Raising MRI Cutoffs for IPMN Boosts Specificity to 89.9% and AUC to 0.808

Specificity for malignant IPMN rose from 66.9% to 89.9% with revised MRI cutoffs (HRS-95), but sensitivity fell from 82.7% to 53.1%; AUC improved significantly (from 0.771 to 0.795–0.808, p=0.046).

• Original high-risk stigmata (enhancing mural nodule ≥5 mm, main pancreatic duct ≥10 mm) had only 80.4% specificity; obstructive jaundice and positive cytology were highly specific (98.8–99.6%).
• Feature-level thresholds achieving ≥95% specificity were 17.5 mm for enhancing mural nodule and 13.5 mm for main pancreatic duct diameter.

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