Learning objectives
Early primary pancreatic cancer can be sometimes missed at prediagnostic examinations (US,CT,MRI), performed for other clinical questions.Technical artefacts and radiologist expertise play a role to distinguish between pancreatic/peripancreatic non-neoplastic findings(inflammatory diseases, anatomic variants,senile fatty involution) and signs of malignant pancreatic neoplasm growing.The purposes of this educational poster are to illustrate pancreatic imaging pitfalls in the diagnosis of pancreatic malignancy and to provide tips for early detection of malignant pancreatic adenocarcinoma (PDA) and intraductal papillary mucinous neoplasm (IPMN).
Background
Early signs of pancreatic malignancy are sometimes missed by radiologists. Pre-diagnostic imaging exams performed months or even years before the diagnosis of PDA and malignant IPMN may show in some cases subtle suspicious findings of malignancy.Acquisition of adequate CT and MR protocols (Figure 1) for pancreas evaluation are of utmost importance in the diagnostic path[1].
Findings and procedure details
The most common mimickers
Some non-neoplastic pancreatic diseases and anatomic variants can mimic pancreatic adenocarcinoma (PDA).
Pancreatitis
Focal chronic pancreatitis and autoimmune pancreatitis may have a radiologic appearance similar to PDA(focal lesion with upstream biliary or pancreatic duct dilatation).Patient symptoms can be similar:abdominal pain and weight loss.Chronic pancreatitis, with inflammation and fibrosis,can lead to irregular parenchymal enhancement on contrast CT,glandular atrophy,calcifications and pancreatic duct dilation[1-2].
MRI is useful for differential diagnosis.On MRI,PDA shows low signal intensity on unenhanced T1w sequences and an enhancement that is...
Conclusion
Prediagnostic CT and MR may show pitfalls and subtle findings suggestive of indolent early detection of PDA and malignant IPMN. The most common findings are focal hypoattenuating lesion, pancreatic duct dilatation and/or interruption, associated with pancreatic tail atrophy. Radiologist confidence in the acknowledgment of early, indirect signs of neoplastic lesion has a leading role in the multidisciplinary decision of surgical resectability of a pancreatic lesion.
Personal information and conflict of interest
Dr. Rossana Taravella
email:
[email protected]
Twitter: @rossanatar1
Dr. Federica Vernuccio
email:
[email protected]
Twitter: @DrF_Vernuccio
Dr. Roberto Cannella
email:
[email protected]
Twitter: @cannella_rob
Prof. Giuseppe Brancatelli
email:
[email protected]
Prof. Massimo Midiri
email:
[email protected]
The authors declare that they have no conflict of interest:
Biomedicina, Neuroscienze e Diagnostica avanzata (Bi.N.D.)
University of Palermo
Via del Vespro 129, 90127, Palermo, Italy
References
[1]. Vernuccio F, et al. Common and uncommon pitfalls in pancreatic imaging: it is not always cancer. Abdom Radiol (2016) 41:283–294.
[2]. Al-Hawary MM, et al. (2013) Mimics of pancreatic ductal adenocarcinoma. Cancer Imaging 13(3):342–349.
[3]. Kim JK, et al. (2007) Focal pancreatic mass: distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo MRI. J Magn Reson Imaging 26(2):313–322.
[4]. Ichikawa T, et al. (2001) Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 221(1):107–116.
[5]. Raimondi S, et...
