Isoattenuating Pancreatic Adenocarcinoma at Multi–Detector Row CT: Secondary Signs

Prokesch, Rupert; Chow, Laurence C.; Beaulieu, Christopher F.; Bammer, Roland; Jeffrey, R. Brooke

doi:10.1148/radiol.2243011284

Cited by 299 publications

(159 citation statements)

References 15 publications

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“…Discrimination becomes apparent mainly in the late arterial (pancreatic) phase and to a lesser degree in the portal phase of a biphasic helical or multidetector row CT examination ( fi g. 1 , 3 ). It has been reported that about 90% of pancreatic adenocarcinoma display obvious lower attenuated values with a mean tumorpancreas contrast of about 75HU + 35 during the late arterial phase of CT imaging [36] . The remainder 10% of pancreatic adenocarcinomas exhibit a mean tumor-pancreas contrast of only about 9HU + 11, differences which are not visually perceptible, impeding on the CT detection of small lesions [36] .…”

Section: Tumor Detection In Acute Pancreatitismentioning

confidence: 99%

Pancreatitis associated with pancreatic carcinoma

Balthazar

2005

Pancreatology

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Section: Tumor Detection In Acute Pancreatitismentioning

confidence: 99%

Pancreatitis associated with pancreatic carcinoma

Balthazar

2005

Pancreatology

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“…(19) The same is true with the case of BOP-treated hamsters. However the contrast between tumors and parenchyma in hamster pancreas was slightly inferior to that in humans, despite the higher dose of iopamidol than the manufacturer's recommendations for humans.…”

Section: Discussionmentioning

confidence: 69%

Imaging study of pancreatic ductal adenocarcinomas in Syrian hamsters using X‐ray micro‐computed tomography (CT)

Kitahashi¹,

Mutoh

Tsurusaki

et al. 2010

Cancer Science

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X-ray computed tomography (CT) has been used for diagnoses of human pancreatic cancer. Although micro-CT is a useful approach to evaluate macromorphology of organs ⁄ tissue also in animal models, reports on pancreatic tumors are limited. In this study, the utility of micro-CT was assessed in characterizing chemically induced pancreatic tumors in Syrian hamsters. Hamsters treated with or without N-nitrosobis(2-oxopropyl)amine (BOP) were injected with the antispasmodic agent, scopolamine butylbromide, and contrast agents, 5 or 10 mL ⁄ kg body weight of iopamidol or Fenestra VC at 18-38 weeks, then examined by micro-CT scanning with a respiratory gating system. Both peristaltic and respiratory movements were substantially suppressed by the combination of scopolamine butylbromide treatment and the respiratory gating system, resulting in improvements of image qualities. Iopamidol clearly visualized the pancreatic parenchyma and contrasted the margins among the pancreas and other abdominal organs ⁄ tissue. Meanwhile Fenestra VC predominantly contrasted abdominal vascular systems, but the margins among pancreas and other organs ⁄ tissue remained obscure. Six pancreatic tumors of 4-13 mm in diameter were detected in four of 15 animals, but not the five tumors of 1-4 mm in diameter. The inner tumor images were heterogeneously or uniformly visualized by iopamidol and Fenestra VC. Overall, iopamidol could clearly contrast between pancreatic parenchyma and the tumors as compared with Fenestra VC. All tumors confirmed were histopathologically diagnosed as pancreatic ductal adenocarcinomas. Thus, micro-CT could be useful to evaluate the carcinogenic processes and preventive methods of pancreatic cancer in hamsters and to assess the novel contrast agents for detection of small pancreatic cancer in humans. (Cancer Sci 2010; 101: 1761-1766 P ancreatic cancer is the fifth cause of cancer death in Japan and ranks high in mortality among developed countries. (1,2) Because of the difficulty in detecting pancreatic cancer in early operable stages, and because of the lack of any curative treatment approaches other than complete surgical removal, 5-year relative survival rate is <6%.(3,4) Therefore, for improvement of outcome, future strategies for early diagnosis of pancreatic cancer should aim at diagnosing most pancreatic cancers before they grow 20 mm in size. (5,6) X-ray computed tomography (CT) has been widely used in detection and evaluation of pancreatic tumor progression and metastasis during clinical treatment. Recently, the CT devices have been markedly improved in their volume coverage speed, longitudinal resolution, and quality of three-dimensional reformations. In addition, dynamic CT scanning has been developed, in which CT-images of pancreas can be obtained for a short time with breath holding. This method reveals some adequate contrasts between pancreatic parenchyma and neoplastic lesions. However, detectability of small pancreatic cancer, especially those <10 mm in size, has not yet been satisfactory.(8-10) Further a...

