Paraduodenal Pancreatitis: Clinical Performance of MR Imaging in Distinguishing from Carcinoma

Kalb, Bobby; Martín, Diego R.; Sarmiento, Juan M.; Erickson, Sarah H.; Gober, Daniel; Tapper, Elliot B.; Chen, Zhengjia; Adsay, Volkan

doi:10.1148/radiol.13112056

Cited by 69 publications

(42 citation statements)

References 19 publications

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“…PDAC and GV are quite difficult to distinguish due to similar features including low signal intensity on fat-suppressed T1-weighted images, intermediate to high signal intensity on T2-weighted MR images, and hypovascularity during the early phase of contrastenhanced CT and MR imaging with variable degrees of delayed enhancement during the delayed phase [85,86]. The key imaging features are mainly depicted on MR imaging and include (a) cystic changes around an accessory pancreatic duct in association with hyperenhancing, thickened wall of the descending duodenum; (b) smooth long stricture of the intrapancreatic CBD without marked upstream biliary dilatation; and (c) displaced CBD and GDA away from the duodenal lumen due to pancreaticoduodenal groove inflammatory tissue [84,[86][87][88] (Fig. 11).…”

Section: Mimics Of Pdacmentioning

confidence: 99%

Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

2020

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Pancreatic ductal adenocarcinoma (PDAC) has continued to have a poor prognosis for the last few decades in spite of recent advances in different imaging modalities mainly due to difficulty in early diagnosis and aggressive biological behavior. Early PDAC can be missed on CT due to similar attenuation relative to the normal pancreas, small size, or hidden location in the uncinate process. Tumor resectability and its contingency on the vascular invasion most commonly assessed with multi-phasic thin-slice CT is a continuously changing concept, particularly in the era of frequent neoadjuvant therapy. Coexistent celiac artery stenosis may affect the surgical plan in patients undergoing pancreaticoduodenectomy. In this review, we discuss the challenges related to the imaging of PDAC. These include radiological and clinical subtleties of the tumor, evolving imaging criteria for tumor resectability, preoperative diagnosis of accompanying celiac artery stenosis, and post-neoadjuvant therapy imaging. For each category, the key imaging features and potential pitfalls on cross-sectional imaging will be discussed. Also, we will describe the imaging discriminators of potential mimickers of PDAC.

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Section: Mimics Of Pdacmentioning

confidence: 99%

Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

2020

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“…The slight hyperintensity on T2 weighted images owes to the initial edema during the subacute phase in the paraduodenal groove; however with time the signal diminishes as edema is replaced with fibrosis [4] , [5] . MRI is more sensitive than CT for demonstrating cystic changes within the thickened duodenal wall [7] , [17] . Post-gadolinium MRI typically demonstrates patchy enhancement on venous phase.…”

Section: Discussionmentioning

confidence: 99%

Paraduodenal pancreatitis as an uncommon cause of gastric outlet obstruction: A case report and review of the literature

Larjani

Stephens

James

et al. 2017

International Journal of Surgery Case Reports

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HighlightsParaduodenal pancreatitis is a rare form of focal chronic or recurrent pancreatitis that can present as gastric outlet obstruction.Endoscopic ultrasound and fine needle aspiration biopsy provides the best diagnostic modality.Key histopathologic features include Brunner gland hyperplasia, myofibroblastic proliferation, spindle cells and foamy cells.Cross-sectional imaging demonstrates a fibrotic, sheet-like mass with cystic change between the duodenal wall and pancreatic head.The optimal treatment for refractory symptoms is pancreaticoduodenectomy.

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“…On imaging a key differentiating feature between GP and cancer is the duodenal wall thickening and cystic changes, a finding extremely uncommon in pancreatic adenocarcinoma. These features have been used to accurately differentiate GP from pancreatic cancer and can be easily identified even by inexperienced radiologists [19]. Other differential considerations such as duodenal adenocarcinoma and ampullary cancer may also be sometimes difficult to differentiate from GP.…”

Section: Discussionmentioning

confidence: 99%

Dual-phase CT findings of groove pancreatitis

Zaheer

Haider

Kawamoto

et al. 2014

European Journal of Radiology

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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.

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Paraduodenal Pancreatitis: Clinical Performance of MR Imaging in Distinguishing from Carcinoma

Abstract: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13112056/-/DC1.

Cited by 69 publications

References 19 publications

Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

Paraduodenal pancreatitis as an uncommon cause of gastric outlet obstruction: A case report and review of the literature

Dual-phase CT findings of groove pancreatitis

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