ArticleAbdominal radiology (New York)2026
Abbreviated versus comprehensive MRI protocols in the surveillance of branch-duct intraductal papillary mucinous neoplasms (BD-IPMN): an exploratory analysis of inter-reader agreement, management concordance, time and cost savings.
Article in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimTo compare abbreviated (APs) and comprehensive (CP) MRI protocols for branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) surveillance in terms of imaging findings, management recommendations and inter-reader agreement across readers with different levels of expertise, while assessing potential time and cost savings.
methodsThis single-center retrospective study included patients with BD-IPMN undergoing baseline and follow-up MRI between January 2018 and April 2024. The CP included axial and coronal T2WI, axial fat-saturated T1-weighted images before and after contrast injection (T1WI), 2D- and 3D-MRCP and DWI images. Two APs were obtained from CP follow-up examinations: AP with DWI consisted of axial and coronal T2WI, 2D- 3D-MRCP, axial fat-saturated T1WI and DWI; AP without DWI consisted of the same AP sequences excluding DWI. A senior radiologist (> 20 years of experience in pancreatic imaging) and a junior radiologist (4th-year-radiology resident), blinded to subsequent examinations, independently analysed each protocol according to Kyoto guidelines and management recommendations. Inter-reader and inter-protocol agreement were analysed using Cohen's and Fleiss' Kappa. Acquisition times and resource-saving were compared using national reimbursement rates (p < 0.05 statistically significant).
resultsOverall, 40 patients (25 women and 15 men) with a median age of 67 years (range 48-87) were included. No statistically significant differences were observed among the 3 protocols in identifying worrisome features, including high-risk stigmata, cyst size, main pancreatic duct dilation and mural nodules. The inter-protocol agreement was almost perfect (Fleiss' Kappa = 0.82). Substantial inter-reader agreement (Cohen's Kappa > 0.6) was observed for all protocols, with almost perfect agreement (Cohen's Kappa > 0.8) in some instances. APs demonstrated up to 48% reduction in acquisition time and a 27.4% resource-saving compared to CP. The addition of DWI did not significantly improve inter-reader and inter-protocol agreement or influence management recommendations.
conclusionsAbbreviated protocols, particularly without DWI, showed substantial agreement with CP and similar management recommendations, supporting their feasibility as resource-saving alternatives for BD-IPMN surveillance, even among less experienced radiologists.
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