Intraductal papillary mucinous neoplasms of the pancreas: correlation of helical CT and dynamic MR imaging features with pathologic findings

BACKGROUND: We assessed the imaging features of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas paying special attention to underlying pancreatic fibrosis on three-phase helical computed tomography (CT) and dynamic magnetic resonance (MR) imaging. METHODS: Sixteen patients with histopathologically proven IPMNs underwent three-phase helical CT and dynamic MR imaging. RESULTS: IPMNs were seen as a cluster of cyst-like structures in branch duct (n = 5) and combined types (n = 10), and as a fusiform appearance in the main duct type (n = 1). IPMN shape was most easily visualized at the portal venous dominant phase or delayed phase owing to rim-like enhancement of the dilated ducts. Pathologically mild to severe fibrosis was seen on this enhanced rim replacing the surrounding pancreatic parenchyma. Communication between the dilated branch ducts and main pancreatic duct was identified in 15 patients on helical CT and 14 patients on dynamic MR imaging. In patients with fibrosis of pancreatic parenchyma surrounding this, communication was most easily visualized at the later phase on CT and MR imaging. Adenocarcinomas were depicted as papillary projections in eight of nine patients on CT and MR imaging. Invasion of the pancreatic parenchyma was seen in five of six patients as a solid mass in the pancreatic parenchyma. These masses were most easily visualized at the arterial dominant phase on both CT and MR imaging. CONCLUSION: Three-phase helical CT and dynamic MR imaging were useful in the diagnosis of IPMN of the pancreas.     

Branch duct IPMTs: value of cross-sectional imaging in the assessment of biological behavior and follow-up

Branch duct intraductal papillary mucinous tumors (IPMTs) are increasingly being described and represent a challenge for the physician. Recent imaging modalities, especially computed tomography and magnetic resonance, allow for a correct diagnosis, but IPMTs can manifest with different degrees of cellular atypia so it is very important to be able to establish the biological behavior of the lesion. Sixty-five patients were included in this study: 29 of them underwent surgery, and the other 36 were followed with cross-sectional imaging. Among patients who underwent surgery, 11 had benign lesions and 18 had malignant lesions. Overall sensitivity, specificity, and accuracy in the diagnosis of malignancy for all the cross-sectional imaging techniques were 61%, 81%, and 69%, respectively. Among patients who were followed and had a magnetic resonance cholangiopancreatographic diagnosis of branch duct IPMT with imaging features indicative of benignity, only two showed modifications over the follow-up period. Even considering some important biases (small number of patients and relatively short follow-up), interesting conclusions can be drawn: the imaging diagnosis of malignancy can be trusted, whereas that of benignity cannot be relied upon, but if the signs of malignancy are absent, the slow growth of the lesions justifies watchful follow-up in the correct clinical setting.     

Papillary cystic neoplasm of the pancreas: Radiological findings

We report a series of 10 papillary cystic neoplasms of the pancreas evaluated in our institution. The lesions are analyzed in retrospect to define the existence of eventual specific imaging patterns as well as to point out the existing problems of differential diagnosis versus other pancreatic tumors.     

胰腺常见囊性肿瘤的临床特点、影像学表现和鉴别

胰腺囊性肿瘤（PCN）是以囊性改变为主胰腺肿瘤的统称。常见的PCN分为浆液性囊性肿瘤（SCN）、黏液性囊性肿瘤（MCN）、导管内乳头状黏液性肿瘤（IPMN）、实性假乳头性肿瘤（SPT）等。各型肿瘤生物学特性各异,良恶性均有涉及,因此提高PCN的术前影像学诊断对临床有一定的指导意义。本文就PCN的影像学表现、病理特点及鉴别诊断进行综述。     

胰腺导管内乳头状黏液性肿瘤的多层螺旋CT诊断

目的探讨胰腺导管内乳头状黏液性肿瘤在多层螺旋CT上的影像特点。方法回顾性分析30例经手术切除和病理学证实的胰腺导管内乳头状黏液性肿瘤的临床、多层螺旋CT影像学资料,结合CT血管造影(computed tomography angiography,CTA)、多平面图像重组和二维曲面重组等影像技术观察其影像学表现,分析影像学表现与病理结果的相关性。结果 30例胰腺导管内乳头状黏液性肿瘤的多层螺旋CT诊断:主胰管型13例,分支胰管型9例,混合型8例;术后病理结果显示胰腺导管内乳头状黏液性瘤8例,胰腺交界性或低度恶性乳头状黏液瘤8例,胰腺导管内乳头状黏液癌14例。结论胰腺导管内乳头状黏液性肿瘤具有特征性的影像学表现,螺旋CT能协助诊断并能对其分型,运用CTA、多平面图像重组和二维曲面重组等影像技术有助于术前评估肿瘤的良、恶性。     

