Type:
Educational Exhibit
Keywords:
Dilatation, Diagnostic procedure, MR, CT, Pancreas, Oncology, Abdomen
Authors:
N. Deresh, O. Chukanov; Kiev/UA
DOI:
10.1594/ecr2018/C-0015
Background
Duct of Wirsung is the main duct of the pancreas,
which is connected to smaller channels.
The physiological function of the duct is to transfer secretion of the pancreas into the digestive tract.
The duct begins at the tail of the organ,
passes through the entire body to its head and opens into the duodenum,
has about 20 cm in length,
up to 4 mm in diameter with small gradient: tail 1.5 mm,
body 2.5 mm,
head 3.5-4.0 mm.
Unexpanded branch ducts are normally not visible on CT and MRI.
Ectasia of the duct of Wirsung is one of the main symptoms of pancreatic disease (tumors in particular) and its features may have a large impact on the differential diagnostics of morphologically different formations.
Pancreatic ductal adenocarcinoma is characterized by an abundant desmoplastic stroma and causes early stenosis of MPD.
So,
even slight dilatation of the main pancreatic duct appears to be a sign of high risk for pancreatic cancer.
Isolated MPD dilatation often is the first sign of diseases,
even without any visible mass on images or very small size of lesions.
Some authors evaluated differential CT features of benign and malignant main pancreatic duct dilatation.
The diagnostic performance of radiologists with regard to differentiation was significantly improved with knowledge of highly suggestive CT criteria.
Multidetector spiral CT with thin collimation could acquire high-quality curved planar reformations to display the profile of the whole pancreas,
to trace the pancreatic ducts and to show the relationship of lesions in one curved plane (Fig.1).
Magnetic resonance cholangiopancreatography (MRCP) continues to have a fundamental role in the non-invasive investigation pancreatico-biliary ducts,
can image the ductal system in detail (Fig.2).