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Kang JG, Park JH, Park MS, Han K, Lee HS, Yang HK. Differentiation of intrapancreatic accessory spleen from pancreatic neuroendocrine tumor using MRI R2. Abdom Radiol (NY) 2025:10.1007/s00261-024-04758-y. [PMID: 39841231 DOI: 10.1007/s00261-024-04758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 12/09/2024] [Accepted: 12/10/2024] [Indexed: 01/23/2025]
Abstract
PURPOSE To evaluate the performance of R2* in distinguishing intrapancreatic accessory spleens (IPASs) from pancreatic neuroendocrine tumors (PNETs). METHODS Two radiologists (R1 and R2) retrospectively reviewed the MRIs of 20 IPAS and 20 PNET patients. IPASs were diagnosed with uptake on 99mTc labeled heat-damaged red blood cell scintigraphy or characteristic findings on CT/MRI and ≥ 12 month-long-stability. PNETs were histopathologically diagnosed with resection. Using McNemar test, sensitivities and specificities of the diagnostic criterion based on R2* mass-to-spleen ratio (MSR) were compared with those of the other criteria using contrast-enhanced (CE) MRI and apparent diffusion coefficient (ADC) MSR. RESULTS The study included 40 patients (median age, 54; interquartile range, 43-65; 24 men, 16 women). IPASs exhibited spleen-isointensity on T2WI, late arterial and portal phases, and diffusion-weighted images more frequently than PNETs (p <.05). ADC MSRs were lower (p <.001) and R2* MSRs were higher (p <.001) in IPASs compared to PNETs. For R1, sensitivity and specificity were 45.0% and 100.0% for criterion 1 (spleen-isointensity on CE-MRI); 45.0% and 85.0% for criterion 2 (ADC MSR ≤ 1.08); 90.0% and 95.0% for criterion 3 (0.9 ≤ R2* MSR ≤ 1.7). For R2, 75.0% and 100.0%; 45.0% and 90.0%; 90.0% and 100.0%. Criterion 3 showed higher sensitivity than criterion 1 for R1 (p =.004), and criterion 2 for R1 and R2 (p =.012). There was no difference in specificity. CONCLUSION For differentiating IPAS from PNET, R2* showed higher sensitivity than, and similar specificity to CE-MRI and ADC.
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Affiliation(s)
- Jun Gu Kang
- Severance Hospital, Seoul, Republic of Korea
| | | | - Mi-Suk Park
- Severance Hospital, Seoul, Republic of Korea
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Tsujimoto R, Kurokawa R, Yamamoto A, Kawaguchi Y, Miyashita M, Hasegawa K, Abe O. Epidermoid Cyst in an Intrapancreatic Accessory Spleen Complicating Clinical Decision-Making: A Case Report With Characteristic Imaging Findings. Cureus 2024; 16:e69957. [PMID: 39445281 PMCID: PMC11496593 DOI: 10.7759/cureus.69957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2024] [Indexed: 10/25/2024] Open
Abstract
Epidermoid cyst in intrapancreatic accessory spleen (ECIPAS) is a rare benign condition that occasionally mimic malignant pancreatic neoplasms. We present a case of ECIPAS in a 53-year-old asymptomatic male, initially discovered incidentally during imaging for a suspected hepatic hemangioma. The lesion, located in the pancreatic tail, demonstrated characteristic imaging features on contrast-enhanced computed tomography and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI), including a cystic component with peripheral solid tissue exhibiting splenic enhancement patterns. Despite these typical ECIPAS findings, the lesion increased in size from 38 × 33 mm to 50 × 45 mm over 12 months, accompanied by a significant rise in serum carbohydrate antigen 19-9 (CA19-9) from 21 to 330 U/mL. This clinical progression raised concerns about potential malignancy, leading to a robot-assisted spleen-preserving distal pancreatectomy. Histopathological examination confirmed the diagnosis of ECIPAS. Postoperatively, the patient's serum CA19-9 levels normalized. This case highlights that ECIPAS can complicate clinical decision-making through size increase and CA19-9 elevation, complicating preoperative diagnosis. However, careful analysis of imaging characteristics, particularly on SPIO-enhanced MRI, can aid in accurate diagnosis.
