Nossa experiência clínica e resultados no acompanhamento de casos de cisto hidático

Background and objectivesHydatid cyst is a zoonotic disease caused by Echinococcus granulosus. The aim of our study is to present the clinical features of the patients who were treated for hydatid cyst, determine the interventional techniques and anesthesia methods used and review the occurred complications in detail.MethodsThis study included 393 patients who were followed up and/or treated with the diagnosis of hydatid cyst between January 2013 and November 2018. The patients’ data was evaluated retrospectively.ResultsThe mean age of the patients was 31.0 ± 17.2 years. Of the patients, 111 (28.4%) had more than one cyst and 36 (9.2%) patients had multi‐organ involvement. Six of the patients refused the intervention or was transferred to another hospital. Among the remaining 387 patients, 335 (85.2%) received general anesthesia and intubation, 9 patients (2.3%) received general anesthesia and laryngeal mask airway, 39 patients (9.9%) received sedoanalgesia and 4 patients (1%) received regional anesthesia. Perioperative mortality was developed in one patient. The most common periopertaive complication was allergic reaction (1.5%), whereas the most common post‐operative complications were atelectasis (3.3%) and biliary fistula (3%). The mean Intensive Care Unit stay (ICU) was 1.9 ± 1.1 days in patients requiring ICU. Recurrence during the 40 ± 17 months follow‐up occurred in 8.4% patients.ConclusionsAnesthesiologists have an important role in the management of hydatid cyst patients. Patients should be evaluated exhaustively in terms of multi‐organ involvement and the presence of more than one cyst in the same organ. The type of treatment procedure and the localization of the cysts determine the anesthetic management.     

Mesothelial cyst in the liver round ligament: A case report and review of the literature

IntroductionCysts of the liver round ligament are rare and they are benign in the majority of cases. Current literature has been reviewed on this subject.Presentation of caseA 22-year-old woman with a history of epigastric pain was admitted at our institution. Computed tomography (CT) of the abdomen showed a 14-mm cystic lesion in the epigastrium. A large cyst of the liver round ligament was successfully removed during exploratory laparoscopy and histopathology revealed a benign mesothelial cyst.DiscussionMesothelial cysts of the liver round ligament are rare entities and we found a total of 5 cases from the literature. Diameter varies from 5 to 14 cm. Most patients were asymptomatic or may complain abdominal pain in the upper quadrants. Ultrasonography and CT scan are the most useful diagnostic tools, however differential diagnosis between various abdominal cystic lesions can be difficult. Treatment is usually surgical excision.ConclusionMesothelial cysts of the liver round ligament are extremely rare but should be taken in consideration in the differential diagnosis of intra-abdominal cystic lesions. We stress the importance of exploratory laparoscopy that can allow both diagnosis and radical surgical excision.     

Benign Primary Cystic Lesions of Mediastinum in Adult: The Clinical Spectrum and Surgical Treatment

Background and objectiveThe mediastinal cysts form a group of heterogeneous and uncommon benign lesions of neoplastic, congenital, or inflammatory conditions. The forgoing controversy is how to manage them; surgical removal or observation. We reviewed our experience including some rare conditions, emphasizing the clinical spectrum and surgical treatment.Patientes and methodsThis is a retrospective review between 2000 and 2007 included 34 cases of primary mediastinal cystic lesions. Clinical features, imaging techniques, surgical operation, morbidity, mortality and follow-up were analyzed.ResultsThere were 18 females (53%) and 16 males (47%), with a mean age ± standard deviation of 45.3 ± 14.1 years (range: 22-74). Most of cysts were congenital (94%), except patients with hydatid disease (6%). 24% of cysts (n = 8) were detected in anterior mediastinum. Rest of them (n = 26) were located in visceral mediastinum. Patients usually were symptomatic (61%). Chest pain and discomfort was most common symptom, others were dyspnea, cough and hemoptysis, respectively. Cysts excision was performed in all cases with an uneventful recovery and with no recurrence in long term follow up.ConclusionsAsymptomatic mediastinal cysts are not rare. Surgery is a reliable method of treatment of mediastinal cysts with acceptable mortality and morbidity.     

