Comparison of Current Radiologic Approaches to the Diagnosis of Pancreatic Disease

Eaton, S. Boyd; Fleischli, Donald J.; Pollard, James J.; Nebesar, Robert A.; Potsaid, Majic S.

doi:10.1056/nejm196808222790801

Cited by 63 publications

(8 citation statements)

References 10 publications

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“…The scan has been found helpful in the diagnosis and assessment of pancreatitis, both in the present study and by other workers (Sodee, 1966;Van Vaerenbergh, Van Vaerenbergh, Demeulenaere, Yvergneaux, and Barbier, 1966;Marabini, Donati, Cabassa, and Gagni, 1967;Swyngedauw et al, 1967;Centi-Colella and Pigorini, 1968;Eaton, Fleischli, Pollard, Nebesar, and Potsaid, 1968; We should like to express our sincere thanks to the many clinicians who referred cases for study. Particular thanks are due to Professor Sheila Sherlock, Sir Francis Avery Jones, Drs T. D. Kellock, A. M. Dawson, C. N. Mallinson, N. Compston, and A. G. Beckett who referred many of the patients and cooperated closely in obtaining detailed information following the scan.…”

supporting

confidence: 71%

75Se-selenomethionine scanning in the diagnosis of tumours of the pancreas and adjacent viscera: The use of the test and its impact on survival

McCarthy¹,

Brown²,

Melmed³

et al. 1972

Gut

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SUMMARYThe results ofpancreatic scanning with 75Se-selenomethionine in 393 carefully documented patients over a two-year period are presented. On follow up 50 patients had operatively proven malignant tumours in the gland and a further 22 had similar tumours in adjacent organs, clinically mimicking carcinoma of the pancreas and in many cases causing scan abnormalities. Five patients had pancreatic adenomata. Remote tumours rarely affected the scan. Examination of the role of scanning in patients with neoplastic disease revealed that the test was effective in screening and in detection; false negative diagnoses were rare. By contrast, survival following diagnosis was extremely poor with only 8 % of pancreatic tumours resectable and 50 % metastasized at the time of surgery. Causes of pancreatic dysfunction, other than pancreatitis or carcinoma, which were associated with abnormalities on the scan are described and general aspects of reporting on the scan are discussed. The patterns seen in abnormal scans, while non-specific with regard to aetiology, were anatomically meaningful and useful adjuncts to the diagnosis of pancreatic disease. A normal scan excluded pancreatic cancer with a probability greater than 95 %.Following the development of successful pancreatic scanning in human subjects injected with 75Se-selenomethionine (Blau and Bender, 1962)

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supporting

confidence: 71%

75Se-selenomethionine scanning in the diagnosis of tumours of the pancreas and adjacent viscera: The use of the test and its impact on survival

McCarthy¹,

Brown²,

Melmed³

et al. 1972

Gut

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“…Our experience is similar to that of Eaton et al (1968) and suggests that these are generally the most useful techniques employed in the diagnosis of pancreatitis and pancreatic carcinoma, though distinction between the two conditions is often difficult.…”

