Pancreas divisum: thin-section CT

Twelve patients with known pancreas divisum underwent thin-section computed tomography (CT) to determine the capability of CT to depict this pancreatic anomaly. Focal pancreatic enlargement was present in five patients. Two distinct pancreatic moieties separated by a fat cleft were noted in three patients; a fourth patient had focal atrophy in the distribution of the dorsal pancreas. The two pancreatic moieties were identified at the same craniocaudal level in all four of these patients. The dorsal duct was depicted in all 12 patients, while the short ventral duct was seen in only five of the 12 patients. Failure of the ventral and dorsal pancreatic ducts to fuse was identified in all five patients in whom both ducts were seen. CT may not enable specific diagnosis of pancreas divisum in the majority of patients. If, however, distinct pancreatic moieties or unfused ductal systems are evident, the diagnosis may be confidently suggested.     

Computed tomography findings in pancreas divisum

In 29 patients with abdominal pain the diagnosis of pancreas divisum (PD) was verified by endoscopic retrograde pancreatography (ERP) via both the major and the minor papilla. Computed tomography (CT) was done in all patients to evaluate contour, volume, antero-posterior diameters and attenuation values of the gland in comparison with a normal reference series. Also, the validity of the CT grading of pancreatitis was assessed in comparison with ERP grading. Patients with PD had an increased cranio-caudal diameter of the pancreatic head (p less than 0.001). Further, the main pancreatic duct was visualized more often in patients with PD (p less than 0.01), who also had an increasing frequency of pancreatic calcifications (p less than 0.05). Otherwise there were no differences compared with the normal series. The observed reduction in the volume of the gland in patients with marked pancreatitis at ERP seemingly reflected the severity of inflammation. No cleavage between the dorsal and ventral anlage was identified. CT was found to be too unspecific to be of any use in grading of pancreatitis. In conclusion, CT findings in patients with PD are sparse, unspecific and preferably a reflection of pancreatitis, if present. ERP remains the 'gold standard' for the diagnosis.     

Pancrease divisum: CT and ERCP findings

A case of pancreas divisum diagnosed by CT is reported. ERCP via the major pipilla revealed a very short pancreatic duct, which appeared to be abruptly interrupted by a tumor. CT, however, demonstrated two definite pancreatic moieties separated by a fat cleft, indicating the presence of pancreas divisum.     

Pancreas divisum: depiction with multi-detector row CT

PURPOSE: To retrospectively evaluate contrast material-enhanced multi-detector row computed tomography (CT) in the depiction of pancreas divisum. MATERIALS AND METHODS: This study was approved by the investigational review board. Seventy-seven patients (46 men and 31 women; mean age, 51 years) underwent CT with a four-detector row scanner and endoscopic retrograde pancreatography (ERP). Section thickness was 3.2 mm, and the reconstruction interval was 3 mm. Two radiologists independently evaluated the CT data sets with picture archiving and communication system (PACS) workstations equipped with software for two- and three-dimensional postprocessing reformations; the radiologists were blinded to the clinical and ERP data. Pancreas divisum was diagnosed at CT if what the authors termed the "dominant dorsal duct sign" (the caliber of the dorsal duct was larger than that of the ventral duct) was present and if the dorsal and ventral ducts did not appear to communicate with each other at cine review of images. ERP findings were used as the standard of reference for determining the performance (sensitivity, specificity, positive and negative predictive values) of the radiologists' CT interpretations. Interobserver agreement was measured by using kappa statistics. RESULTS: For four of the 77 patients (5%), both radiologists considered that depiction of the pancreatic duct on CT images was not sufficient to enable evaluation of ductal anatomy. These patients were excluded from further analysis. In the remaining 73 patients, ERP demonstrated pancreas divisum in 10 (14%); both observers made the correct diagnosis in nine of these patients. In addition, one radiologist had one false-positive interpretation, whereas the other radiologist had two false-positive interpretations. Thus, for observer 1, the calculated sensitivity was 90% (95% confidence interval [CI], 60%-98%) and the specificity was 98% (95% CI, 91%-100%). For observer 2, sensitivity was 90% (95% CI, 60%-98%) and specificity was 97% (95% CI, 89%-99%). Interobserver agreement was excellent (kappa = 0.93). CONCLUSION: CT scans obtained with multi-detector row scanners and interpreted with PACS workstations enable depiction of pancreas divisum. This assessment is possible only when the pancreatic duct is visualized.     

Enlargement of the pancreatic head in patients with pancreas divisum

Pancreas divisum (PD) is a congenital anomaly present in 6-10% of the population. Computed tomography (CT) examinations in eight of 15 patients (53%) with endoscopic retrograde pancreatography (ERCP)-proven PD were interpreted as showing enlargement of the pancreatic head. Two of these had carcinoma, three had pancreatitis limited to the ventral pancreas, and three were normal. Criteria to distinguish nonpathologic enlargement of the pancreatic head due to PD alone from pathologic causes may include homogeneous parenchyma and an absence of other abnormal signs on CT. Because PD may simulate a pancreatic head mass, the radiologist should be familiar with this variant, and ERCP should precede biopsy unless other evidence of malignancy is present.     