胰腺导管内乳头状黏液性肿瘤的影像学诊断进展

胰腺导管内乳头状黏液性肿瘤是一种位于扩张的主胰管和(或)分支胰管内、伴大量黏液分泌的肿瘤,易与慢性胰腺炎或胰腺囊腺瘤混淆而延误诊断.本文就国内外近年来关于胰腺导管内乳头状黏液性肿瘤的临床病理学及影像学研究进展进行综述,评价不同影像技术(US、CT、MRCP、ERCP)在胰腺导管内乳头状黏液性肿瘤诊断中的作用.     

胰腺导管内乳头状黏液性肿瘤的MSCT征象

目的探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的MSCT特点。方法回顾性分析27例经病理证实的IPMN的MSCT表现。所有患者均接受16层或64层CT平扫及增强检查,其中7例接受ERCP检查。结果27例IPMN中,主胰管型11例,包括2例交界性肿瘤,4例原位癌,5例腺癌;CT表现为胰腺不同程度萎缩,主胰管扩张,8例内部可见壁结节,1例见多发斑块状钙化。分支胰管型9例,包括腺瘤和交界性肿瘤各3例,1例原位癌,2例腺癌;其中7例位于胰头部,表现为与主胰管相通的囊性病灶,内见分隔和乳头状壁结节,呈"葡萄串"样,1例可见点状钙化;2例位于胰尾部,呈类圆形囊性病灶,增强无强化。混合型7例,包括交界性肿瘤和腺癌各3例,原位癌1例,表现为主胰管及分支胰管扩张伴腔内壁结节,3例病变内可见不同程度钙化。7例接受ERCP,其中5例明确显示囊性病灶与主胰管相通。结论 IPMN的MSCT表现具有一定特征。MSCT结合ERCP检查有助于术前准确诊断。     

胰腺导管内乳头状黏液性肿瘤的超声分型与诊断分析

摘 要 目的 探讨胰腺导管内乳头状黏液性肿瘤（IPMN）的超声分型,旨在提高超声诊断准确率。方法 收集29例胰腺IPMN的临床与超声检查资料,分析其超声特征及诊断信息。结果 根据声像图表现不同,胰腺IPMN可分为单房囊性型（10.3%,3/29）、多房囊性型（44.8%,13/29）、实性型（17.2%,5/29）和主胰管型（27.6%,8/29）。IPMN胰管扩张,病灶与主胰管相通,乏血供。术前超声检查对多房囊性型IPMN的诊断准确率达84.6%。结论 胰腺IPMN的超声分型可分为单房囊性型、多房囊性型、实性型和主胰管型,其中多房囊性型IPMN的术前超声诊断准确率最高。     

CT virtual pancreatoscopy: a new method for diagnosing intraductal papillary mucinous neoplasm (IPMN) of the pancreas

Background We sought to validate computed tomographic virtual pancreatoscopy (CT-VP) created by multidetector row CT (MD-CT) in the clinical diagnosis of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Methods Five cases of pancreatic IPMNs were included in this study. A nasopancreatic drainage tube was inserted and the pancreatic duct was filled with contrast medium, after which an upper abdominal scan was performed by MD-CT. CT-VP and three-dimensional (3D) CT pancreatographic images were created using a workstation and compared with images by conventional diagnostic techniques. All cases were evaluated by endoscopic retrograde pancreatography (ERP) and three cases of main duct type were assessed by intraoperative real pancreatoscopy (RP). Results In the main duct cases, papillary projections in the main pancreatic duct and branch orifices were clearly detected by CT-VP. These lesions and structures were confirmed by intraoperative RP, and the CT-VP images were clearer than RP images. In branch cases, a surface-rendering method allowed protruding lesions to be clearly detected in the dilated branches. Conclusion Compared with conventional ERP or RP, CT-VP and 3D-CT pancreatographic images were finer in quality, and the procedures were less invasive, faster, and less expensive. The potential shown by CT-VP with 3D-CT pancreatography in the clinical diagnosis of pancreatic IPMNs suggests that this approach may replace ERP in the near future.     

