Anomalies, Anatomic Variants, and Sources of Diagnostic Pitfalls in Pancreatic Imaging
ABSTRACT In this review, a brief discussion of the important events of pancreatic embryology is followed by presentation of congenital anomalies and normal variants. For each variant, the appearance at different radiologic modalities including computed tomography, magnetic resonance (MR) imaging, endoscopic retrograde cholangiopancreatography, MR cholangiopancreatography, and fluoroscopy will be demonstrated. © RSNA, 2013.
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ABSTRACT: The early and accurate characterization of pancreatic masses remains a challenge in diagnostic radiology, while the continuously evolving diagnostic possibilities give rise to an ever-increasing number of incidentally found pancreatic masses. This article discusses the relevance and role of ultrasound, endoscopic ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) in the diagnosis of pancreatic lesions. Specific protocols such as MR cholangiopancreatography and multiphase CT allow for a close characterization. While CT and MRI deliver information to further evaluate pancreatic disease, PET/CT has shown potential for staging purposes and in the clinical follow-up of pancreatic cancer patients. Common differential diagnoses regarding pancreatic cancer are discussed, and typical imaging features of anatomical variations, cystic lesions and pancreatitis are illustrated, together with clinical signs of pancreatic disease. The use of cross-sectional imaging in correlation with clinical features allows for an accurate and early detection of pancreatic masses and assists in differentiating benign from malignant disease. © 2014 S. Karger AG, Basel.Digestive Diseases 01/2015; 33(1):91-8. DOI:10.1159/000366045 · 1.83 Impact Factor
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ABSTRACT: To investigate the computed tomography (CT) features of heterotopic pancreas of the jejunum (HPJ) and to assess their associations with HPJ pathology features. In this retrospective series analysis, two radiologists reviewed the CT images of 17 patients with surgically proven HPJ in order to determine in consensus the location, long diameter, margin, shape, contour, and growth pattern of the lesions, the presence of a duct-like structure, the lesion enhancement patterns, including the homogeneity, and the degree of contrast enhancement compared with that of the main pancreas. The pathology features of the surgical specimens were reviewed and their associations with the CT features were assessed. On CT, the HPJs typically appeared as a small (< 3 cm), well-defined, ovoid or flat-shaped mass in the proximal jejunum with multiple and tiny lobulations. The growth pattern varied and the duct-like structure was rarely visible. The HPJs mostly appeared to be homogeneous and exhibited hyper- or isoattenuation compared to the main pancreas in the arterial and portal phases. However, these enhancement patterns varied slightly depending on the microscopic composition of the lesions (i.e., acinar vs. ductal predominance). Most HPJs comprised histologically of large acini, some ducts, and small islet cells, and had ductal communication with the jejunum. HPJs typically manifested as small, well-defined, ovoid or flat-shaped, homogeneous, and well-enhancing masses with a microlobulated contour in the proximal jejunum on CT, and their enhancement patterns associated with their microscopic composition. The pathology features of HPJs generally mimic those of the normal pancreas.Abdominal Imaging 06/2014; 40(1). DOI:10.1007/s00261-014-0177-y · 1.73 Impact Factor