Imaging mimics of pancreatic ductal adenocarcinoma

Gandhi, Namita; Feldman, Myra K.; Le, Ott; Morris‐Stiff, Gareth

doi:10.1007/s00261-017-1330-1

Cited by 36 publications

(24 citation statements)

References 44 publications

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“…These key imaging features are also critical imaging findings in pancreatic ductal adenocarcinoma (PDAC). Overlaps in imaging findings between PNEC and PDAC have been reported previously [ 7 ]. In a prior study, we found that 57% of PNEC was misdiagnosed as PDAC [ 6 ].…”

Section: Introductionmentioning

confidence: 70%

The differentiation of pancreatic neuroendocrine carcinoma from pancreatic ductal adenocarcinoma: the values of CT imaging features and texture analysis

et al. 2018

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BackgroundImaging findings for pancreatic neuroendocrine carcinoma (PNEC) and pancreatic ductal adenocarcinoma (PDAC) often overlap. The aim of this study was to demonstrate the value of computed tomography (CT) imaging features and texture analysis to differentiate PNEC from PDAC.MethodsTwenty-eight patients with pathologically-proved PDAC and 14 patients with PNEC were included in this study. CT imaging findings, including tumor boundary, size, enhancement degree, duct dilatation and parenchymal atrophy were used to compare PDAC and PNEC. CT texture features were extracted from CT images at the arterial and portal phases.ResultsMore PNEC than PDAC had well-defined margins (57.1% vs 25.0%, p = 0.04). Parenchymal atrophy was more common in PDAC than in PNEC (67.9% vs 28.1%, p = 0.02). CT attenuation values (HU) and contrast ratios of PNEC inthe arterial and portal phases were higher than those of PDAC (p < 0.05 or 0.01). Entropy was lower and uniformity was higher in PNEC compare to PDAC at the arterial phase (p < 0.05). Contrast ratio showed the highest area under curve (AUC) for differentiating PNEC from PDAC (AUC = 0.98–0.99). Entropy and uniformity also showed an acceptable AUC (0.71–0.72).ConclusionsOur data indicate that CT imaging features, including tumor margin, enhanced degree and parenchymal atrophy, as well as texture parameters can aid in the differentiation of PNEC from PDAC.

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Section: Introductionmentioning

confidence: 70%

The differentiation of pancreatic neuroendocrine carcinoma from pancreatic ductal adenocarcinoma: the values of CT imaging features and texture analysis

et al. 2018

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“…due to overlap of the imaging ndings. [31,32] In this study, we found that suspicious lymph nodes, abutment or encasement of the arteries around the pancreas, venous involvement, and the tumor size have no abilty to differentiate between CP and CP with PDAC. Many other clinical features such as the duration of symptoms before admission, jaundice, high-colored urine, diabetes mellitus, total bilirubin levels, and the carbohydrate antigen 19 − 9 (CA19-9), the carbohydrate antigen 125 (CA125) were insigni cant using logistic regression, which are in agreement with these in preivout studies.…”

Section: Discussionmentioning

confidence: 65%

Clinical Significance of Pancreatic Calcifications: A 15-Year Single Center Observational Study

Wang

Chai

Zhu

et al. 2021

Preprint

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Objective Pancreatic calcifications (PC) are considered specific for chronic pancreatitis (CP), but PC may also be present in non-CP diseases. The aims are to understand the pattern of calcifications in different diseases and to determine they were related to malignant diseases. Methods A retrospective study was performed including patients with PC or CP undergoing surgery in the Department of General Surgery of Ruijin Hospital from January 2003 to June 2018. Results PC were observed in 168 (4.5%) of the 3755 patients with pancreatic diseases. The majority of patients with PC had three kinds of CP (73.2%) while 26.8% had other five kinds of non-CP diseases. The incidences of PC in the pancreatic diseases were lower than these in previous studies. In patients with non-CP diseases, the incidence of PC in malignant intraductal papillary mucinous neoplasm (IPMN) was significantly higher than benign IPMN (8.3% vs. 0.7%, p = 0.004). In 204 patients with CP, pancreatic calcification (OR = 3.7), advanced age (> 55 years), high BMI (> 24 kg/m2), parenchymal atrophy and pancreatic mass were independent predictors for malignancy. In patients of CP wih pancreatic mass (n = 81), the ability of PC (OR = 28.6) to predict malignancy increased nearly sevenfold. Conclusion The disease spectrum with PC was very diverse but the incidences of PC in the pancreatic diseases were low. PC may be related to malignant IPMN in non-CP diseases and is related to malignancy in the patients with CP, including the cases without pancreatic mass.

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“…Similar to PDAC, focal CP can lead to focal parenchymal atrophy or enlargement and appears as a hypovascular mass on imaging, accompanied by upstream ductal dilation and atrophy[ 35 ]. Imaging features that point towards an inflammatory cause include an unobstructed or smooth tapering pancreatic duct through the hypovascular mass (duct-penetrating sign), while PDAC usually demonstrates an abrupt or irregular obstruction (Figure 2 )[ 36 - 38 ].…”

Section: Diagnostics: Pancreatitis or Pancreatic Cancer?mentioning

confidence: 99%

Pancreatitis and pancreatic cancer: A case of the chicken or the egg

Umans¹,

Hoogenboom²,

Sissingh³

et al. 2021

WJG

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Acute pancreatitis (AP), chronic pancreatitis (CP) and pancreatic cancer are three distinct pancreatic diseases with different prognoses and treatment options. However, it may be difficult to differentiate between benign and malignant disease. AP may be a first symptom of pancreatic cancer, particularly in patients between the ages of 56 and 75 with presumed idiopathic AP who had a concomitant diagnosis of new-onset diabetes mellitus or patients who present with CP at diagnosis of AP. In these patients, additional imaging is warranted, preferably by endoscopic ultrasonography. CP may lead to pancreatic cancer through oncogenic mutations, mostly in patients with hereditary CP, and in patients in whom risk factors for pancreatic cancer ( e.g. , nicotine and alcohol abuse) are also present. Patients with PRSS1 -mediated CP and patients with a history of autosomal dominant hereditary CP without known genetic mutations may be considered for surveillance for pancreatic cancer. Pancreatic inflammation may mimic pancreatic cancer by appearing as a focal mass-forming lesion on imaging. Differentiation between the above mentioned benign and malignant disease may be facilitated by specific features like the duct-penetrating sign and the duct-to-parenchyma ratio. Research efforts are aimed towards developing a superior discriminant between pancreatitis and pancreatic cancer in the form of imaging modalities or biomarkers. This may aid clinicians in timely diagnosing pancreatic cancer in a potentially curable stage.

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Imaging mimics of pancreatic ductal adenocarcinoma

Cited by 36 publications

References 44 publications

The differentiation of pancreatic neuroendocrine carcinoma from pancreatic ductal adenocarcinoma: the values of CT imaging features and texture analysis

The differentiation of pancreatic neuroendocrine carcinoma from pancreatic ductal adenocarcinoma: the values of CT imaging features and texture analysis

Clinical Significance of Pancreatic Calcifications: A 15-Year Single Center Observational Study

Pancreatitis and pancreatic cancer: A case of the chicken or the egg

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