Curative surgery for locally advanced retroperitoneal mature teratoma in an adult. Case report

INTRODUCTIONPrimary teratomas of retroperitoneum are not usual in the adult population. These tumors most commonly seen at the gonadal and sacrococcygeal regions. Herein we describe a case of an 18-year-old female who had a benign cystic teratoma at the retroperitoneum.PRESENTATION OF CASEThe patient underwent an operation at another hospital following a misdiagnosis of hydatid cyst. The patient was referred to our hospital because of the detection of an unresectable tumor during her operation. A computerized tomography (CT)–angiography revealed a cystic mass, with a diameter of 14 cm which was invaded into the retrohepatic suprarenal inferior vena cava and also extended to the posterior aspect of the liver. Additionally the mass invaded the posterior wall of the inferior vena cava and the right renal vein. The tumor was completely resected with a vascular resection. The inferior vena cava was reconstructed with a 12 cm Dacron^® graft and the renal vein was implanted. The patient's postoperative period was uneventful.DISCUSSIONGerm cell tumors of retroperitoneum are usually seen in children, but there are also some reports of adult cases in the literature. Adult cases are especially seen in females. Imaging studies are paramount for diagnosis, preoperative strategy and safe surgical excision. CT scans and MRIs can identify various components of these tumors.CONCLUSIONEven though primary retroperitoneal teratomas are quite rare in adults. Preoperative radiology imaging and strategy is critical for performing a safe surgery. The gold standard treatment strategy for this neoplasm is the surgical resection.     

Parasitic leiomyoma: A case report with literature review

IntroductionParasitic leiomyoma is an extremely rare variant of uterine leiomyoma occurring outside uterus. The aim of this study is to report a case of parasitic leiomyoma with brief literature report.Case reportA 46-yearo-old lady presented with upper abdominal heaviness and swelling of about 6 year duration. associated with nausea, shortness of breath and palpitation. There was large well defined, mobile, hard mass in epigastric area measuring about 12 × 10 cm. Abdominal ultrasound showed well defined, solid, 94 × 76 mm, mass in the epigastric region. Abdominal computed tomography scan showed round homogenous opacity at the epigastric region with features consistent with benign lesion. Laparotomy was done, histopathological examination confirmed the diagnosis of parasitic leiomyoma.ConclusionParasitic leiomyoma is an extremely rare subtype of uterine leiomyoma, presents with vague symptoms, diagnosed by ultrasound and managed by complete resection. Previous uterine procedures have been implicated in its etiology.     

Primary hydatid cyst of pancreas with acute pancreatitis

Context

Primary hydatid disease of the pancreas is very rare and even rarer to cause pancreatitis.

Case report

We report the case of a 20-year-old man who presented with abdominal pain and an epigastric mass. A diagnosis of a pancreatic hydatid cyst was established by ultrasonography and CT scan before surgery. The treatment consisted of laparoscopic cyst evacuation with omentoplasty. The recovery was uneventful and the patient has remained symptom free so far.

Conclusions

Hydatid disease should be considered in the differential diagnosis of all cystic masses in the pancreas, especially in the geographical regions where the disease is endemic.Keyword: Primary hydatid cyst of pancreas     

