Keywords:
Abdomen, Pancreas, CT, MR, Education, eLearning, Inflammation, Neoplasia, Tissue characterisation
Authors:
B. Op de Beeck1, A. Snoeckx2, M. Spinhoven1, R. Salgado1, P. M. Parizel1; 1Edegem/BE, 2Zandhoven/BE
Learning objectives
A common diagnostic problem is how to differentiate malignant solid pancreatic lesions from benign entities like pancreatitis.
Especially if you are dealing with focal forms like paraduodenal pancreatitis (cystic dystrophy of the duodenum or groove pancreatitis) or autoimmune pancreatitis (IgG4 related pancreatitis).
Paraduodenal pancreatitis is a distinct form of chronic pancreatitis characterized by inflammation and fibrous tissue formation,
affecting the groove area near the minor papilla between the head of the pancreas,
the duodenal wall and the common bile duct.
Paraduodenal pancreatitis has been divided into pure (the head of the pancreas is spared),
segmental (the pancreatic head and the ducts are affected) and non segmental (secondary to established chronic pancreatitis) forms.
Autoimmune pancreatitis is distinct from calcifying and obstructive forms of chronic pancreatitis.
Destructive changes of the pancreatic ducts characterized by multiple or single strictures without marked upstream dilatation are important features.
Pancreatic calcifications and pseudocysts are usually absent.
We radiologists have the important role to differentiate these benign entities from pancreatic adenocarcinoma,
neuroendocrine tumours,
lymphoma and pancreatic metastases.
The typical CT-findings and limitations will be demonstrated as well as the additional and complementary role of MRI.
We will focus on morphological signs (pancreatic,
peripancreatic and ductal),
dynamic contrast behaviour and value/limitations of diffusion weighted imaging and ADC.
Clues to a correct diagnosis will be given and pitfalls in imaging interpretation will be discussed.