how to manage incidentally detected pancreatic cysts. No results stated in abstract 4
8. Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 12(3):183-97, 2012 May-Jun. Review/Other-Dx N/A To present guidelines for management of intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN) that include recent information and recommendations based on our current understanding, and highlight issues that remain controversial and areas where further research is required. No results stated in abstract 4
9. Vege SS, Ziring B, Jain R, Moayyedi P, Clinical Guidelines Committee, American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 148(4):819-22; quize12-3, 2015 Apr. Review/Other-Dx N/A To present the official recommendations of the American Gastroenterological Association (AGA) on the management of pancreatic cysts. No results stated in abstract 4
10. Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. [Review] [86 refs]. Pancreatology. 6(1-2):17-32, 2006. Review/Other-Dx N/A Proposed guidelines for management of Intraductal Papillary Mucinous Neoplasms and Mucinous Cystic Neoplasms of the Pancreas that represent a consensus of the working group of the International Association of Pancreatology. No results stated in abstract 4
11. Sahora K, Crippa S, Zamboni G, et al. Intraductal papillary mucinous neoplasms of the pancreas with concurrent pancreatic and periampullary neoplasms. Eur J Surg Oncol. 42(2):197-204, 2016 Feb. Observational-Dx 441 patients To describe the prevalence, clinicopathologic characteristics and prognosis of Intraductal papillary mucinous neoplasms (IPMN) with concurrent pancreatic and ampullary neoplasms, especially concurrent, distinct pancreatic ductal adenocarcinoma (con-PDAC). 2762 patients underwent pancreatic surgery from January 2000 to December 2012. Sixteen percent (n = 441) had pathologicallyconfirmed IPMN and 11% of these (n = 50) had a different distinct synchronous pancreatic neoplasm. The majority of these, 62%, werecon-PDAC, followed by neuroendocrine neoplasms (10%) and ampullary carcinoma (10%). Less frequently, mucinous (6%) as well as serouscystic neoplasms (6%), adenosquamous carcinoma (4%) and distal bile duct cancer (2%) were diagnosed. Among all patients withsynchronous neoplasms, 66% harbored BD-IPMN, 28% combined IPMN and 6% main duct IPMN. Abdominal pain and/or jaundicewere the leading symptoms in half of patients. 3
12. Schmid RM, Siveke JT. Approach to cystic lesions of the pancreas. [Review]. Wiener Medizinische Wochenschrift. 164(3-4):44-50, 2014 Feb. Review/Other-Dx N/A To review the approach to cystic lesions of the pancreas No results stated in abstract 4
13. Tanaka M, Fernandez-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. [Review]. Pancreatology. 17(5):738-753, 2017 Sep - Oct. Review/Other-Dx N/A To present revised guidelines for management of intraductal papillary mucinous neoplasm (IPMN) that include updated information and recommendations based on our current understanding, and highlight issues that remain controversial or where further research is required. No results stated in abstract 4
14. Flusberg M, Paroder V, Kobi M, Rozenblit AM, Chernyak V. Patients 65 years and older with incidental pancreatic cysts: Is there a relationship between all-cause mortality and imaging follow-up?. Eur J Radiol. 85(6):1115-20, 2016 Jun. Observational-Dx 5125 patients To assess the relationship between imaging follow-up and all-cause mortality in subjects =65 years with and without incidental pancreatic cysts (IPC). There were 1320 subjects in IPC group and 3805 in No-IPC group, with mean ages 79.1 (±8.0) and 78.8 (±8.0) years, respectively (p = 0.293), and median follow-up times of 3.1 (IQR 0.74–5.26) and 3.0 (0.36–5.23) years, respectively (p = 0.009). Adjusted odds ratios of post-index imaging for IPC were 2.18 (p < 0.001) in subgroup <84 years and follow-up <4years, 3.37 (p < 0.001) in subgroup <84 years and follow-up =4 years, and 1.20 (p = 0.201) in subgroup =84 years. Number of follow-up CTs and MRs was not independently associated with decreased odds of death in any subgroup. 3