Laparoscopic resection of a hepatic mucinous cystic neoplasm: A case report

IntroductionWe aimed to present a case of hepatic mucinous cystic neoplasm (MCN-H) that was completely resected by laparoscopy.Presentation of caseA 47-year-old female exhibited mild elevation of serum liver enzyme levels. Abdominal computed tomography revealed a 45-mm multilocular cystic tumor in segment IV of the liver, along with intermittent border calcification and minimal wall thickness. Magnetic resonance imaging revealed fluid-to-fluid level in the cystic tumor, thereby increasing the suspicion of a mild hemorrhage. The patient underwent laparoscopic liver resection (LLR) with a diagnosis of suspected mucinous cystic neoplasm of the liver. The entire tumor was successfully resected with a laparoscopic approach. The resected specimen was a 4.2 × 3.3 × 2.2-cm cystic tumor. Histological findings revealed mucin-producing singular epithelium and ovarian-like stroma. The tumor was diagnosed as a MCN-H with no malignancy.DiscussionThis is the first report in which a MCN-H was completely resected by laparoscopy. MCN-H is rare and is observed in only <5% of liver cystic tumors. MCN-H has been reported to have the malignant potential. And complete resection might be a good treatment option. Along with technical development, LLR has been indicated for benign liver tumors to date. Benign liver tumors are commonly observed in young females. The smaller incisions of the laparoscopic approach might provide cosmetic advantages for patients.ConclusionWe presented the first case of a MCN-H completely resected by laparoscopy. Benign tumors and tumors with malignant potential might be good indications for a laparoscopic surgery.     

Large bronchogenic cyst of stomach: A case report

IntroductionBronchogenic cysts are congenital cysts arising as an abnormal budding from primitive tracheobronchial tree. They are lined by pseudostratified columnar or cuboidal ciliated epithelium and contain smooth muscle fibers, submucosal bronchial glands and/or cartilage. They are most frequently located in the mediastinum or the lung parenchyma. Intramural occurrence of bronchogenic cyst in the gastric wall is very rare.Presentation of caseWe present a case of 65-year-old lady with a 7 × 8 cm lesion in the gastric cardia suspicious of gastrointestinal stromal tumor. Because of the large size, total gastrectomy with Roux-en-Y esophagojejunal anastomosis was performed. The postoperative course was uneventful. Histopathological examination revealed a sub-mucosal cyst lined by PCCE with presence of smooth muscle fibers and focal mucous glands. Final diagnosis of bronchogenic cyst was made. On the last follow up at one year, she was symptom free.DiscussionOn extensive Medline/Pubmed search, only 38 cases of gastric bronchogenic cysts were found to be reported till date. They are typically located in the posterior gastric wall close to the gastric cardia. On radiological imaging, they appear as well defined intramural cystic lesion without any characteristic features. Surgical resection is considered in symptomatic cases or in case of diagnostic dilemma.ConclusionGastric bronchogenic cysts often mimic gastrointestinal stromal tumor on preoperative imaging. They should be included in the differential diagnosis while dealing with an intramural gastric lesion close to the cardia or gastroesophageal junction.     

Pancreatic schwannoma: A rare case and a brief literature review

IntroductionPancreatic schwannoma (PS) is an extremly rare benign tumor. Less than 50 cases of pancreatic schwannoma have been described in the English literature over the past thirty years.Presentation of case reportA 63-year-old female underwent left modified radical mastectomy 2 years ago due to breast cancer. During her routine check-up, a 65 × 63 × 55 mm measured calcified, well-demarcated, cystic-mass having septations and calcifications that localized to the pancreatic head was detected by abdominal computerized tomography. She was asymptomatic and her tumor markers were in normal ranges. A standard Whipple procedure was performed, and the histo-pathological diagnosis of the resected specimen was reported as ancient schwannoma with clear surgical margins. Patient’s postoperative course was eventful. She had a biliary leakage after surgery which was managed conservatively. She is under follow-up.DiscussionPancreatic schwannoma also known as neurilemoma or neuroma is a slowly growing, encapsulated, mostly benign tumor with smooth well-delineated margins that originates from myelin producing schwann cells located on the nerve sheath of the peripheral epineurium of either the sympathetic or parasympathetic autonomic fibers. PS’s are extremly rare. The head of pancreas being involved in the vast majority of cases (40%), followed by its body (20%). Management of pancreatic schwannomas remains largely controversial. Both enucleation and radical surgical resections have revealed great therapeutic efficiency. with a well prognosis without recurrences.ConclusionAlthough rare, PS’s should be considered in the differential diagnosis of the other solid or cystic masses of the pancreas.     