supporting

confidence: 69%

Value of hypotonic duodenography as an adjunct to pancreatic scanning

McCarthy¹,

Kreel²,

Agnew³

et al. 1969

Gut

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LondonSUMMARY A technique has been developed which allows the position of the upper gastrointestinal tract, as determined radiographically, to be superimposed on the pancreatic photoscan, performed after an injection of 75Se-selenomethionine. Results of the technique applied to 27 'abnormal' and 23 'normal' subjects are described. The importance of the additional information gained by the combined technique is discussed in terms of normal variation and increased diagnostic yield, and the situations in which it was found most useful are described. The addition of correlated duodenography rendered scan reporting more objective in 50 % of cases.Comparisons of the usefulness of radiological and other techniques in solving specific diagnostic problems in pancreatic disease have been undertaken by a number of workers (Sullivan, Meaney, Rodriguez-Antunez, and : Kreel, 1967Eaton, Fleischli, Pollard, Nebesar, and Portsaid, 1968). The reports suggest that all the techniques have well defined 'blind spots'. Pancreatic scanning after injection of 75Se-selenomethionine (Rodriguez-Antu(nez, Filson, Sullivan, and Brown, 1966;Centi Colella and Pigorini, 1967;Brown, Sircus, Smith, Donaldson, Dymock, Falconer, and Small, 1968;Melmed, Agnew, and Bouchier, 1968) and hypotonic duodenography (Raia and Kreel, 1966;Bilbao, Frische, Dotter, and Rosch, 1967;Kreel, 1969;Martel, 1968) have proved to be simple, safe procedures particularly when 'tubeless' hypotonic duodenography is employed. Our experience is similar to that of Eaton et al (1968) and suggests that these are generally the most useful techniques employed in the diagnosis of pancreatitis and pancreatic carcinoma, though distinction between the two conditions is often difficult.A technique, described below, has been developed which allows the position of the duodenal loop, as determined by duodenography, to be superimposed on the photoscan. Using this technique a study was undertaken aimed primarily at answering the question, 'Does the addition of correlated hypotonic duodenography as a routine procedure in patients subjected to pancreatic scanning yield additional information helpful to the interpretation of the scan?'The study also allowed close examination of the scan in difficult interpretive situations. These arise when glandular uptake of the isotope is poor and not greatly in excess of background activity; when the isotope appears in abnormal sites or concentrations; or when the liver or bowel overlaps the pancreas. Under such conditions it may be difficult if not impossible to delineate precise boundaries of the gland. For such reasons one-tenth of scans are unreadable and as many more are interpreted with little confidence. The technique was therefore employed in the hope of reducing this uncertainty and it permitted close study of isotope distribution in the context of known anatomical relations of the pancreas. As no similar studies had been previously reported, interpretation of the results of the study was carried out at a communal reporting session for the first 3...

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“…Furthermore it indicates the severity of functional impairment fairly well. A minority of cases will turn out to have a carcinoma but this problem is not solved by the performance of a Lundh test, and discriminative information is probably best obtained from gas-distension duodenography (Raia and Kreel, 1966), arteriography (Rosch, 1967;Eaton et al, 1968), or percutaneous cholangiography in those who are jaundiced (George, Young, Walker, and Sherlock, 1965). In patients shown to have a localized abnormality in the head of the pancreas on scanning, measurement of duodenal tryptic activity may give a very good indication as to whether or not the abnormality is due primarily to a pancreatic tumour, provided that other rare causes of filling defects, eg, penetration of an area of the head by a peptic ulcer, mesenteric fibrosis, and mesenteric aneurysms (Melmed et al, 1968), can be excluded on other grounds.…”

Section: Discussionmentioning

confidence: 99%

Measurement of duodenal tryptic activity and 75Se-selenomethionine pancreatic scanning compared as tests of pancreatic function

McCarthy¹,

Brown²

1969

Gut

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As 75Se-selenomethionine is incorporated into newly synthesized protein components of the pancreas (Hansson and Blau, 1963) and appears rapidly in secreted enzymes (Van Goidsenhoven, Denk, and Knight, 1965), it seemed logical to compare with the scan the result of a test of enzyme synthesis, and therefore acinar cell function, rath-r than a test of the volume and bicarbonate secretory capacity of the gland in which acinar function may be less important. The Lundh test (Lundh, 1962;Bramwell Cook, Lennard-Jones, Sherif, and Wiggins, 1967) seemed to satisfy this requirement. It is simple to perfotm and furthermore employs only the physiological stimulus of a standard meal before the test.

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Comparison of Current Radiologic Approaches to the Diagnosis of Pancreatic Disease

Cited by 63 publications

References 10 publications

75Se-selenomethionine scanning in the diagnosis of tumours of the pancreas and adjacent viscera: The use of the test and its impact on survival

75Se-selenomethionine scanning in the diagnosis of tumours of the pancreas and adjacent viscera: The use of the test and its impact on survival

Value of hypotonic duodenography as an adjunct to pancreatic scanning

Measurement of duodenal tryptic activity and 75Se-selenomethionine pancreatic scanning compared as tests of pancreatic function

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