Dual-phase CT findings of groove pancreatitis

Abstract

Purpose Groove pancreatitis is a rare focal form of chronic pancreatitis that occurs in the pancreaticoduodenal groove between the major and minor papillae, duodenum and pancreatic head. Radiologic appearance and clinical presentation can result in suspicion of malignancy rendering pancreaticoduodenectomy inevitable. This study reports dual phase CT findings in a series of 12 patients with pathology proven groove pancreatitis. Materials and methods Retrospective review of preoperative CT findings in 12 patients with histologically proven groove pancreatitis after pancreaticoduodenectomy. Size, location, attenuation, presence of mass or cystic components in the pancreas, groove and duodenum, calcifications, duodenal stenosis and ductal changes were recorded. Clinical data, laboratory values, endoscopic ultrasonographic and histopathological findings were collected. Results Soft tissue thickening in the groove was seen in all patients. Pancreatic head, groove and duodenum were all involved in 75% patients. A discrete lesion in the pancreatic head was seen in half of the patients, most of which appeared hypodense on both arterial and venous phases. Cystic changes in pancreatic head were seen in 75% patients. Duodenal involvement was seen in 92% patients including wall thickening and cyst formation. The main pancreatic duct was dilated in 7 patients, with an abrupt cut off in 3 and a smooth tapering stricture in 4. Five patients had evidence of chronic pancreatitis with parenchymal calcifications. Conclusion Presence of mass or soft tissue thickening in the groove with cystic duodenal thickening is highly suggestive of groove pancreatitis. Recognizing common radiological features may help in diagnosis and reduce suspicion of malignancy.

Clinicoradiological appraisal of ′paraduodenal pancreatitis′: Pancreatitis outside the pancreas!

“…[ 30 ] More recently, Zaheer et al , reported pancreatic duct dilatation in 8 of their 12 patients (66.66%), calcifications localized to the head in 4 (33%), diffuse calcification in 1 (8.33%), and pancreatic glandular atrophy in 3 (25%) patients. [ 31 ] Twelve of our 33 (36.3%) patients showed pancreatic parenchymal atrophy, while 10 (30.3%) patients showed pancreatic calcifications and as many as 18 (54.54%) patients showed main pancreatic duct dilatation.…”

“…[ 24 28 ] The pure form of the disease is relatively uncommon; in a surgical series of 600 patients, the pure form was detected in only 2% cases, although the changes in the pancreatic head may not always identifiable on imaging alone. [ 9 31 ]…”

The role of diffusion-weighted imaging in the diagnosis of thymic metastasis

“…However, we would like to acquaint the readership with other terminologies that are used synonymously to describe groove pancreatitis including paraduodenal pancreatitis, cystic duodenal dystrophy, duodenal pancreatitis, etc. [2,3]. Of these, paraduodenal pancreatitis needs a distinct mention.…”

“…PET/CT is relevant for the imaging of thymic tumors but it is expensive, includes high doses of radiation exposure, and is not readily available [2]. In fact, DWI could be used for the diagnosis of a tumor as well as aggressiveness of a lesion.…”

“…In fact, DWI could be used for the diagnosis of a tumor as well as aggressiveness of a lesion. Razek et al have shown that the cutoff mean apparent diffusion coefficient (ADC) value is 1.22×10 − 3 mm 2 /s (b-values 0, 400, and 800 s/mm 2 ) in differentiate low-risk thymoma, high-risk thymoma, and thymic carcinoma [2]. Seki et al reported that mean ADC values are significantly lower in malignant tumors [1.11+0.40×10 − 3 mm 2 /s (bvalues 0 and 1000 s/mm 2 )] than thymomas [3].…”