Intratendinous ganglion cyst of the extensor digitorum longus tendon: A case report

IntroductionGanglion cysts are benign lesions, common in the hand and wrist. Intratendinous ganglion, however, are rare. We present the first reported case of an intratendinous ganglion cyst in an extensor digitorum longus (EDL) tendon of the foot.Case reportA 35-year old presented with a left-sided painful dorsolateral foot swelling. Ultrasound suggested a ganglion cyst in proximity to the EDL tendon of the 5th toe. Two distinct swellings were identified on surgical exploration, including a 6 × 1 cm ganglion lying within the EDL tendon substance that had resulted in tendon splitting. The lesions were excised and EDL tendon repaired. Histological analysis confirmed that both lesions were ganglion cysts. Post-operative recovery was uneventful.DiscussionIntratendinous ganglion cysts are rare lesions that pose a unique set of diagnostic and treatment challenges. Unlike conventional ganglion, their diagnosis may not be possible until surgical exploration. They have been reported to increase the risk of spontaneous tendon rupture. As such, a lower operative threshold should be applied to prevent their progression. A high index of suspicion should be applied to any ganglion reported radiologically to be in close contact with tendons. If diagnosed upon surgical exploration, it is essential that the operating surgeon is prepared to appropriately modify the procedure to involve primary tendon repair, tendon transfer or tenodesis.     

Cyst decreased in size post maxillary sinus floor augmentation surgery in diabetic patient: A case report

IntroductionWhether mucosal cyst of maxillary sinus is contraindication for sinus floor augmentation surgery has been a controversial hot spot for years.Presentation of caseThis case aims to present the surgical procedure of sinus floor augmentation surgery with cyst (18.72 mm × 24.61 mm) in diabetic patient. And 6 months later, the cyst decreased in size. The authors elevated the sinus floor and cyst simultaneously. The surgery was carried out successfully without sinus membrane perforation and the alveolar ridge gained about 8 mm height. Six months later, the cyst decreased in size and osseointegration was observed.DiscussionInterdisciplinary cooperation is encouraged to diagnose benign mucosal cyst. The isolation between sinus lumen and the grafted sub-sinus space is important. Graft contamination or dispersion into the sinus lumen should be avoided. The integrity of the sinus membrane and use of antibiotics are very important to prevent the occurrence of postoperative sinus infectionConclusionThe authors conclude that sinus augmentation surgery could be done with mucosal cyst in diabetic patient.     

Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication

IntroductionSymptomatic non-parasitic hepatic cysts with biliary communication are rare and no standard treatment has been established yet. Careful attention should be paid to avoidance of postoperative bile leakage during surgical treatment.Presentation of caseWe report the case of a 74-year-old man who visited our department complaining of right upper abdominal pain and elevated serum levels of the liver enzymes. Computed tomography revealed hepatic cysts including a large one measuring 16 cm in diameter in Segments IV and VIII. Percutaneous drainage of the cyst revealed bile-staining of the cyst fluid. Endoscopic retrograde cholangiography demonstrated the presence of a cyst–biliary communication. We performed open deroofing of the cyst. During the operation, the biliary fistula was invisible, however, air injection into the bile duct through the stump of the cystic duct caused release of air bubbles from the cyst cavity, which allowed us to detect the small biliary orifice and repair it successfully by suture.DiscussionWe utilized the intraoperative air leak test, which has previously been reported to be effective for preventing postoperative bile leakage in patients undergoing hepatectomy to detect of a small cyst–biliary communication in a case undergoing non-parasitic hepatic cyst surgery.ConclusionAn intraoperative air leak test may be a useful test during surgical treatment of non-parasitic hepatic cysts with biliary communication.     

