The Diagnostic Performance of the Three Imaging Examinations in PCNs

Regarding the 90 PCNs, CEUS was able to discriminate PCNs from nonneoplastic PCLs with a sensitivity of 88.9% (80/90) and an accuracy for differentiating the specific type of PCN of 64.4% (58/90); MRI was able to discriminate PCNs from nonneoplastic PCLs with a sensitivity of 91.8% (78/85) and an accuracy of 70.6% (60/85) for differentiating the specific type of PCN; and CT was able to discriminate PCNs from nonneoplastic PCLs with a sensitivity of 84.1% (58/69) and an accuracy for differentiating the specific type of PCN of 53.6% (37/69). There were no significant differences in sensitivity for discriminating PCNs from nonneoplastic PCLs between CEUS and MRI (p=0.614), between CEUS and CT (P=0.479), or between MRI and CT (P=0.207). Regarding the accuracy for differentiating the specific type of PCN, CEUS and MRI were both higher than that of CT (p=0.017, p=0.03), but there was no significant difference between CEUS and MRI (p=0.791) (Figure 1, Table 2).

Figure 1

Table 2

Diagnostic Accuracy of Different Cyst Sizes and Detection Rates of Nodules, Septa, and Duct Dilatation in PCNs by CEUS, MRI and CT


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In this study, there were 15 patients who underwent both CEUS and CT with small (<3 cm) cysts and 54 patients with large (≥3 cm) cysts. CEUS was superior to CT in differentiating the specific type of PCN for large lesions (77.8% vs 59.3%, p=0.041), while these two imaging modalities showed no large differences for small lesions (40.0% vs 33.3%, p=1.000). For CEUS and MRI, the result was the opposite. Twenty-two patients underwent both CEUS and MRI with small cysts and 63 patients with large cysts. There were no significant differences between the two modalities in differentiating the specific type of PCN for large lesions (74.6% vs 71.4%, p=0.774); however, MRI was superior to CEUS for small lesions (36.4% vs 68.2%, p=0.039). Septa were detected in 37 of 69 cysts by CEUS and in 20 of 69 cysts by CT (53.6% vs 29.0%, p= 0.003). Among the patients who underwent both CEUS and MRI, septa were detected in 46 of 85 cysts by CEUS and in 41 of 85 cysts by MRI (54.1% vs 48.2%, p=0.443). With regard to nodules, the detection rate by CEUS (24.6%, 17/19; 31.8%, 27/85) was higher than that by CT (8.7%, 6/69; p=0.018) or MRI (17.6%, 15/85;p=0.033). There were no significant differences in the detection rates of duct dilation between CEUS and CT (14.5% vs 11.6%, p=0.625) or between CEUS and MRI (14.1% vs 15.3%, p=1.000) (Table 3).

Table 3

Comparison of Location, Shape and Septa Between SCAs and MCAs by CEUS

There were 15/36 lesions detected in the head location and 21/36 in the body–tail location with SCA. For MCAs, the lesion was located in the head region in 11/29 patients (one SCA had multiple cysts, and only the largest one was assessed in the location research) and 18/29 patients in the body–tail region. There was no significant difference in terms of location between SCAs and MCAs. For shape, a regular shape was noted in 14/36 patients with SCA, and in 19/29 patients with MCA, and an irregular shape was detected in 22/36 patients with SCA, and in 10/29 patients with MCA. Zero to two septa were present in 14/36 cases of SCA and in 20/29 cases of MCA, and ≥2 septa were present in 22/36 cases of SCA and 9/29 patients with MCA. There was a significant difference in the shape and number of septa between SCAs and MCAs using CEUS (Table 4).

Table 4

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