Possibility of Radiology Diagnostics of Pancreatic Pseudocysts

BACKGROUND: Surgical treatment of pancreatic cysts is one of the most difficult procedures in pediatric surgery. In children with pancreatic cysts, the issues of differential diagnosis and determining the connection of the cyst cavity with the main pancreatic duct remain problematic. Recent publications have focused on the use of endoscopic ultrasonography in pediatric practice to visualize the parenchyma and the ductal system of the pancreas with high accuracy. AIM: This work aimed to study the results of treatment of children with cystic formations of the pancreas using modern radiation diagnostic methods and minimally invasive surgical technologies. MATERIALS AND METHODS: Analysis was conducted on the results of treatment of 66 patients consisting of 30 boys (45.5%) and 36 girls (54.5%) aged 6 months to 18 years (average age of 10.9 5.2 years) with extraparenchymatous and intraparenchymatous pancreatic cysts. RESULTS: Multispiral computed tomography (Se 90%, Sp 91%, and Ac 91%; p 0.05) and magnetic resonance imaging (Se 96%, Sp 94%, Ac 95%; p 0.05) are the most informative for the differential diagnosis of intra- and extraparenchymatous pancreatic cysts. For thin-walled extraparenchymatous cysts up to 6 cm in size, conservative therapy is effective in the early period of the disease. External (42.4%) and internal (51.3%) drainage of cysts can be performed when the existence of pancreatic pseudocysts is prolonged (more than 2 months). Indications for simultaneous longitudinal pancreaticoejunostomy may occur in 9.5% of patients. Excision of the pseudocyst with pancreatic resection may be required in 4.7% of cases. For intraparenchymatous cysts, 33.3% of cases require the enucleation of cystic formation, 25% require the distal splenoserving resection of the pancreas, 25% require the central resection of the pancreas with the imposition of distal pancreatoejunoanastomosis, and 12.5% require pylori-preserving pancreatoduodenal resection. Approximately 70.8% of surgical interventions on the pancreas in children can be performed by laparoscopic access with a conversion rate in 12.5% of cases. CONCLUSIONS: The choice of surgical intervention in children with pancreatic cysts is determined by the etiology, cyst size, localization, connection with the main pancreatic duct, and degree of involvement of the parenchyma in the tumor process. Most operations on the pancreas may be performed using minimally invasive approaches.

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Characterization of the structure of local complications of necrotic pancreatitis in the late phase using CT and MRI

Arablinskii,

Titov,

Buslavskaya

2024

Medicinskaâ vizualizaciâ

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Introduction: Computed tomography is the most common imaging modality used to identify necrotic collectionsin acute pancreatitis. However, using CT alone, it can be difficult to differentiate necrotic residues from the liquid component, which plays an important role in planning the intervention and predicting the outcome.Objective. To evaluate the advantages and disadvantages, as well as the specifics of the use of CT and MRI in characterizing these complications. To characterize and structure local complications of pancreatic necrosis in the late phase using CT and MRI.Materials and methods. The data of patients of the Botkin State Clinical Hospital for 2017–2022 with a diagnosis of necrotising pancreatitis, who underwent both CT and MRI after 2 weeks or more from the onset of the disease (2nd or late phase of necrotising pancreatitis), were analyzed. There are 57 people in total (34 men and 23 women), the age range is 18–71 years. CT was performed with intravenous four-phase contrast, images in the pancreatic phase were used for evaluation. MRI was performed using a standard protocol including T2-weighted images or the MRCP protocol.Results. A total of 102 peripancreatic collectionswere identified, the minimum size for evaluation was 20 mm, one patient could have more than one collection. The data obtained were structured in pairs: one collection corresponded to its images on CT and on MRI. CT showed a sensitivity of 77% with respect to dense material in the structure, while MRI revealed sequestration in all cases, sensitivity of 100%. It was possible to visualize the communication of the main pancreatic duct with accumulation on MRI in 12% of cases, on CT in 4% of cases. The identified collectionswere classified into three types based on their structure.Conclusions. CT remains the “gold standard” for the diagnosis of acute pancreatitis and necrotising pancreatitis, however, it has limited sensitivity in characterizing the structure of local complications in the late phase of the disease. Due to its greater tissue contrast MRI allows to assess the composition of peripancreatic collections and determine their possible connection with the ductal system. The types of collectionswe have identified based on CT and MRI imaging contribute to a more objective assessment of the picture in order to select the most appropriate method of patient management and the type of possible surgical treatment.

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Possibility of Radiology Diagnostics of Pancreatic Pseudocysts

Cited by 3 publications

References 4 publications

Minimally invasive treatment of a giant pancreatic pseudocyst

Minimally invasive treatment of a giant pancreatic pseudocyst

Pancreatic cysts in children: diagnostical and surgical tactics

Characterization of the structure of local complications of necrotic pancreatitis in the late phase using CT and MRI

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