Computed tomography features of acinar cell carcinoma of the pancreas

PurposeTo report the computed tomography (CT) features of pancreatic acinar cell carcinoma (ACC) and identify CT features that may help discriminate between pancreatic ACC and pancreatic ductal adenocarcinoma (PDA).Materials and methodsThe CT examinations of 20 patients (13 men, 7 women; mean age, 66.5 ± 10.7 [SD] years; range: 51–88 years) with 20 histopathologically proven pancreatic ACC were reviewed. CT images were analyzed qualitatively and quantitatively and compared to those obtained in 20 patients with PDA. Comparisons were performed using univariate analysis with a conditional logistic regression model.ResultsPancreatic ACC presented as an enhancing (20/20; 100%), oval (15/20; 75%), well-delineated (14/20; 70%) and purely solid (13/20; 65%) pancreatic mass with a mean diameter of 52.6 ± 28.0 (SD) mm (range: 24–120 mm) in association with visible lymph nodes (14/20; 70%). At univariate analysis, well-defined margins (Odds ratio [OR], 7.00; P = 0.005), nondilated bile ducts (OR, 9.00; P = 0.007), visible lymph nodes (OR, 4.33; P = 0.028) and adjacent organ involvement (OR, 5.67; P = 0.02) were the most discriminating CT features to differentiate pancreatic ACC from PDA. When present, lymph nodes were larger in patients with pancreatic ACC (14 ± 4.8 [SD]; range: 7–25 mm) than in those with PDA (8.8 ± 4.1 [SD]; range: 5–15 mm) (P = 0.039).ConclusionOn CT, pancreatic ACC presents as an enhancing, predominantly oval and purely solid pancreatic mass that most frequently present with no bile duct dilatation, no visible lymph nodes, no adjacent organ involvement and larger visible lymph nodes compared to PDA.     

Primary Hydatid Cyst of the Pancreas

Background: Hydatid cyst of the pancreas is rare, accounting for less than 1% of the various sites of hydatid disease, even in countries where echinococcosis is endemic. We report a case of pancreatic hydatid cyst to increase awareness for this important condition.

Case report: We describe a 33-year-old male with abdominal discomfort of one-year duration. On abdominal examination, there was mild tenderness with fullness in the right upper quadrant. Laboratory investigations revealed no abnormalities. Abdominal ultrasonography showed a cystic mass over the head of the pancreas. Abdominal CT scan confirmed the presence of a solitary cyst in the pancreatic head, with no enhancement on contrast CT. Indirect hemagglutination test for hydatid disease was negative. A pre-operative diagnosis of cystic neoplasm of the pancreas was made and laparo-tomy was done; on exploration there was a cystic mass arising from the head of the pancreas. A pericystectomy was carried out and the diagnosis of hydatid cyst of the pancreas was confirmed by histopathology. The postoperative period was uneventful and no recurrence was seen after 2 years of follow-up.

Conclusion: Pancreatic hydatidosis, though very rare, should be considered in the differential diagnosis of pancreatic cystic lesions in the appropriate epidaemiological setting.     