False pancreas divisum: a complication of post-endoscopic retrograde pancreatography pancreatitis

Pancreas divisum (PD) and meandering main pancreatic duct (MMPD) are common developmental variants of the pancreatic ductal system. They always appear in the head of the pancreas and are associated with idiopathic pancreatitis. The condition of these variants is rarely reported to have changed after birth. We present a rare case of false PD that occurred with alteration of loop-type MMPD after endoscopic retrograde pancreatography (ERP) and brush cytology followed by post-procedural pancreatitis. A 76-year-old female underwent pre-surgical ERP and brush cytology for an incidentally detected, expanding branch-type intraductal papillary mucinous neoplasm in the body of pancreas. The guidewire was inserted along the main pancreatic duct (MPD) and had uncoiled the loop-shaped MPD into a linear shape; soon afterwards, the patient developed post-procedural acute pancreatitis. Follow-up magnetic resonance cholangiopancreatography study 1 month later revealed the morphology of PD with an absent ventral duct. We hypothesize that inflammatory synechia had occluded the uncoiled ventral duct. This single case provides evidence that pancreatic ductal anatomy is flexible in some situations.     

Periodontoid pseudotumor: CT and MRI imaging

Periodontoid pseudotumor (PP) can be a severe and disabling disease. This disease process typically presents in elderly patients with a longstanding history of myelopathy. We reviewed four cases of PP in order to summarize the clinical and imaging features.     

胰腺腺泡细胞癌的CT特征分析

目的 探讨胰腺腺泡细胞癌(acinar cell carcinoma of pancreas,ACCP)的CT特征.方法 回顾性分析经手术证实的10例ACCP患者资料,患者均行CT平扫加动态增强扫描检查,分析其影像特征.结果 肿瘤发生在胰腺钩突4例、胰腺头部1例、胰腺颈部1例、胰腺体部2例、胰尾2例.平均直径6.7 cm.直径＞10 cm的2例为囊实性肿瘤,其余均为实性.肿瘤边界清晰,无浸润邻近器官、包绕血管表现.增强后动脉期和门静脉期肿瘤强化较周围胰腺弱.所有患者均可见完整或不完整的包膜线状强化.7例对胰(胆)管无明显侵犯;3例引起主胰管扩张,其中1例引起肝内、外胆管扩张.结论 ACCP在CT图像上具有特征性表现,有助于疾病的诊断.     

胰腺实性-假乳头状瘤的CT影像分析

目的:分析胰腺实性-假乳头状瘤的CT表现,探讨CT对胰腺实性-假乳头状瘤的诊断价值.方法:回顾性分析手术病理证实的5例胰腺实性-假乳头状瘤的CT特征,包括肿瘤的部位、大小、形态、密度及强化特征.结果:5例肿瘤位于胰头1例,胰体尾部4例.5例瘤体均为囊、实混合性,其中3例肿瘤有钙化,增强后实性部分均有强化,囊性部分无强化.肿瘤均有完整包膜,不伴有胆总管和胰管扩张.结论:胰腺实性-假乳头状瘤的CT表现有一定特征,对确定手术方案有重要价值.     

Pancreatic necrosis: CT manifestations

Pancreatic necrosis is a potential sequela of acute pancreatitis, which pathologically represents a collection of devitalized tissue. Appropriate therapeutic planning requires definition of this irreversibly damaged gland, the presence of which is not consistently diagnosed on the basis of clinical and laboratory data. Over an 18-month period, 22 patients with pancreatic necrosis were studied by one or more computed tomographic (CT) examinations. Retrospective analysis showed the findings to vary with the developmental stage of the necrotizing process. During the acute phase, there was considerable morphologic overlap of necrosis and pancreatic phlegmon. Typical findings were seen in the subacute and chronic stages and included diffuse enlargement of the gland with largely decreased central density. A thick, smooth surrounding rim produced a characteristic saclike configuration. CT-guided aspiration for culture material was performed in four patients with suspected superinfection. Negative gram stain and culture results in two patients allowed surgery to be performed on a more elective basis.     

