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Peter Mönnings, Orlin Belyaev, Waldemar Uhl, Arnd Giese, Andrea Tannapfel, Odo Köster, Juris Meier

• \(\textit {Introduction:}\) Determining the dignity of intraductal papillary mucinous neoplasms (IPMNs) by imaging procedures is challenging. Various CT-based criteria were evaluated. \(\textit {Patients and Methods:}\) Preoperative CT scans from 47 patients with IPMN were analyzed. Predefined criteria of malignancy were compared between patients with benign (bIPMN; \(\it n\) = 28) and malignant (mIPMN; \(\it n\) = 19) tumors, and a summation score was determined. \(\textit {Results:}\) Preoperative carbohydrate-antigen 19-9 levels were higher in patients with mIPMN (\(\it p\) = 0.013). The diameter of the main pancreatic duct was greater in patients with mIPMN ((\(\it p\) < 0.0001). More patients with mIPMN showed bile duct obstruction ((\(\it p\) = 0.0076), solid tumor components ((\(\it p\) = 0.0076), contrast enhancement in cystic walls ((\(\it p\) = 0.0086), peripancreatic lymph nodes ((\(\it p\) = 0.0076), and abrupt diameter changes of the main pancreatic duct ((\(\it p\) = 0.0008). The CT density of the cysts was higher in mIPMN ((\(\it p\) = 0.0063). The diagnostic accuracy of the summation score (sensitivity: 0.84, specificity: 0.96) was greater when compared to each individual CT parameter. \(\textit {Conclusions:}\) The prevalence and extent of various CT-based abnormalities are greater in patients with mIPMN, but the wide overlap limits the diagnostic value of each individual parameter. A simple summation score largely enhances the diagnostic accuracy.