Application of computed tomography in evaluating imaging features of intraductal papillary mucinous neoplasms

Intraductal papillary mucinous neoplasms (IPMNs) are increasingly detected owing to high-resolution imaging. IPMNs have malignant potential, ranging from low-grade dysplasia to invasive carcinoma. However, data from Vietnam are limited. This study aimed to describe computed tomography (CT) features of IPMNs and evaluate their diagnostic value. We performed a retrospective case series of patients with histopathologically confirmed IPMNs between January 2016 and December 2024. Thirty-two patients who underwent preoperative CT scans and met inclusion criteria were analyzed. CT features were assessed for their association with malignancy. The cohort comprised 32 patients from 17 malignant and 15 benign cases. The mean age was 64.5±10.2 years of 19 men, 13 women. CT features significantly associated with malignancy were enhancing mural nodules (p<0.001), main pancreatic duct diameter (p=0.047), cyst size (p=0.047), thickened enhancing cyst walls (p=0.031), abrupt ductal caliber change with distal atrophy (p=0.026), and lymphadenopathy (p=0.019). Mural nodules≥5 mm demonstrated high sensitivity and specificity (82.4% and 80%). When patients had ≥4 worrisome features, the corresponding sensitivity (82.4%), specificity (80%), and accuracy (81.3%) in this small surgical series should be interpreted as descriptive, hypothesis-generating estimates rather than as definitive values or as directly comparable to those of high-risk stigmata. CT provides valuable information for not only diagnosing IPMNs but also predicting malignant potential. Mural nodules ≥5 mm and accumulation of worrisome features can help identify patients who may benefit from surgical intervention.