Pancreatic metastases: CT assessment

We report the CT appearance of pancreatic metastases and describe their features in relation to the originating primary tumor. We also discuss some limitations in their differential diagnosis and report some theories explaining the pathogenesis of their occurrence. A total of 20 cases (9 males and 11 females) of pancreatic metastases were diagnosed at staging or follow-up of oncologic patients. All patients were evaluated with CT before and after contrast medium administration and had subsequent pathologic confirmation. In 1 case metastases were located solely in the pancreas; in 6 there was only another metastatic location, and in the remaining 13 there was diffuse spread throughout the body. Two of our patients exhibited a multinodular metastatic involvement of the pancreas, 11 had a solitary nodule or mass, and the remaining 7 had a diffusely enlarged pancreas, without any signs of focal disease. All but one of the solitary lesions measured more than 4 cm. In 2 cases a metachronous malignancy was detected at follow-up. Primary malignancies were located: 6 in the lungs, 2 on the skin (melanomas), 3 in breasts, 2 in the ovaries, 3 in the colon, 1 in the stomach, 2 in the kidney, and 1 the thyroid. Our findings confirm the existence of three patterns of metastatization to the pancreas: large solitary masses, multinodular lesions, and diffuse enlargement of the pancreas without focal signs at CT. In contrast to other studies, the large solitary lesion was our most frequent encounter, therefore making differential diagnosis vs primary cancer difficult. Metastases tended to repeat the imaging pattern of the primary. Nevertheless, we wrongly diagnosed pancreatitis due to a small nondetected metastasis, pseudo-cystic mass as a mucinous cystadenocarcinoma, conglomerate of peripancreatic lymph nodes, and a solitary pancreatic mass diagnosed as primary pancreatic cancer. Thus, when faced with a solitary pancreatic lesion at follow-up, histologic diagnosis is strongly recommended. In 2 cases changes in aspect and size were related to therapy. Received 2 August 1995; Revision received 1 May 1996; Accepted 6 May 1996     

Pancreatic pseudoaneurysm: CT features

Haemorrhage is a serious and life-threatening complication of pancreatitis. We present a case of bleeding pancreatic pseudoaneurysm in which CT established t the diagnosis. Correspondence to: A. A. Ghiatas     

Choledochocele with pancreas divisum:A rare cooccurrence diagnosed on magnetic resonance cholangiopancreatography

We report a case of a 42-year-old male with symptomatic choledochocele and incidental pancreas divisum diagnosed with magnetic resonance cholangiopancreatography (MRCP). Small choledochocele is rare congenital malformation associated with non-specific symptoms and a delay in diagnosis. The coexistence of choledochocele and pancreas divisum is extremely rare with only two case reports published in literature. In both cases MRCP failed to diagnose any biliary or pancreatic abnormality. This case suggests that the patients with recurrent abdominal pain and pancreas divisum should not be presumed to be suffering from pancreatitis. Careful evaluated for additional anomalies in the biliary tree should be sought for refractory symptoms. MRCP is a useful one-stop-shop for diagnosing pancreatic and biliary ductal anomalies.     

儿童胰腺分裂的临床和磁共振特征分析

目的:分析单中心儿童胰腺分裂的影像,了解胰腺分裂的类型及分布特点,及其与儿童腹部疾病的关系.方法:回顾分析北京儿童医院2011年1月-2016年1月由于腹痛行上腹部核磁共振(MRI)及磁共振胰胆管成像(MRCP)检查的600例儿童的影像图像,最终影像诊断为胰腺分裂28例,其中女18例,男10例,按照胰腺分裂诊断标准进行影像分型.结果:MRI和MRCP综合诊断Ⅰ型为4例,Ⅱ型为22例,Ⅲ型为2例.28例胰腺分裂中10例合并特发性胰腺炎,18例合并胆总管囊肿.特发性胰腺炎中Ⅰ型2例,Ⅱ型7例,Ⅲ型1例,胆总管囊肿合并Ⅰ型2例,Ⅱ型15例,Ⅲ型1例.结论:MRI和MRCP相互结合可以很好诊断胰腺分裂畸形,同时儿童胰腺分裂多并发胰腺炎和胆总管囊肿.     

肺炎性假瘤CT诊断分析

肺炎性假瘤为肺内良性肿瘤样病变,是非特异性炎症所致的一种慢性炎性增生性肿块.其临床表现错综复杂,影像学有多种不典型征象,常与肺内其他肿块性病变相似,特别与周围型支气管肺癌鉴别困难.本文搜集经CT检查、手术及随访证实的炎性假瘤27例作回顾性分析,以探讨X线与CT对肺炎性假瘤的诊断价值.     

肺炎性假瘤的CT分析

目的：探讨肺炎性假瘤的CT征象和鉴别诊断。方法：回顾性分析28例经手术病理证实的肺炎性假瘤的CT表现。结果：①病灶部位：两肺下叶基底段13例、背段8例，上叶后段(尖后段)5例，中叶(舌段)2例；均邻近胸膜。②CT征象：病灶呈类圆形26例，不规则形2例，密度均匀27例，空洞1例，边缘光整20例，有粗长毛刺或锯齿状8例，呈尖角状4例，分叶2例，病灶有垂直于胸膜的刀切样边缘12例，局部胸膜增厚粘连21例。肿块与邻近胸壁之间有低密度条状影18例。结论：全面分析CT征象能提高肺炎性假瘤的正确诊断率。     

Calcified postinflammatory pseudotumor of the lung: CT features

A densely calcified, large postinflammatory pseudotumor (plasma cell granuloma) in the lung of an 8-year-old girl is presented. The lesion mimicked a chondroid hamartoma on CT. Review of the literature revealed a small but significant incidence of calcification detected in plasma cell granuloma, despite what is commonly written in textbooks of radiologic diagnosis. Inflammatory pseudotumor in children is as likely as in adults to contain calcification and may be more likely to calcify.