Infarcted mesothelial cyst: A case report

IntroductionMesenteric and omental mesothelial cysts are rare, accounting for only 1 in 100,000 hospital admissions for abdominal pain (Tan Jane et al., 2009) [1]. They are often discovered only on CT imaging, which is frequently non-definitive in identifying an exact tissue source owing to overlapping radiographic features with other masses (Stoupis et al., 1994) [2]. The symptoms manifested by such masses are also nonspecific, favoring consideration of more frequently encountered problems in the scope of general surgery over cystic masses in the differential diagnosis. Definitive diagnosis of a mesothelial cyst in this case was made on histopathologic examination of a surgically resected specimen. This case is reported in line with SCARE criteria (Dragoslav et al., 2007) [6].Presentation of caseA 41 year-old male patient presented to an academic teaching hospital with several days of abdominal pain with nausea and vomiting. Initial workup was unremarkable, save for abdominal CT revealing a central mesenteric focus of inflammation. Neuroendocrine tumor was excluded by normal serum octreotide, 5-HIAA, and chromogranin A. A 4 × 2 cm mass was identified and resected on laparoscopy. Histopathologic diagnosis of the specimen was infarcted mesothelial cyst. The patient reported resolution of symptoms and remains well on most recent follow-up.DiscussionThe rapid diagnosis of intra-abdominal cystic masses is obscured by their rarity, nonspecific symptomatology, and radiographic features that overlap among such masses (Stoupis et al., 1994) [2]. The etiology of symptoms is likely owed to local mass effect exerted by the cyst on surrounding tissues. Continued resolution of symptoms on resection of such a cyst supports this conclusion.Conclusionimaging following an overall unremarkable physical and laboratory workup for this patient’s abdominal pain directed our further workup and management efforts towards surgical excision of an intra-abdominal cystic mass. Histopathologic examination of the cyst was ultimately diagnostic of an infarcted mesothelial cyst.     

Nutritional status is associated with health-related quality of life in children with cystic fibrosis aged 9–19 years

BackgroundThe impact of improved nutritional status on health-related quality of life (HRQOL) is unknown for children with cystic fibrosis (CF).MethodsAssociations between nutritional status and HRQOL were examined over 2 years in 95 children, aged 9–19 years, who were followed in the Wisconsin Newborn Screening Project. HRQOL was assessed using the Cystic Fibrosis Questionnaire (CFQ). Associations between height z-score (HtZ), BMI z-score (BMIZ) and seven CFQ dimensions were evaluated.ResultsMean values of at least 80 were observed for all CFQ dimensions except respiratory symptoms and treatment burden. Treatment burden was significantly worse in patients with meconium ileus (57) compared to pancreatic insufficient (65) and sufficient (78) subjects, p < 0.0001. HtZ and BMIZ were positively associated with physical functioning and body image (p < 0.05).ConclusionsBetter nutritional status was associated with increased HRQOL scores. Early diagnosis through newborn screening and improved nutrition provides an opportunity to enhance quality of life and body image perception.     

Erythromycin improves gastric emptying half-time in adult cystic fibrosis patients with gastroparesis

BackgroundGastrointestinal manifestations are frequently encountered in cystic fibrosis patients. Gastroparesis evidenced by a variety of diagnostic methods has been described in patients with cystic fibrosis, predominantly in children and in individuals with advanced lung disease. The presence of gastroparesis in adult patients with different degrees of lung involvement and its response to the acute and chronic administration of macrolides have not been reported.MethodsUsing the University of Florida Cystic Fibrosis database we identified symptomatic patients who had gastroparesis confirmed by a prolonged half-time during gastric emptying scintigraphy.ResultsOf 86 cystic fibrosis patients, periodically followed in our institution, we found five who had classical symptoms and prolonged gastric emptying half-time. Age 25.2 ± 8 years, 80% females, BMI 22 ± 9 kg/m², HbA1c 5.8 ± 0.6 g/dl, FEV1 53.2 ± 15% of predicted. Gastric emptying half-time was 191.4 ± 91.4 min (range 100–300 min) and decreased to 12.2 ± 6 min (range 5–20 min) after IV administration of erythromycin (p = 0.043). Patients were followed up for 3 ± 2.1 years. All patients but one, who was taking opiods, had good clinical response to PO macrolides.ConclusionsGastroparesis occurs in patients with cystic fibrosis, even in patients with relatively preserved lung function and in those without cystic-fibrosis related diabetes. Macrolides may be an effective therapy in cystic fibrosis patients with gastroparesis when administered acutely or chronically.     

