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• Special Focus •
Diagnostic value of non-contrast MRI in evaluating benign and malignant mural nodules of intraductal papillary mucinous neoplasms of the pancreas
FANG Xu  BIAN Yun  LU Jianping 

Cite this article as: FANG X, BIAN Y, LU J P. Diagnostic value of non-contrast MRI in evaluating benign and malignant mural nodules of intraductal papillary mucinous neoplasms of the pancreas[J]. Chin J Magn Reson Imaging, 2025, 16(5): 8-13. DOI:10.12015/issn.1674-8034.2025.05.002.


[Abstract] Objective To explore the diagnostic value of non-contrast MRI in evaluating benign and malignant mural nodules of intraductal papillary mucinous neoplasms (IPMN) of the pancreas.Materials and Methods Patients with pancreatic IPMN who were pathologically diagnosed after radical surgical resection in the First Affiliated Hospital of Naval Medical University from August 2013 to February 2024 were collected. A total of 238 patients with IPMN containing mural nodules were screened out through non-contrast MRI. According to the pathological grading criteria of IPMN, the patients were divided into the benign mural nodule group (low-grade dysplasia) and the malignant mural nodule group (high-grade dysplasia, invasive carcinoma). Independent sample t-test, rank sum test and chi-square test were used for statistical analysis to compare the differences in non-contrast MRI features between the two groups. Multivariate logistic regression was used to analyze the independent predictors of the malignant mural nodule group of pancreatic IPMN, and a diagnostic model was constructed. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated.Results The diameter of mural nodules in the malignant mural nodule group [15.00 (10.00, 23.00) mm] was larger than that in the benign mural nodule group [7.00 (6.00, 9.75) mm], and the difference was statistically significant (P < 0.001). In the malignant mural nodule group, the manifestations such as main pancreatic duct or mixed pancreatic duct type, high signal of cystic fluid on T1WI, main pancreatic duct dilation ≥ 10 mm, cysts ≥ 40 mm, thickening of the cyst wall, and abrupt change in caliber of pancreatic duct with distal pancreatic atrophy. There were statistically significant differences when compared with the benign group of mural nodules (all P < 0.05). The results of multivariate logistic regression analysis showed that the threshold diameter of mural nodules of 9.5 mm, thickening of the cyst wall, and abrupt change in caliber of pancreatic duct with distal pancreatic atrophy were independent predictors for the malignant mural nodule group (all P < 0.05). A model was established by combining these three independent predictors to diagnose the malignant mural nodule group, and the AUC was 0.851 [95% confidence interval (CI): 0.802 to 0.900], with a sensitivity of 70.7% and a specificity of 90.5%.Conclusions The threshold diameter of mural nodules of 9.5 mm, thickening of the cyst wall, and abrupt change in caliber of pancreatic duct with distal pancreatic atrophy are independent predictors for evaluating malignant mural nodules of pancreatic IPMN based on the features of non-contrast MRI. The diagnostic model combining these three factors shows good diagnostic efficacy.
[Keywords] pancreas；intraductal papillary mucinous neoplasm；mural nodule；magnetic resonance imaging

FANG Xu   BIAN Yun   LU Jianping*  

Department of Radiology, the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Shanghai 200433, China

Corresponding author: LU J P, E-mail: cjr.lujianping@vip.163.com

Conflicts of interest   None.

Received  2024-12-06
Accepted  2025-03-06
DOI: 10.12015/issn.1674-8034.2025.05.002
Cite this article as: FANG X, BIAN Y, LU J P. Diagnostic value of non-contrast MRI in evaluating benign and malignant mural nodules of intraductal papillary mucinous neoplasms of the pancreas[J]. Chin J Magn Reson Imaging, 2025, 16(5): 8-13. DOI:10.12015/issn.1674-8034.2025.05.002.

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