15. Sahani DV, Kadavigere R, Blake M, Fernandez-Del Castillo C, Lauwers GY, Hahn PF. Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations--correlation with MRCP. Radiology. 238(2):560-9, 2006 Feb. Observational-Dx 25 patients To retrospectively compare accuracy of multi– detector row computed tomography (CT), combined with two-dimensional (2D) curved reformations, and that of magnetic resonance (MR) cholangiopancreatography (MRCP) for characterization of intraductal papillary mucinous neoplasm (IPMN) as malignant, with pathologic examination as reference standard. Excellent correlation between modalities was observed. Cyst communication was seen in 20 and 21 of 24 branch pancreatic duct (BPD) IPMNs with CT and MRCP, respectively. Sensitivity, specificity, and accuracy for detection of malignancy were 70%, 87%, and 76% (CT) and 70%, 92%, and 80% (MRCP), respectively. Interobserver agreement was good to perfect for both readers in all comparisons (overall, kappa = 0.70–1.00). 2
16. Matsumoto T, Aramaki M, Yada K, et al. Optimal management of the branch duct type intraductal papillary mucinous neoplasms of the pancreas. Journal of Clinical Gastroenterology. 36(3):261-5, 2003 Mar. Observational-Dx 43 patients To determine the optimal management of the intraductal papillary mucinous neoplasms (IPMNs) according to the morphologic type based on distinguishing between benign and malignant diseases. Among the 43 resected IPMNs, 25 were benign and 18 were malignant. Malignant tumors were significantly greater in diameter than benign tumors (52.9 vs. 30.2 mm, P < 0.05). All main duct type tumors with mural nodules were malignant. All branch duct type tumors less than 30 mm in diameter and without mural nodules were benign. Twelve branch duct type IPMNs size less than 30 mm were not resected and have not progressed. 3
17. Pausawasdi N, Heidt D, Kwon R, Simeone D, Scheiman J. Long-term follow-up of patients with incidentally discovered pancreatic cystic neoplasms evaluated by endoscopic ultrasound. Surgery. 147(1):13-20, 2010 Jan. Observational-Dx 71 patients To evaluate how the endoscopic ultrasound (EUS) findings and cyst fluid analysis predicted long-term clinical behavior of incidentally discovered asymptomatic pancreatic lesions. Overall, 317 patients underwent EUS for evaluation of pancreatic cysts from 1995 to 2005. A total of 97/317 (31%) had asymptomatic, incidentally discovered pancreatic cysts; of 97 asymptomatic patients, 93 were contacted. Of these patients, 71/93 (76%) had lesions<3 cm and benign EUSfeatures. All were followed without operative therapy. The mean follow-up was 44 months (range, 6--123). A total of 69/71 (97%) were alive and free of symptoms of pancreatic disease; 2 patients died of unrelated causes. Among these 71 patients with lesions <3 cm, FNA was performed in 33 patients andcytology was negative for malignant cells in all. Overall, 45/71 patients had either follow-up crosssectional imaging or EUS. All of them had stable lesions. Surveillance studies were performed with a mean follow-up of 28 months (range, 4--120). The 22 patients with lesions >3 cm and/or concerningEUS features underwent resection. Pathologic analysis revealed that 2/22 patients had adenocarcinoma and that 60% had premalignant lesions. 3
18. Song SJ, Lee JM, Kim YJ, et al. Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. Journal of Magnetic Resonance Imaging. 26(1):86-93, 2007 Jul. Observational-Dx 53 patients To compare the diagnostic performance of multirow- detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the differentiation of intraductal papillary mucinous neoplasms (IPMNs) from other pancreatic cystic masses. The Az values for each observer for predicting ductal communication of the lesion and differentiating IPMN from other lesions were as follows: For MRI they wererespectively 0.949 and 0.995 for reader 1, and 0.916 and 0.932 for reader 2. For MDCT they were respectively 0.790 and 0.875 for reader 1, and 0.774 and 0.850 for reader 2. In addition, for differentiating IPMNs from other lesions, MRI was significantly more accurate than MDCT (P < 0.05) for one observer, but for the other observer there was no significant difference between the two examinations (P =0.059). For predicting ductal communication of the cystic lesions for both observers, MRI was significantly more accurate than MDCT (P < 0.05). The weighted k values indicate good agreement (k= 0.61) between observers forMDCT, and excellent agreement (k= 0.82) for MRI. 2
