Quantitative MRI of pancreatic parenchyma in intraductal papillary mucinous neoplasm: association with risk stratification based on guideline features.

Abstract

To investigate the association between quantitative MRI parameters of the pancreatic parenchyma and risk stratification of intraductal papillary mucinous neoplasm (IPMN). This study included 235 participants: 163 with IPMN and 72 with a normal pancreas. IPMN cases were stratified into IPMN without guideline-based features (n = 111) and with guideline-based features (n = 52) groups based on the 2024 International Consensus Guidelines. The MRI parameters analyzed included pancreas-to-muscle signal intensity ratios on in-phase, opposed-phase, and T2-weighted images; apparent diffusion coefficient (ADC); proton density fat fraction (PDFF); and T1 and T2* relaxation times in the pancreatic head, body, and tail. Clinical data (age, sex, body mass index (BMI), HbA1c, bilirubin, amylase, and CA19-9) were collected. Associations with IPMN risk stratification were evaluated using Spearman's rank correlation and univariate and multivariate logistic regression. In the pancreatic head, IPMN risk stratification showed significant correlations with age (p < 0.001), BMI (p < 0.001), HbA1c (p = 0.024), ADC (p = 0.025), PDFF (p = 0.008), and T1 relaxation time (p < 0.001). In the body and tail, risk stratification correlated with age (p < 0.001), BMI (p = 0.004), and T1 relaxation time (p < 0.001). In multivariate analysis, age, BMI, and T1 relaxation time were independent predictors of IPMN in both regions. T1 relaxation time significantly distinguished patients with and without guideline-based features in both regions (p < 0.001). T1 relaxation time is significantly associated with IPMN risk stratification and may serve as a valuable imaging biomarker. Question Pancreatic fat content and fibrosis are potential imaging biomarkers, but their relationship to IPMN risk stratification has not been clearly established. Findings T1 relaxation time was independently associated with IPMN risk stratification, and T1 relaxation time differentiated normal pancreas from that with and without guideline-based features of IPMN. Clinical relevance MRI-derived T1 relaxation time demonstrates utility in IPMN risk stratification and suggests its potential as an imaging biomarker that complements guideline-based features of IPMN.