Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography

Figure 1 Chart of the clinical course of all the branch duct intraductal papillary mucinous neoplasm patients. ¹These two patients underwent resection after follow-up due to repeated pancreatitis or an increasing main pancreatic duct diameter. BD-IPMN: Branch duct intraductal papillary mucinous neoplasm; MNs: Mural nodules; EUS: Endoscopic ultrasonography; CE-EUS: Contrast-enhanced EUS.

Figure 2 Correlations between mural nodules height measured by each imaging modality and mural nodules height measured on pathological specimens. A: A positive correlation was identified between MN height measured by CT and that measured on pathological specimens; B: A positive correlation was identified between MN height measured by EUS and that measured on pathological specimens; C: A positive correlation was identified between MN height measured by CE-EUS and that measured on pathological specimens. H_CT: MN height measured by CT; H_EUS: MN height measured by EUS; H_CE-EUS: MN height measured by CE-EUS; H_Path: MN height measured on pathological specimens; MN: Mural nodule; CT: Computed tomography; EUS: Endoscopic ultrasonography; CE-EUS: Contrast-enhanced EUS.

Figure 3 Comparison of measurement error values. The measurement error values for CE-EUS were significantly lower than those for CT or EUS. |H_CT-H_Path|, measurement error value for CT; |H_EUS-H_Path|, measurement error value for EUS; |H_CE-EUS-H_Path|, measurement error value for CE-EUS. Statistically significant, ^aP < 0.05, |H_CT-H_Path| vs |H_CE-EUS-H_Path|, statistically significant, ^bP < 0.01, |H_EUS-H_Path| vs |H_CE-EUS-H_Path|. CT: Computed tomography; EUS: Endoscopic ultrasonography; CE-EUS: Contrast-enhanced EUS.

Figure 4 Receiver operating characteristic curve analysis. Based on the receiver operating characteristic curve analysis, when 8.8 mm was utilized as the cut-off value for MN height, as measured by CE-EUS, the diagnosis of malignant BD-IPMN had an accuracy of 94%. BD-IPMN: Branch duct intraductal papillary mucinous neoplasm; MN: Mural nodule; CE-EUS: Contrast-enhanced endoscopic ultrasonography.