19. NCCN Guidelines For Patients. Pancreatic Cancer. Version 1.2017.  Available at: https://www.nccn.org/patients/guidelines/pancreatic/files/assets/common/downloads/files/pancreatic.pdf. Review/Other-Dx N/A To explain which tests and treatments experts in pancreatic cancer recommend. No abstract available 4
20. Al-Hawary MM, Francis IR, Chari ST, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association. Gastroenterology. 146(1):291-304.e1, 2014 Jan. Review/Other-Dx N/A To improve the decision-making process for the management of patients with pancreatic ductal adenocarcinoma by providing a complete, pertinent, andaccurate reporting of disease staging to optimize treatment recommendations that can be offered to the patient. No results stated in abstract 4
21. Galvin A, Sutherland T, Little AF. Part 1: CT characterisation of pancreatic neoplasms: a pictorial essay. Insights Into Imaging. 2(4):379-388, 2011 Aug. Review/Other-Dx N/A To outline the characteristic CT appearances of the spectrum of pancreatic neoplasms, as well as important demographic and clinical information that aids diagnosis. No results stated in abstract 4
22. Sainani NI, Saokar A, Deshpande V, Fernandez-del Castillo C, Hahn P, Sahani DV. Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. AJR. American Journal of Roentgenology. 193(3):722-31, 2009 Sep. Observational-Dx 30 patients, 38 lesions To compare MDCT with MRI–MR cholangiopancreatography (MRCP) in characterizing small pancreatic cysts (= 3 cm) and predicting aggressiveness Of 38 lesions, 14 were side-branch intraductal papillary mucinous neoplasms (IPMNs), 12 mixed IPMNs, six mucinous cystic neoplasms, and six nonneoplastic cysts. On histopathology, 26 lesions were nonaggressive (six nonneoplastic cysts, six benign mucinous cystic neoplasms, 14 low-grade dysplasias in IPMNs), whereas 12 lesions revealed aggressive biology (eight moderate-grade dysplasias, four high-grade dysplasias in IPMNs). Thesensitivity of MRCP for the detection of morphologic features was better than that of MDCT, but the differences were not statistically significant (p = 0.25–1). Interreader agreement and MDCT–MRI agreement for morphologic features were good to perfect (? = 0.7–1). The accuracy of MDCT and MRI was higher in classifying cysts as mucinous or nonmucinous than in determining a specific diagnosis (71–84.2% vs 39.5–44.7%, respectively), whereas the accuracyof the two techniques in characterizing cysts into nonaggressive and aggressive categories was similar (MDCT vs MRI, 75–78% vs 78–86%, respectively; p > 0.05 2
23. Chiang AL, Lee LS. Clinical approach to incidental pancreatic cysts. [Review]. World J Gastroenterol. 22(3):1236-45, 2016 Jan 21. Review/Other-Dx N/A To review clinical approach to incidental pancreatic cysts. No results stated in abstract 4
24. Lee HJ, Kim MJ, Choi JY, Hong HS, Kim KA. Relative accuracy of CT and MRI in the differentiation of benign from malignant pancreatic cystic lesions. Clinical Radiology. 66(4):315-21, 2011 Apr. Observational-Dx 63 patients To assess the diagnostic accuracies of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for differentiating benign from malignant lesions and suggesting the specific diagnoses for pancreatic cystic lesions, and to assess whether review of both MDCT and MRI is beneficial. MDCT and MRI yielded comparable results for the characterization of malignancy (Az: 0.639, 0.735, 0.806 for MDCT and 0.732, 0.753, 0.792 for MRI, for each reviewer). The accuracies of specific diagnosis based on MDCT or MRI were 61.9 versus 55.6% for reviewer 1; 76.2 versus 76.2% for reviewer 2; and 65.1 versus 61.9% for reviewer 3. There was a trend toward better prediction of malignancy (Az: 0.787, 0.745, 0.849 for each reviewer), and better accuracy in suggesting a specific diagnosis (77.8, 73, and 73% for each reviewer) for MDCTþ MRI over MDCT or MRI alone, although it was statistically significant for one reviewerin the comparison of MDCT versus MDCTþ MRI for the prediction of malignancy, and MRI versus MDCT for suggesting a specific diagnosis. 2
