Blunt pancreatic trauma in children: CT diagnosis.

The purpose of this study is to determine the efficacy of CT in the diagnosis of pancreatic injury after blunt abdominal trauma in children. Pancreatic injury was diagnosed at surgery, at autopsy, or on the basis of the development of clinical pancreatitis or a pseudocyst on follow-up imaging evaluation in 18 of 1045 consecutive children examined with CT after blunt trauma. Types of pancreatic injury included laceration in 11 children, transection in two, contusion in one, and tumor with hemorrhage in one. Three children had clinical pancreatitis without a pancreatic abnormality noted on CT. The pancreatic injury was prospectively identified on CT in 12 children (67%). The presence of fluid in the lesser sac was a useful marker for injury to the pancreas. This was noted in 13 children with pancreatic injury, whereas it was observed in only six (1%) of 1028 children in the absence of pancreatic injury (sensitivity, 72%; specificity, 99%). Fluid in the anterior pararenal space was less helpful in establishing the diagnosis of pancreatic injury (sensitivity, 44%; specificity, 98%). A pancreatic pseudocyst developed in four of the 11 survivors. Our experience shows that direct signs of pancreatic trauma may be difficult to identify on CT. Recognition of the limitations of CT diagnosis of pancreatic injury is important in helping to reduce errors of interpretation.     

胰腺囊腺瘤的多层螺旋CT诊断价值探讨

目的：胰腺囊腺瘤属于少见的胰腺良性囊性肿瘤,文章中探讨胰腺囊腺瘤的CT表现,提高对该病的诊断水平。方法：回顾性分析20例经手术病理证实的胰腺囊腺瘤患者的CT表现,总结其特征性表现。结果：胰腺囊腺瘤好发于中老年女性,20例患者均呈单囊或多囊状改变,囊大小不等,无明显特异性。单囊14例,多囊6例,4例囊内有分隔,见壁结节4例,2例见有点状、泥沙状钙化,1例伴有胆结石,1例肾囊肿,1例肝囊肿,1例伴有脾脏炎性假瘤。结论：胰腺囊腺瘤在CT检查中有一定的特异性,表现典型者可做出明确诊断。     

胰腺腺泡细胞癌的影像学表现与病理对照

目的：分析胰腺腺泡细胞癌（ACC）的CT和MRI表现,以提高对该病影像表现的认识。方法：回顾性分析经手术病理证实的胰腺腺泡细胞癌4例的CT和MRI表现,并与病理结果对照分析。结果：胰腺腺泡细胞癌均为单发肿瘤,肿瘤平均最大径为4.9 cm,2例位于胰头部,2例位于胰腺体尾部。3例形态不规则,呈浸润性生长;1例呈卵圆形,见完整包膜。4例肿瘤均以实性成分为主,1例可见出血,CT或MRI增强扫描各期实性成分轻度强化,其强化程度均低于周围胰腺组织,包膜强化。2例伴胰管扩张,其中1例伴低位胆管梗阻,1例伴肝转移。镜下见肿瘤细胞被细薄的纤维血管间质分隔呈腺泡状或条索状排列。结论：胰腺腺泡细胞癌的CT和MRI表现具有一定的特征性,认识该病的影像表现有助于正确诊断。     

胰腺癌的可切除性评价(经动脉双期螺旋CT与血管造影的对比分析)

分别采用经动脉双期螺旋ＣＴ扫描和选择性血管造影,对胰腺癌的可切除性进行术前前瞻性评价,以确定各自的临床应用价值。方法对１５例胰腺癌术前均行选择性造影及经动脉增强双期螺旋ＣＴ扫描,对胰腺癌的临床应用价值。结论经动脉双期螺旋ＣＴ扫描弥补了血管造影的不足,能够更为准确,全面地评价胰腺癌的可切除术,具有较高的临床应用价值。     

Retinal angiomatosis and pancreatic cysts in von Hippel-Lindau disease: use of computed tomography scanning for diagnosis and surveillance

Reports of the retinal and pancreatic manifestations of von Hippel-Lindau disease have been previously published. We present a case of von Hippel-Lindau disease in which computed tomography scanning was used in a new manner for diagnosis of retinal disease and for diagnosis and surveillance of pancreatic disease. We emphasize the importance of these new findings and recommend the use of yearly CT scanning of the abdomen. This replaces the previous recommendation of exploratory laparotomy in patients with pancreatic lesions. We further advocate that CT surveillance of the offspring of von Hippel-Lindau disease patients begin in the second decade, with the anticipation of curing potentially serious, blinding, or life-threatening lesions.     

