Atypical and uncommon CT and MR imaging presentations of pancreatic ductal adenocarcinoma

Gong, Xu; Xu, Jian; Li, Qian

doi:10.1007/s00261-021-03089-6

Cited by 6 publications

(3 citation statements)

References 43 publications

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“…This finding suggests that patients with hepatic metastases undergo microscopic changes that are not visible to the naked eye early in the course of the disease and incidentally confirms the reliability of the present study for predicting hepatic metastases in patients with PDAC from the perspective of microcirculation. According to previous studies (20)(21)(22), PDAC, as a tumor with a lack of blood supply, consists of more fibrous stroma and fewer microvessels. We hypothesized that PDAC in the group without hepatic metastasis had more acinar cells and loose fibrous stroma.…”

Section: Discussionmentioning

confidence: 98%

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

Jia¹,

Yang²,

Chen³

et al. 2023

Quant Imaging Med Surg

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Background: Contrast-enhanced ultrasound (CEUS) has proven valuable in diagnosing benign and malignant pancreatic diseases, but its value in evaluating hepatic metastasis remains to be further explored.This study investigated the relationship between CEUS features of pancreatic ductal adenocarcinoma (PDAC) and concomitant or recurrent liver metastases after treatment.Methods: This retrospective study included 133 participants with PDAC who were diagnosed with pancreatic lesions with CEUS at Peking Union Medical College Hospital from January 2017 to November 2020. According to the CEUS classification methods in our center, all the pancreatic lesions were classified as either with rich or poor blood supply. Additionally, quantitative ultrasonographic parameters were measured in the center and periphery of all pancreatic lesions. CEUS modes and parameters of the different hepatic metastasis groups were compared. The diagnostic performance of CEUS was calculated for diagnosing synchronous and metachronous hepatic metastasis.Results: The proportions of rich blood supply and poor blood supply were 46% (32/69) and 54% (37/69), respectively, in the no hepatic metastasis group; 42% (14/33) and 58% (19/33), respectively, in the metachronous hepatic metastasis (MHM) group; and 19% (6/31) and 81% (25/31), respectively, in the synchronous hepatic metastasis (SHM) group. The wash-in slope ratio (WIS ratio) between the center of the lesion and around the lesion and peak intensity ratio (PI ratio) between the center of the lesion and around the lesion had higher values in the negative hepatic metastasis group (P<0.05). In predicting synchronous and metachronous hepatic metastasis, the WIS ratio had the best diagnostic performance. The sensitivity (SEN), specificity (SPE), accuracy (ACC), positive predictive value (PPV), and negative predictive value (NPV) were 81.8%, 95.7%, 91.2%, 90.0%, and 91.7%, respectively, for MHM; and 87.1%, 95.7%, 93.0%, 90.0%, and 94.3%, respectively, for SHM. MethodsThis study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The institutional review board of Peking Union Medical College Hospital approved the study (No. SK1733), and the requirement for individual consent for this retrospective analysis was waived.Conclusions: CEUS would be helpful in image surveillance for synchronous or metachronous hepatic metastasis of PDAC.

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Section: Discussionmentioning

confidence: 98%

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

Jia¹,

Yang²,

Chen³

et al. 2023

Quant Imaging Med Surg

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“…The detection rate of SPNs has increased due to the widespread use of medical examination technology. The varying radiological imaging features of SPNs has made it easy to be diagnosed radiologically to be PDAC, neuroendocrine tumors, or cystadenoma[ 1 , 4 - 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 8% of PDAC cases have cystic characteristics, which share similar radiological imaging features with cystic pancreatic tumors and lead to misinterpretation[ 6 ]. Most PDAC with cystic changes reported in the literature were poorly differentiated tumors showing pseudocystic changes[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison between solid pseudopapillary neoplasms of the pancreas and pancreatic ductal adenocarcinoma with cystic changes using computed tomography

Ren,

Qian,

et al. 2024

World J Radiol

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BACKGROUND Solid pseudopapillary neoplasms of the pancreas (SPN) share similar imaging findings with pancreatic ductal adenocarcinoma with cystic changes (PDAC with cystic changes), which may result in unnecessary surgery. AIM To investigate the value of computed tomography (CT) in differentiation of SPN from PDAC with cystic changes. METHODS This study retrospectively analyzed the clinical and imaging findings of 32 patients diagnosed with SPN and 14 patients diagnosed with PDAC exhibiting cystic changes, confirmed through pathological diagnosis. Quantitative and qualitative analysis was performed, including assessment of age, sex, tumor size, shape, margin, density, enhancement pattern, CT values of tumors, CT contrast enhancement ratios, “floating cloud sign,” calcification, main pancreatic duct dilatation, pancreatic atrophy, and peripancreatic invasion or distal metastasis. Multivariate logistic regression analysis was used to identify relevant features to differentiate between SPN and PDAC with cystic changes, and receiver operating characteristic curves were obtained to evaluate the diagnostic performance of each variable and their combination. RESULTS When compared to PDAC with cystic changes, SPN had a lower age (32 years vs 64 years, P < 0.05) and a slightly larger size (5.41 cm vs 3.90 cm, P < 0.05). SPN had a higher frequency of “floating cloud sign” and peripancreatic invasion or distal metastasis than PDAC with cystic changes (both P < 0.05). No significant difference was found with respect to sex, tumor location, shape, margin, density, main pancreatic duct dilatation, calcification, pancreatic atrophy, enhancement pattern, CT values of tumors, or CT contrast enhancement ratios between the two groups (all P > 0.05). The area under the receiver operating characteristic curve of the combination was 0.833 (95% confidence interval: 0.708-0.957) with 78.6% sensitivity, 81.3% specificity, and 80.4% accuracy in differentiation of SPN from PDAC with cystic changes. CONCLUSION A larger tumor size, “floating cloud sign,” and peripancreatic invasion or distal metastasis are useful CT imaging features that are more common in SPN and may help discriminate SPN from PDAC with cystic changes.

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2023

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Atypical and uncommon CT and MR imaging presentations of pancreatic ductal adenocarcinoma

Cited by 6 publications

References 43 publications

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

Comparison between solid pseudopapillary neoplasms of the pancreas and pancreatic ductal adenocarcinoma with cystic changes using computed tomography

The Cuff sign

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