25. Theisen BK, Wald AI, Singhi AD. Molecular Diagnostics in the Evaluation of Pancreatic Cysts. [Review]. Surg Pathol Clin. 9(3):441-56, 2016 Sep. Review/Other-Dx N/A To discuss the current management guidelines for pancreatic cysts, their underlying genetics, andthe integration of molecular testing in cyst classification and prognostication. No results stated in abstract 4
26. de Oliveira PB, Puchnick A, Szejnfeld J, Goldman SM. Prevalence of incidental pancreatic cysts on 3 tesla magnetic resonance. PLoS ONE. 10(3):e0121317, 2015. Observational-Dx 2583 reports To ascertain the prevalence of pancreatic cysts detected incidentally on 3-Tesla magnetic resonance imaging (MRI) of the abdomen and correlate this prevalence with patient age and gender; assess the number, location, and size of these lesions, as well as features suspicious for malignancy; and determine the prevalence of incidentally detected dilatation of the main pancreatic duct (MPD). Pancreatic cysts were detected incidentally in 9.3% of patients (239/2,583). The prevalence of pancreatic cysts increased significantly with age (p<0.0001). There were no significant differences in prevalence between men and women (p=0.588). Most cysts were multiple (57.3%), distributed diffusely throughout the pancreas (41.8%), and 5 mm or larger (81.6%). In 12.1% of cases, cysts exhibited features suspicious for malignancy. Overall, 2.7% of subjects exhibited incidental MPD dilatation. 3
27. Manfredi R, Bonatti M, D'Onofrio M, et al. Incidentally discovered benign pancreatic cystic neoplasms not communicating with the ductal system: MR/MRCP imaging appearance and evolution. Radiol Med (Torino). 118(2):163-80, 2013 Mar. Observational-Dx 62 patients To determine magnetic resonance/magnetic resonance cholangiopancreatography (MR/MRCP) imaging features of incidentally discovered benign, noncommunicating cystic neoplasms (BNCNs) of the pancreas to assess their evolution over time and identify MR/MRCP imaging features predictive of tumour growth. A total of 64 BNCNs was detected. Macroscopic pattern was mixed in 31/64 (48%), microcystic in 28/64 (44%) and macrocystic in 5/64 (8%). BNCNsappeared multicystic in 38/64 (59%) cases, oligocystic in 22/64 (35%) and unicystic in 4/64(6%). All qualitative parameters remained unchanged during follow-up. At diagnosis, the median maximum BNCN diameter was 35.0 mm and 38.0 mm at the final examination (p<0.001). BNCNs showed a tumour growth rate of 2 mm/year. 3
28. Ardengh JC, Lopes CV, de Lima-Filho ER, Kemp R, Dos Santos JS. Impact of endoscopic ultrasound-guided fine-needle aspiration on incidental pancreatic cysts. A prospective study. Scand J Gastroenterol. 49(1):114-20, 2014 Jan. Observational-Dx 302 patients To evaluate the management impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) on incidental pancreatic cysts (IPCs) A total of 302 PC patients were recruited. Of these, 159 (52.6%) patients had asymptomatic IPCs. The average size was 2.3 cm (range: 0.2–7.1 cm), and 110 patients having smaller than 3 cm sized cysts. Lesions were located in the pancreatic head in 96 (61%) cases, and most patients (94%) had only a single cyst. The final diagnoses, obtained by EUS-FNA (91) and surgery (68), were 93 (58%) benign lesions, 36 (23%) cysts with malignant potential, 14 (9%) noninvasive malignancies, 10 (6%) malignant precursor lesions (PanIN), and 6 (4%) invasive malignancies. Management strategy changed significantly after EUS-FNA in 114 (71.7%) patients: 43% of the cases were referred to surgery, 44% of the patients were discharged from surveillance, and 13% of the cases were given furtherperiodical imaging tests. 3