Time interval between abnormalities seen on CT and the clinical diagnosis of pancreatic cancer: retrospective review of CT scans obtained before diagnosis

OBJECTIVE: Our purpose was to determine whether abdominal CT can detect pancreatic cancer before its clinical diagnosis. SUBJECTS AND METHODS: Two radiologists interpreted in a blinded manner 62 CT scans in 28 pancreatic cancer patients that were obtained before histologic diagnosis and 89 CT scans in 89 control subjects and noted specific CT findings. The presence of pancreatic cancer was characterized as definite, suspicious, low probability, or normal. The scans of the pancreatic cancer patients were divided into four groups on the basis of the time interval preceding cancer diagnosis (0-2, 2-6, 6-18, or > 18 months), and one scan (closest to 18 months) was selected per patient per time interval. Sensitivity and specificity for pancreatic cancer and interobserver agreement for CT findings were calculated. RESULTS: Radiologists agreed that CT findings definite or suspicious for pancreatic cancer were present in 50% of the scans obtained 2-6 and 6-18 months before the diagnosis of pancreatic cancer (3/6 and 4/8 scans, respectively), but they noted such CT findings in only 7% (1/15) of the scans obtained more than 18 months before diagnosis. Pancreatic duct dilatation and cutoff were early CT findings identified by both radiologists and were associated with near-perfect and substantial interobserver agreement (kappa = 0.84 and 0.76, respectively). Ninety-five percent confidence intervals of specificity for tumor absence ranged from 92% to 100%. CONCLUSION: CT can detect a significant proportion of asymptomatic incident pancreatic cancers before the clinical diagnosis of pancreatic cancer. CT should be considered in screening at-risk patient populations. Pancreatic duct dilatation and cutoff are early findings associated with the development of pancreatic cancer and can be detected on CT with a high degree of reproducibility.     

胰腺损伤早期CT检查的临床价值

目的:评价CT在胰腺损伤早期诊断中的临床价值。方法:回顾性分析17例胰腺损伤患者的CT资料,按照手术结果观察其首次CT表现及24h内动态变化特点。结果:17例胰腺损伤中,手术探查证实挫伤11例,裂伤6例;首次CT检查,胰腺未见异常3例,漏诊2例,明确提示有胰腺损伤12例,敏感性70%;10例经24h内的动态观察,CT均显示损伤加剧的征象。结论:胰腺损伤合并伤多且早期常缺乏特异的临床症状和体征,容易漏诊。胰腺损伤包括胰腺实质损伤和胰腺导管破裂,CT扫描对多数胰腺实质损伤能作出早期诊断,对胰腺导管破裂无法直接显示。对血液动力学稳定的患者,早期密切随访对胰腺损伤的诊断和决策治疗是必要的。     

Abdominal computed tomography in children with unexplained prolonged fever

Twenty-eight children with unexplained fever lasting at least 1 week were referred for CT of the abdomen. Of the 28 patients, 22 had clinical and radiographic findings localizing disease to the abdomen prior to CT. In these 22 patients CT correctly detected an abnormality in 19 of 22 (86%) and favorably affected therapy in 13 of 22 (59%). In the six patients without localizing findings CT was abnormal in two and normal in four. Computed tomography was correct in all six patients and favorably affected management in two patients. Our results suggest that in children with fever and findings localizing disease to the abdomen--especially the retroperitoneum--CT is helpful in diagnosing a wide variety of lesions, as well as influencing therapy. If no localizing signs are present, CT has a relatively lower yield.     

Imaging of blunt pancreatic trauma

Blunt pancreatic trauma is an exceedingly rare but life-threatening injury with significant mortality. Computed tomography (CT) is commonly employed as the initial imaging modality in blunt trauma patients and affords a timely diagnosis of pancreatic trauma. The CT findings of pancreatic trauma can be broadly categorized as direct signs, such as a pancreatic laceration, which tend to be specific but lack sensitivity and indirect signs, such as peripancreatic fluid, which tend to be sensitive but lack specificity. In patients with equivocal CT findings or ongoing clinical suspicion of pancreatic trauma, magnetic resonance cholangiopancreatography (MRCP) may be employed for further evaluation. The integrity of the main pancreatic duct is of crucial importance, and though injury of the duct may be strongly suggested upon initial CT, MRCP provides clear delineation of the duct and any potential injuries. This article aims to review and illustrate the CT and magnetic resonance imaging findings of blunt pancreatic trauma and delineate the integration of these modalities into the appropriate imaging triage of severely injured blunt trauma patients.     

CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy

Computed tomography (CT) findings that may differentiate walled-off pancreatic necrosis (WOPN) from pancreatic pseudocyst were investigated. CT examinations performed before endoscopic therapy of pancreatic fluid collection (PFC) in 73 patients (45 WOPN, 28 pseudocysts) were evaluated retrospectively by two radiologists. PFC was evaluated for size, extension to paracolic space, characteristics of wall and internal structure. The pancreas was evaluated for deformity or discontinuity, and pancreatic duct dilation. CT findings that were associated with WOPN or pseudocyst were identified. CT score (number of CT findings associated with WOPN minus number of findings associated with pseudocyst) was calculated for each PFC. PFC was categorized as WOPN or pseudocyst using a CT score threshold. Larger size, extension to paracolic space, irregular wall definition, presence of fat attenuation debris in PFC, pancreatic deformity or discontinuity (P < 0.05–0.0001) were findings associated with WOPN. Presence of pancreatic duct dilation was associated with pseudocyst. Using a CT score of 2 or higher as a threshold, CT differentiated WOPN from pseudocyst with an accuracy of 79.5–83.6%. Thus, CT can differentiate WOPN from pseudocysts.     

^18F-FDG PET／CT在胰腺癌诊断中的价值

目的评价^18F-脱氧葡萄糖（FDG）PET／CT鉴别诊断胰腺良恶性病变及检测淋巴结和（或）远处转移的价值。方法回顾性分析上海交通大学医学院附属仁济医院行^18F—FDGPET／CT检查的46例临床疑胰腺肿瘤患者的影像学检查资料和临床资料,其中胰腺癌患者26例,良性病变者20例,比较分析PET和CT的特征。结果当选择最大标准摄取值（SUVmax）=2．95为判断良恶性的界值时,对胰腺癌诊断的灵敏度是88．5％（23／26）,特异性是85．0％（17／20）。^18F—FDGPET／CT显像假阳性3例,假阴性3例。同时发现16例检查前未确定的肝、肺、骨及淋巴结转移患者。根据显像结果,11例患者治疗方案得以修正。结论根据现有资料分析,^18F—FDGPET／CT是鉴别诊断胰腺良恶性病变及检测胰腺癌患者淋巴结和（或）远处转移一种较好的方法。     

CT对胰腺实性假乳头状瘤的诊断价值

目的:研究胰腺实性假乳头状瘤的CT表现,提高CT对该病的诊断水平。方法:回顾分析7例经病理证实的胰腺实性假乳头状瘤的CT表现。结果:7例患者均为女性。CT表现为囊实性肿块,边界清楚,5例位于胰头部,1例位于胰体,1例位于胰腺尾部;其中2例肿块内可见钙化;所有病例胰管、胆管均未见扩张。增强后肿块囊壁及实性部分明显强化,无局部浸润或淋巴结转移。结论:胰腺实性假乳头状瘤好发于年轻女性,CT表现具特征性,结合临床特征可在术前作出诊断。     

Staging of acute pancreatitis

Management of patients with acute pancreatitis is based on the early assessment of severity of disease. Initial staging is established on clinical and laboratory grounds and on the findings of contrast-enhanced CT imaging. Individual clinical parameters and laboratory indices, although sometimes helpful, are not sufficiently accurate to reliable assess the severity of an acute attack. Numerical grading systems (Ranson's, APACHE II) with sensitivities of about 70% are commonly used today as indicators of systemic failure and predictors of disease severity. Helical or MDCT scanning performed during the administration of a bolus of i.v. contrast material is performed to evaluate pancreatic morphology, detect pancreatic necrosis, and depict retroperitoneal complications. CT staging and the CT severity index have proved to be a reliable indicator of disease severity, having shown an excellent correlation with the risk of death and the development of local and systemic complications in this population.     

Pelvic inflammatory disease with periappendicitis in a pediatric patient

Pelvic inflammatory disease (PID) is generally a disease of young, sexually active patients. However, there have been few reports of computed tomography (CT) and the histopathologic findings of periappendicitis with PID in children. We present a case of PID with periappendicitis in a 12-year-old girl. Her CT findings are described, and the histopathologic findings of periappendicitis are discussed.     

The role of imaging studies in pancreatic injury due to blunt abdominal trauma in children

BACKGROUND: The role imaging studies play in the choice of treatment in traumatic pancreas damage remains unclear. This study was performed to gain insight into the role of radiological studies in children 16 years of age or younger admitted to our hospital with pancreatic damage due to a blunt abdominal trauma. METHOD: Retrospectively, the radiological as well as patient clinical records were reviewed of all children admitted to our hospital between 1975 and 2003 with a pancreatic lesion due to blunt abdominal trauma. RESULTS: Thirty-four children with ages ranging from 3 to 14 years old were admitted with traumatic pancreas damage. Initially 33 children were treated conservatively for the pancreatic damage and only one had immediate surgery of the pancreas with a Roux-y pancreaticojejunostomy. Five other children had immediate surgery for other reasons. Overall, five children proved to have a pancreas transection on CT scans or during laparotomy. One child had a pancreas hematoma and 28 a pancreas contusion. In total 15 children developed a pseudocyst (44%), nine of which resolved spontaneously while six were treated by intervention. None of the children had residual morbidity, and there were no deaths. Considering the pancreas, the 11 available CT's were re-evaluated by two radiologists independently. Grade 3 pancreas damage (distal transection of the pancreatic duct) was diagnosed in five patients by radiologist A and four patients by radiologist B (80% match); Grade 1 was diagnosed in, respectively six and one patients (15% match). An US was performed on 19 children with 82 follow-up examinations, mostly for follow-up of the pseudocysts. CONCLUSION: Traumatic pancreas damage is a rare and difficult diagnosis. There is no straightforward answer for diagnostic imaging in blunt abdominal trauma in children. The diagnostic relevance of CT is limited. CT in combination with MRCP may be a better option for exclusion of pancreatic duct lesions.     