Ultrasonographic findings of thyroglossal duct papillary carcinoma: A case report

IntroductionReports on thyroglossal duct cyst carcinoma (TGDCCa) are rare, occurring in approximately 1% of thyroglossal duct cyst (TGDC) cases. The origin and treatment of carcinoma arising in TGDC are controversy.Presentation of caseA 38-year-old woman presented with a midline neck mass at the thyrohyoid level for 3 years. Ultrasound revealed a 2.4 cm cystic mass with a solid mural component and microcalcification. A small right thyroid nodule was also detected. Sistrunk’s operation was performed and the pathology was a primary carcinoma arising in the TGDC with a close surgical margin. Total thyroidectomy was done and revealed a 4 mm papillary carcinoma with partial invasion through the thyroid capsule of the right lobe with a 1 mm papillary carcinoma at the isthmus. The diagnosis was a primary TGDCCa with multifocal papillary thyroid carcinoma.DiscussionSistrunk’s operation is an accepted procedure for the treatment of both TGDC and TGDCCa. Additional total thyroidectomy has been proposed but still controversial. The aims of preoperative ultrasound and ultrasound-guided fine needle aspiration biopsy (FNAB) are differential diagnosis of the possible diseases and operative planning. The results which suggest a carcinoma arising in the TGDC, synchronous thyroid malignancy and metastatic cervical lymph nodes are helpful in determining the magnitude of the operation.ConclusionUltrasound and FNAB of the TGDC, thyroid gland and cervical lymph nodes are the useful preoperative evaluations leading to the accurate diagnosis. The definitive treatment is Sistrunk’s operation with the possible addition of total thyroidectomy and neck dissection when indicated.     

Giant adrenal cyst in a young female patient: A case report

Adrenal cysts are rare cystic masses that arise from the adrenal gland. They are usually non-functional, asymptomatic and less than 10 cm in diameter when discovered incidentally. However, giant adrenal cysts are cysts of the adrenal gland which are larger than 10 cm in diameter. They pose a diagnostic conundrum to the surgeon as localization of the origin of the cyst is very difficult. Indications for surgical intervention include a size exceeding 10 cm in diameter, the presence of symptoms, endocrine abnormalities, intracystic bleeding and suspicion of malignancy. The current treatment of choice is adrenalectomy, either open or laparoscopic. Ultrasound-guided percutaneous drainage is an alternative, especially when there is no doubt regarding the diagnosis. Following, we report on one of the rare cases of a giant adrenal cyst.     

Characterization of focal pancreatic lesions using normalized apparent diffusion coefficient at 1.5-Tesla: Preliminary experience

PurposeTo compare the capabilities of apparent diffusion coefficient (ADC) and normalized ADC using the pancreatic parenchyma as reference organ in the characterization of focal pancreatic lesions.Patients and methodsThirty-six patients with focal pancreatic lesions (malignant, n = 18; benign tumors, n = 10; focal pancreatitis, n = 8) underwent diffusion-weighted MR imaging (DWI) at 1.5-Tesla using 3 b values (b = 0, 400, 800 s/mm²). Lesion ADC and normalized lesion ADC (defined as the ratio of lesion ADC to apparently normal adjacent pancreas) were compared between lesion types using nonparametric tests.ResultsSignificant differences in ADC values were found between malignant (1.150 × 10 ⁻³ mm²/s) and benign tumors (2.493 × 10⁻³ mm²/s) (P = 0.004) and between benign tumors and mass-forming pancreatitis (1.160 × 10⁻³ mm²/s) (P = 0.0005) but not between malignant tumors and mass-forming pancreatitis (P = 0.1092). Using normalized ADC, significant differences were found between malignant tumors (0.933 × 10⁻³ mm²/s), benign tumors (1.807 × 10⁻³ mm²/s) and mass-forming pancreatitis (0.839 × 10⁻³ mm²/s) (P < 0.0001).ConclusionOur preliminary results suggest that normalizing ADC of focal pancreatic lesions with ADC of apparently normal adjacent pancreatic parenchyma provides higher degrees of characterization of focal pancreatic lesions than the conventional ADC does.