CT features of malignant mucinous cystic tumors of the pancreas

This study is aimed at evaluating which pre-operative findings at CT are pr evailingly associated with histologically malignant appearance of mucinous cystic tumor (MCT) of the pancreas. The CT examinations of 52 female patien ts affected with pathologically proved MCT were retrospectively evaluated b y two radiologists, blinded to the histopathological assessment of the biol ogic behavior (either benign or malignant). A multivariate logistic regress ion analysis was performed in order to identify the most important features associated with the malignant nature of MCT Calcifications in the wall and /or in the septa, thick wall, and septations resulted in the most important features associated with malignancy. The simultaneous presence of all thes e radiological signs constitutes an almost "certain" marker of malignancy, being the risk equal to 0.95, whereas the simultaneous presence of at least two of them entails a risk of malignancy ranging from 0.56 to 0.74, accord ing to the type of morphological features. On the other hand, the absence o f the mentioned radiological features entails a negligible risk of malignan cy (0.02). Mucinous cystic tumors characterized by multilocular macrocystic architecture, with thick wall and calcifications in the wall and/or the se pta, present the highest risk of malignancy, and advocate prompt surgical i ntervention. When those signs are absent, the probability of malignancy is lower. In this case a non-operative management is possible.