内镜超声检查对胰腺黏液性囊性肿瘤和导管内乳头状黏液性瘤的诊断价值

目的：评价内镜超声检查（EUS）在胰腺黏液性囊性肿瘤（MCN）和导管内乳头状黏液性瘤（IPMN）及其良恶性鉴别中的价值。方法：回顾分析1998年1月至2007年12月本院经手术病理证实为胰腺黏液性肿瘤患者的EUS影像资料，其中IPMN11例，MCN10例。比较IPMN与MCN的内镜及EUS声像图特征，探讨鉴别MCN、IPMN及其良、恶性的EUS声像图指标。结果：IPMN与MCN患者间肿瘤部位、大小、主胰管直径、十二指肠主乳头开口扩张和黏液流出、肿瘤与主胰管交通等指标的差异有统计学意义（P〈0．05）。肿瘤浸润性生长是判断恶性IPMN与MCN的可靠指标。恶性IPMN主胰管直径大于良性／交界性IPMN[（12．2±3．5）mm比（6．8±2．2）mm，P=-0．011]；恶性IPMN壁结节高度大于良性，交界性IPMN（6．8±1．8）mm比（2．8±1．1）mm，P=0．001]。以主胰管直径≥11．0mm为标准，诊断恶性IPMN，其灵敏度为75％，特异度为100％；以壁结节高度／〉4．3mm为标准，则灵敏度为100％，特异度为100％。恶性MCN囊壁厚度大于良性，交界性MCN[（3．4±0．8）mm比（1．6±1．0）mm，P=-0．0281，恶性MCN壁结节高度大于良性／交界性MCN[（15．9±5．2）mm比（5．0±3．7）mm，P=-0．025]。以囊壁厚度≥2．4mm为标准诊断恶性MCN，灵敏度为100％，特异度为100％；以壁结节高度≥8．9mm为标准，则灵敏度为87．5％，特异度为100％。结论：EUS可用于鉴别IPMN与MCN，并评估肿瘤的良、恶性。     

Ultrasonic evaluation of the pancreas

With the advent of new gray scale imaging techniques, ultrasound plays a major role in the diagnosis of pancreatic lesions. As a noninvasive, nonionizing, accurate, and inexpensive diagnostic modality that directly images the pancreatic gland, ultrasound can be used as a primary screening tool. It is helpful in confirming the diagnosis of acute pancreatitis and in detecting and following pseudocysts and other complications. Neoplasms can be detected with a high rate of accuracy, and by assessing the presence of ascites or metastatic foci in the liver, ultrasound can aid in the staging of the neoplastic process. Bowel gas and obesity remain serious limitations to adequate examination, and in these patients computed tomography offers a complementary modality.     

Endoscopic ultrasonographic-guided punctured pancreatic ductography: an initial and successful trial

A 71-year-old male suffering from an intraductal papillary tumor of the pancreas was admitted to our hospital for further investigation. Diagnostic trials, including endoscopic retrograde pancreatography, did not produce an adequate ductography because of a large amount of mucinous fluid. Therefore, we performed endoscopic ultrasonographic-guided punctured pancreatic ductography (EPPD). This procedure was safely performed without any complications. We report this initial and successful trial of EPPD.     

Focal fatty sparing of the pancreatic head in cystic fibrosis: CT findings

The most common imaging appearance of the pancreas in cystic fibrosis is diffuse, complete fatty replacement. We present a case of complete fatty replacement of the pancreatic body and tail with total sparing of the pancreatic head. To our knowledge, this pattern of fatty sparing and its associated computed tomographic appearance have not been previously reported in cystic fibrosis.     

Sarcomatoid carcinoma of the pancreas — multimodality imaging findings with serial imaging follow-up: A case report and review of literature