Bilobular pancreas: another variant of the divided pancreas?

BACKGROUND: Pancreas divisum is the most common anomaly of the pancreas. This anomaly has been known as a possible cause of recurrent pancreatitis. CASE REPORT: We performed computerized tomography (CT) of the abdomen in 5 children in whom a divided pancreas was confirmed using endoscopic cholangiopancreatography. In a girl, who had three episodes of severe acute pancreatitis, a CT examination confirmed a completely divided embryonal dorsal and ventral primordium. We named this variant of the divided pancreas the "bilobular pancreas". Contrary to the remaining 4 children in whom the control of the number and severity of attacks, as well as the control of pancreatic pain were achieved by pharmacotherapeutics and an adequate diet, in the reported patient sphincteroplasty of the papilla duodeni minor resulted in a full control of the disease. CONCLUSION: The paper discussed the possibility that the variant of the divided pancreas, with anatomically completely separated ventral and dorsal pancreas and their ductal systems, is the key factor that determines the severity of pancreatic disease and an indication for sphincteroplasty of the papilla duodeni minor as the major therapeutic method.     

Spiral CT of the pancreas with multiplanar display.

This essay illustrates the findings obtained with spiral CT imaging in pancreatic disease. Features of spiral CT--fast scanning, dynamic injection of contrast material allowing optimal vessel opacification, and supplemental multiplanar imaging--promise to provide increased accuracy in the diagnosis and staging of pancreatic disease. With further development of continuous (spiral/helical) scanning technology, this technology should expand to cover a wider range of applications.     

胰腺撕裂伤的CT诊断

目的:探讨胰腺撕裂伤的CT表现。方法:搜集18例经临床手术证实的胰腺撕裂伤病例资料,分析其CT平扫及增强表现。普通CT扫描层厚5mm,螺旋CT均行薄层多平面重组(MPR)。结果:胰腺内血肿3例,胰腺局限或弥漫性肿胀11例,网膜囊积液12例,胰周积液及左侧肾前筋膜增厚18例,平扫9例胰腺实质内可见低密度撕裂口,增强扫描所有病例胰腺实质内均可见低密度撕裂伤口,其中胰头5例,胰颈8例,胰腺体尾部5例。主胰管损伤CT诊断符合率70%。合并其他脏器损伤12例。结论:胰腺撕裂伤有较特征性的CT表现,CT薄层增强扫描可准确诊断胰腺撕裂伤。CT对主胰管损伤的判断有一定的限度。     

Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma

IBD CT is the single best modality for diagnosis and staging of patients with suspected pancreatic carcinoma. While carefully performed real-time US is an excellent technique for determining the level and etiology of bile duct obstruction, it is of more limited value for diagnosis of tumors in the body and tail of the gland, and is less accurate than IBD CT for assessment of tumor resectability. Thus, most patients require IBD CT for accurate, nonoperative staging. ERCP and angiography continue to be useful adjunctive procedures for evaluation of patients with suspected pancreatic carcinoma, particularly for evaluation of equivocal CT or US findings. An isolated pancreatic mass, that is, a mass with no ancillary CT or US findings of carcinoma (local extension, distant metastases), is a non-specific finding and requires further evaluation with either ERCP or angiography, and perhaps most importantly, with FNAB. Other neoplasms may mimic pancreatic ductal carcinoma, particularly islet cell carcinoma and lymphoma. Pancreatitis also can result in a focal pancreatic mass, simulating a neoplasm. These diseases usually respond to therapy and thus it is essential to confirm the radiologic diagnosis of pancreatic carcinoma with biopsy, particularly if surgery is not planned or if chemoradiation therapy is anticipated.     

MRI of adenocarcinoma of the pancreas

OBJECTIVE: CT is the established imaging technique for evaluation of pancreatic adenocarcinoma. MRI, however, can play a major role in this disease. The objective of this study is to illustrate the strengths of MRI for evaluating pancreatic adenocarcinoma. CONCLUSION: The superior soft-tissue contrast of MRI compared with CT is useful in the detection and characterization of non-contour-deforming pancreatic masses. MRI compared with CT may be more sensitive in the detection of distant disease, better for defining appropriate surgical candidates, and better for characterizing small liver metastases and peritoneal and omental metastases.