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“…Ductal stenosis is a secondary sign of pancreatic neoplasms, both adenocarcinoma and neuroendocrine neoplasms (74)(75)(76); however, a ductal stenosis may occur also in patients with chronic pancreatitis or autoimmune pancreatitis and as a late complication of abdominal trauma. In some patients, the differential diagnosis between a neoplastic and a benign cause of ductal stenosis is complicated by the coexistence in benign disease of a focal pancreatic enlargement due to inflammation, granulation tissue or lymphocytes, and plasma cell in a periductal infiltrate.…”

Section: Main Pancreatic Duct Stenosismentioning

confidence: 99%

Secretin-enhanced MR Imaging of the Pancreas

Manfredi¹,

Mucelli²

2016

Radiology

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1Secretin is a hormone that stimulates the exocrine pancreatic secretion of bicarbonate-rich fluid from the acinar cells of the pancreas that accumulates within the pancreatic ductal lumen. The exogenous administration of secretin improves the visualization of pancreatic ducts at magnetic resonance (MR) cholangiopancreatography (MRCP), because of an enlargement of the pancreatic duct system and an increase of the fluid content within the lumen of the pancreatic ducts, responsible of an increase of MR signal. In this review, the technique of secretin-enhanced MRCP, which has the aim to depict the whole pancreatic duct system, the biliary tree, the major and minor papillae, and the duodenum, will be described. Because of the anatomic contiguity between the pancreas and the gastrointestinal tract, the presence of fluid within the stomach may overlap with the pancreatic duct system and therefore the pancreatic duct may be difficult to visualize, representing a potential source of diagnostic pitfalls. The technique to reduce the signal intensity of the static fluid present within the stomach and in the duodenal lumen is also described. The technique of secretin administration will be illustrated, with emphasis on the synchronization of secretin administration and MR image acquisition. Furthermore, the frequency and number of MRCP images necessary to achieve a temporal resolution adequate to visualize the physiologic changes in the pancreatic gland, induced by the administration of secretin, is described. The assessment of pancreatic, morphologic, and functional response to the administration of secretin, as depicted on MRCP images, will be illustrated. Finally, the indications for secretin-enhanced MRCP will be discussed to define which patients will benefit from secretin-enhanced MR imaging for their treatment planning. © RSNA, 2016 This copy is for personal use only. To order printed copies, contact reprints@rsna.org I n recent years, magnetic resonance (MR) imaging has increased its role in the detection and characterization of pancreatic diseases. This is most likely due to the capability of MR imaging to simultaneously assess the pancreatic parenchyma and the pancreatic and bile duct systems. This can be achieved by obtaining cross-sectional MR images by using breath-hold T1-weighted gradient-echo sequences performed as two-or three-dimensional gradient-echo, fat-suppression techniques; T2-weighted half-Fourier pulse sequences; diffusion-weighted imaging; and dynamic contrast material-enhanced imaging following the administration of gadolinium chelates that are able to depict and characterize focal pancreatic masses and evaluate diffuse pancreatic diseases. Furthermore, MR cholangiopancreatography (MRCP) is STATE OF THE ART: Essentialsn Secretin-enhanced magnetic resonance cholangiopancreatography (MRCP) is indicated in patients with chronic asymptomatic hyperenzymemia, recurrent acute pancreatitis, sphincter of Oddi dysfunction, anatomic variants, chronic pancreatitis, and main pancreatic duct stenosis.n Se...

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Isoattenuating Pancreatic Adenocarcinoma at Multi–Detector Row CT: Secondary Signs

Abstract: With no visible tumor-pancreas contrast for isoattenuating tumors, indirect signs such as mass effect, atrophic distal parenchyma, and an interrupted duct sign are important indicators for the presence of tumor.

Cited by 299 publications

References 15 publications

Pancreatitis associated with pancreatic carcinoma

Pancreatitis associated with pancreatic carcinoma

Imaging study of pancreatic ductal adenocarcinomas in Syrian hamsters using X‐ray micro‐computed tomography (CT)

Secretin-enhanced MR Imaging of the Pancreas

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