BACKGROUNDSarcomatoid carcinoma of the pancreas is extremely rare and has an extremely poor prognosis. Although a few cases of sarcomatoid carcinoma of pancreas have been reported, most are focused on a histopathological review. To the best of our knowledge, there are no reports documenting multimodality imaging characteristics and chronological changes with emphasis on radiologic features.CASE SUMMARYA 64-year-old woman was admitted to Chungnam National University Hospital with acute appendicitis. Contrast-enhanced computed tomography of the abdomen revealed a 2.6 cm × 2.8 cm multilobular cystic mass in the pancreatic tail. The pancreatic lesion showed suspected mural nodules and thin septa. Hence, mucinous cystic neoplasm of pancreas was considered. After 7 mo, the patient was readmitted for repeated epigastric abdominal pain and nausea. Follow-up contrast-enhanced computed tomography of the abdomen and magnetic resonance imaging revealed a marked enlargement (5.4 cm × 4 cm), with a predominant internal solid component. The mass showed low signal intensity on a T1-weighted image and heterogeneously intermediate high signal intensity on a T2-weighted image. It showed diffusion restriction and peripheral rim enhancement on an arterial phase image, and progressive enhancement on portal venous and delayed phase images. Distal pancreatectomy was performed. Based on the morphology and immunohistochemical staining of the specimen, pancreatic sarcomatoid carcinoma was diagnosed.CONCLUSIONWe present the computed tomography, magnetic resonance imaging, and positron emission tomography computed tomography findings, pathologic features, and chronological changes for preoperative diagnosis.     

胰腺囊性肿瘤及肿瘤样病变CT诊断及鉴别

目的 探讨胰腺不同性质囊性病变的CT表现特点。方法 回顾性分析、横向对比32例胰腺常见不同性质囊性病变CT特点。所有病例均经CT平扫,23例于平扫后行增强扫描。所有病例经手术病理或随访证实。结果 胰腺浆液性囊腺瘤5例,粘液性囊腺瘤3例,囊腺癌3例,1例胰腺导管内乳头状粘液性肿瘤,2例胰腺真性囊肿,18例假性囊肿。结论 真性或假性囊肿结合病史,诊断不难;而浆液或粘液囊腺瘤与囊腺癌容易相互误诊,应仔细分析其CT表现特点。     

Carcinoid tumors of the pancreas: CT findings

Computed tomographic (CT) and ultrasound (US) findings in four cases of carcinoid tumors of the pancreas are reported. Differential diagnosis with other endocrine and nonendocrine pancreatic tumors is discussed. CT and US techniques play an important role in diagnosis, prognosis, and treatment of these tumors.     

Value of Near-Isovoxel Ultrasound for Evaluation of Ductal Communications with Pancreatic Cystic Lesions: Correlation with Magnetic Resonance Cholangiopancreatography

The aim of this study was to determine the value of near-isovoxel ultrasound (ISUS) using xMATRIX technology in assessment of ductal communications with pancreatic cystic lesions. Twenty patients with pancreatic cystic lesions (n = 21) on magnetic resonance cholangiopancreatography (MRCP), underwent 2-D ultrasound (US) and subsequent ISUS using a matrix probe. Two observers assessed the presence of ductal communications with pancreatic cystic lesions for all MRCP, 2-D US, and ISUS images with multi-planar reformation, using a 5-point confidence scale. Weighted-κ statistics and intra-class correlation coefficients were calculated. Inter-observer agreement for MRCP, 2-D US and ISUS was moderate, fair and moderate (0.475, 0.222 and 0.472), respectively. The intra-class correlation coefficients between ISUS and MRCP was higher than that between 2-D US and MRCP (0.8706 vs. 0.5353, observer 1; 0.7206 vs. 0.4818, observer 2, respectively). Correlation and inter-observer agreement were better with MRCP than with 2-D US. We conclude that ISUS may be useful in evaluating ductal communications with pancreatic cystic lesions.     

25例胰腺胰管内乳头状粘液性肿瘤MRI和ERCP比较研究

目的研究胰腺胰管内乳头状粘液性肿瘤的临床特点,MRI影像表现并和ERCP比较。方法自1998年至2001年25例(主胰管型6例,分枝型19例)手术证明的胰管内乳头状粘液性肿瘤患者。手术前所有患者均接受了MRI和ERCP检查,回顾分析了临床特点,MRI和ERCP影像学表现。结果MRI上主胰管型表现为弥漫/节段扩张的主胰管,5例伴有壁结节;分枝型表现为葡萄串状或单发的囊状肿瘤,14例内有壁结节,增强后壁结节明显强化。MRCP可清楚地显示19例分枝型IPMT和主胰管之间的交通。MRI和ERCP对肿瘤的显示率分别是100%,52%。结论与ERCP相比,MRI是一种非侵袭性的有效地诊断胰管内乳头状粘液性肿瘤的方法。MRCP(磁共振胆胰管成像)对分枝型肿瘤的诊断有重要意义。