29. Cocieru A, Brandwein S, Saldinger PF. The role of endoscopic ultrasound and cyst fluid analysis in the initial evaluation and follow-up of incidental pancreatic cystic lesions. HPB. 13(7):459-62, 2011 Jul. Observational-Dx 62 patients To assess the role of endoscopic ultrasound (EUS) in the initial evaluation and follow-up of incidental pancreatic cystic lesions (PCL). There were 62 patients (40 females and 22 males). The mean patient age was 67.7 years (range, 30–89). The Median follow-up was 24 months (range, 12–72). The mean PCL size was 21.6 mm. In all, 13 patients underwent surgery (20.9%). Diagnosis included a mucinous cystic tumour (7), mucinous adenocarcinoma(2), intraductal papillary mucinous neoplasm (1) and a cystic neuroendocrine tumour (1). The overall malignancy rate among patients who underwent surgery was 15.3% (two patients). The mean carcinoembryonic antigen (CEA) level from PCL fluid analysis was also significantly higher in surgically treated group (7760) vs. the stable group (184.7) vs. the enlarging PCL group (361.1). A CEA level above 192 ng/ml predicted mucinous PCL with a sensitivity of 90%. 3
30. Matthaei H, Feldmann G, Lingohr P, Kalff JC. Molecular diagnostics of pancreatic cysts. [Review]. Langenbecks Arch Surg. 398(8):1021-7, 2013 Dec. Review/Other-Dx N/A To summarize some of the salient recent advances in molecular diagnostics of pancreatic cysts with particular focus on the emerging field of biomarker research in pancreatic cyst fluid based on protein, DNA and microRNA analyses. No results stated in abstract 4
31. Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. [Review]. Gastroenterology. 148(4):824-48.e22, 2015 Apr. Review/Other-Dx N/A To review the diagnosis and management of asymptomatic neoplastic pancreatic cysts. No results stated in abstract. 4
32. Gore RM, Wenzke DR, Thakrar KH, Newmark GM, Mehta UK, Berlin JW. The incidental cystic pancreas mass: a practical approach. [Review]. Cancer Imaging. 12:414-21, 2012 Sep 28. Review/Other-Dx N/A To present recommendations concerning the assessment of the more common pancreatic cystic incidental lesions. No results stated in abstract 4
33. Macari M, Lee T, Kim S, et al. Is gadolinium necessary for MRI follow-up evaluation of cystic lesions in the pancreas? Preliminary results. AJR. American Journal of Roentgenology. 192(1):159-64, 2009 Jan. Observational-Dx 56 patients To determine whether gadolinium is necessary in the follow-up evaluation of pancreatic cystic lesions. Concordance between the two different readers for the interpretations (when using the same MRI interpretation technique for follow-up surveillance) was 87.5% with a kappa coefficient to assess interobserver variation of 0.075, suggesting only slight agreement between the two readers. However, treatment recommendations provided by a single reader with and without information from the contrast-enhanced images were discordant only 4.5% of the time. Recommendations were concordant without and with gadolinium 95.5% (107/112; ? = 0.67) of the time, suggesting substantial agreement. A retrospective consensus review ofthe five cases in which gadolinium effected a change in the observer’s recommendation was performed. There was nothing on the gadolinium-enhanced sequences that would specifically alter a change in a management decision, and it is likely that the changes in management decisions in these five cases were simply related to expected variations in categorizing lesions rather than to the use of gadolinium. 2
34. Pozzi-Mucelli RM, Rinta-Kiikka I, Wunsche K, et al. Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol. European Radiology. 27(1):41-50, 2017 Jan. Observational-Dx 154 patients To evaluate: (1) whether a short-protocol (SP) MRI for the surveillance of pancreatic cystic neoplasms (PCN) provides equivalent clinical information as a comprehensive-protocol (CP), and (2) the cost reduction from substituting CP with SP for patient surveillance. For largest cyst diameter (DC) and DMPD, mean values with SP/CP were 21.4/21.7 mm and 3.52/3.58 mm, while mean differences SPCPwere 0.3mm (p=0.02) and 0.06mm (p=0.12), respectively. For presence/absence ofMNC and MNMPD, SP/CP coincided in93 % and 98 % of cases, respectively. Inter-observer agreement was strong for SP/CP. SP-cost was 25 % of CP-cost. 2
35. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
No of Rows: 35