Perfusion CT – Can it resolve the pancreatic carcinoma versus mass forming chronic pancreatitis conundrum?

Yadav, Ajay; Sharma, Raju; Kandasamy, Devasenathipathy; Pradhan, Rajesh; Garg, Pramod Kumar; Bhalla, Ashu Seith; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Sahni, Peush; Upadhyay, Ashish Datt

doi:10.1016/j.pan.2016.08.011

Cited by 50 publications

(37 citation statements)

References 30 publications

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“…However, there are few promising techniques such as CT perfusion has been used to differentiate MFCP from carcinoma pancreas. 21 Both MFCP and carcinoma pancreas showed decreased blood flow compared with normal pancreas on CT perfusion; however, the magnitude of reduction in blood flow was reported to be significantly lower on carcinoma pancreas compared with MFCP. In spite of these advancements in imaging techniques, EUS-guided sampling is still necessary in these patients.…”

Section: Mass Forming Chronic Pancreatitismentioning

confidence: 91%

Imaging in Chronic Pancreatitis

Sood

Kandasamy

Sharma

2020

Journal of Gastrointestinal and Abdominal Radiology

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Chronic pancreatitis (CP) is a chronic progressive process which can cause irreversible damage to both the exocrine and endocrine systems of pancreas. There are various imaging modalities available to evaluate CP of which ultrasonography ( USG), computed tomography (CT), and magnetic resonance imaging (MRI) are most commonly used. USG is used as a screening modality which can show various changes of CP and its complications. However, the information obtained from USG can be limited because of the patient’s body habitus. CT is the workhorse modality which can provide comprehensive information and it is the best modality to detect calcification. MRI, on the other hand, is excellent in demonstrating the pancreatic parenchyma and the ductal system. Alcohol-related pancreatitis is the commonest cause which can show gland atrophy, ductal dilatation, and calcifications. Other less common causes include hereditary and genetic mutation–related pancreatitis. There are other special types of pancreatitis such as autoimmune pancreatitis and groove pancreatitis that have characteristic features on imaging.

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Section: Mass Forming Chronic Pancreatitismentioning

confidence: 91%

Imaging in Chronic Pancreatitis

Sood

Kandasamy

Sharma

2020

Journal of Gastrointestinal and Abdominal Radiology

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“…A malignancy in CP can be seen radiologically as a lesion in diffuse CP or mass forming focal CP [6][7][8]. An inflammatory lesion in head of pancreas, called a pseudotumor, can be seen in 10% of presumed and resected adenocarcinomas [9].…”

Section: Evaluation For Suspicious Malignancy In Cpmentioning

confidence: 99%

“…Blood flow is the single most important parameter [6] in perfusion CT. Blood flow and blood volume as well as peak enhancement are 45 and 43% lower in PDAC, respectively, compared to CP.…”

Section: Evaluation For Suspicious Malignancy In Cpmentioning

confidence: 99%

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Diagnosis and Management of Pancreatic Adenocarcinoma in the Background of Chronic Pancreatitis: Core Issues

Narkhede

Desai

Prasad

et al. 2019

Dig Dis

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Background: The incidence of pancreatic adenocarcinoma (PDAC) in patients with chronic pancreatitis (CP) is as high as 5%. It is a commonly encountered diagnostic challenge in patients with CP on long-term follow-up. Summary: This review consolidates the existing literature on assessment of PDAC in background of CP, its evaluation through the available investigations, surgical management, and prognostication. Recent change in symptomatology of an otherwise stable CP should raise a suspicion of malignancy. Endoscopic ultrasound (EUS) is more specific and sensitive in establishing the diagnosis of PDAC compared to cross-sectional imaging (computed tomography/magnetic resonance imaging). Intraoperative assessment with careful palpation coupled with careful clinical judgment helps in differentiating between an inflammatory mass and pancreatic cancer. Confirmation can be obtained with either preoperative EUS-guided fine needle cytology/core biopsy or intraoperative core biopsy under ultrasound guidance. However, despite complete evaluation with above options, 1–6% patients often show malignancy on final histopathological examination. Key Messages: Diagnosis of PDAC in CP needs a high index of suspicion. Cross-sectional imaging has poor negative predictive value. CA 19-9 with MUC5AC combination may become an ideal investigation. EUS with core biopsy/frozen section has a good sensitivity and specificity and low false negative results. Complete radical resection should be the aim to get long-term survival.

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“…Second, it has been demonstrated that the heat sink effect caused by a high tissue perfusion rate may negatively affect the HIFU treatment efficiency [9]. The pancreas is an organ with a relatively low blood perfusion (blood flow of 94.1 ± 24 mL/100 mL of tissue min) and it has also been shown that perfusion is decreased in pancreatic adenocarcinoma especially, (blood flow of 16.6 ± 13.1 mL/ 100 mL of tissue min) [10]. Pancreatic tissue displacement due to respiratory motion has also been characterized and is known to occur mainly in the cranio-caudal direction, with an average maximum amplitude of 7.5 ± 4.6mm in prone position [11].…”

Section: Introductionmentioning

confidence: 99%

A planning strategy for combined motion-assisted/gated MR guided focused ultrasound treatment of the pancreas

Ferrer

Bos

Borman

et al. 2019

International Journal of Hyperthermia

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Objective: To develop and evaluate a combined motion-assisted/gated MRHIFU heating strategy designed to accelerate the treatment procedure by reducing the required number of sonications to ablate a target volume in the pancreas. Methods: A planning method for combined motion-assisted/gated MRHIFU using 4D-MRI and motion characterization is introduced. Six healthy volunteers underwent 4D-MRI for target motion characterization on a 3.0-T clinical scanner. Using displacement patterns, simulations were performed for all volunteers for three sonication approaches: gated, combined motion-assisted/gated, and static. The number of sonications needed to ablate the pancreas head was compared. The influence of displacement amplitude and target volume size was investigated. Spherical target volumes (8, 15, 20 and 34 mL) and displacement amplitudes ranging from 5 to 25 mm were evaluated. For this case, the number of sonications required to ablate the whole target was determined. Results: The number of required sonications was lowest for a static target, 62 on average (range 49-78). The gated approach required most sonications, 126 (range 97-159). The combined approach was almost as efficient as the hypothetical static case, with an average of 78 (range 53-123). Simulations showed that with a 5-mm displacement amplitude, the target could be treated by making use of motion-assisted MRHIFU sonications only. In that case, this approach allowed the lowest number of sonication, while for 10 mm and above, the number of required sonications increased. Conclusion: The use of a combined motion-assisted/gated MRHIFU strategy may accelerate tumor ablation in the pancreas when respiratory-induced displacement amplitudes are between 5 and 10 mm. ARTICLE HISTORYThermal ablation; high intensity focused ultrasound; imaging (i.e.; MRI); modeling (i.e.; treatment planning)

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Perfusion CT – Can it resolve the pancreatic carcinoma versus mass forming chronic pancreatitis conundrum?

Cited by 50 publications

References 30 publications

Imaging in Chronic Pancreatitis

Imaging in Chronic Pancreatitis

Diagnosis and Management of Pancreatic Adenocarcinoma in the Background of Chronic Pancreatitis: Core Issues

A planning strategy for combined motion-assisted/gated MR guided focused ultrasound treatment of the pancreas

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