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Affiliation(s)
| | | | | | | | - Mari Miyashita
- Hepato-Biliary-Pancreatic Surgery, The University of Tokyo, Tokyo, JPN
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery, The University of Tokyo, Tokyo, JPN
| | - Osamu Abe
- Radiology, The University of Tokyo, Tokyo, JPN
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Ren S, Guo K, Li Y, Cao YY, Wang ZQ, Tian Y. Diagnostic accuracy of apparent diffusion coefficient to differentiate intrapancreatic accessory spleen from pancreatic neuroendocrine tumors. World J Gastrointest Oncol 2023; 15:1051-1061. [PMID: 37389113 PMCID: PMC10302999 DOI: 10.4251/wjgo.v15.i6.1051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/01/2023] [Accepted: 04/19/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Intrapancreatic accessory spleen (IPAS) shares similar imaging findings with hypervascular pancreatic neuroendocrine tumors (PNETs), which may lead to unnecessary surgery. AIM To investigate and compare the diagnostic performance of absolute apparent diffusion coefficient (ADC) and normalized ADC (lesion-to-spleen ADC ratios) in the differential diagnosis of IPAS from PNETs. METHODS A retrospective study consisting of 29 patients (16 PNET patients vs 13 IPAS patients) who underwent preoperative contrast-enhanced magnetic resonance imaging together with diffusion-weighted imaging/ADC maps between January 2017 and July 2020 was performed. Two independent reviewers measured ADC on all lesions and spleens, and normalized ADC was calculated for further analysis. The receiver operating characteristics analysis was carried out for evaluating the diagnostic performance of both absolute ADC and normalized ADC values in the differential diagnosis between IPAS and PNETs by clarifying sensitivity, specificity, and accuracy. Inter-reader reliability for the two methods was evaluated. RESULTS IPAS had a significantly lower absolute ADC (0.931 ± 0.773 × 10-3 mm2/s vs 1.254 ± 0.219 × 10-3 mm2/s) and normalized ADC value (1.154 ± 0.167 vs 1.591 ± 0.364) compared to PNET. A cutoff value of 1.046 × 10-3 mm2/s for absolute ADC was associated with 81.25% sensitivity, 100% specificity, and 89.66% accuracy with an area under the curve of 0.94 (95% confidence interval: 0.8536-1.000) for the differential diagnosis of IPAS from PNET. Similarly, a cutoff value of 1.342 for normalized ADC was associated with 81.25% sensitivity, 92.31% specificity, and 86.21% accuracy with an area under the curve of 0.91 (95% confidence interval: 0.8080-1.000) for the differential diagnosis of IPAS from PNET. Both methods showed excellent inter-reader reliability with intraclass correlation coefficients for absolute ADC and ADC ratio being 0.968 and 0.976, respectively. CONCLUSION Both absolute ADC and normalized ADC values can facilitate the differentiation between IPAS and PNET.
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Affiliation(s)
- Shuai Ren
- Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Kai Guo
- Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Yuan Li
- Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Ying-Ying Cao
- Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Zhong-Qiu Wang
- Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Ying Tian
- Department of Radiology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
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Kim JW, Kim KA, Sim KC, Lee J, Park BN, Song MJ, Park YS, Lee J, Choi JW, Lee CH. Ectopic lesions in the abdomen and pelvis: a multimodality pictorial review. Abdom Radiol (NY) 2022; 47:2254-2276. [PMID: 35441342 DOI: 10.1007/s00261-022-03520-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
Various ectopic lesions occur in the abdomen and pelvis and affect multiple organs including liver, gallbladder, pancreas, spleen, and organs of the genitourinary system. Ectopic organs may be present outside their normal positions, or ectopic tissues may develop while the original organ exists in its normal position. Both benign and malignant lesions can occur in ectopic organs and tissues. Owing to their unusual location, they can often be misdiagnosed as other lesions or even malignant lesions, such as metastasis or seeding. This multimodality pictorial review provides various cases of ectopic lesions in the abdomen and pelvis, which will help narrow the differential diagnosis and guide clinical decision-making.
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Affiliation(s)
- Jeong Woo Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea.
| | - Ki Choon Sim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jisun Lee
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Bit Na Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Mi Jin Song
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Jae Woong Choi
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
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Huang JY, Yang R, Li JW, Lu Q, Luo Y. Cavernous hemangioma of an intrapancreatic accessory spleen mimicking a pancreatic tumor: A case report. World J Clin Cases 2022; 10:1973-1980. [PMID: 35317146 PMCID: PMC8891771 DOI: 10.12998/wjcc.v10.i6.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/02/2021] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intrapancreatic accessory spleen (IPAS) is an uncommon condition, with the majority of cases presenting as solid lesions. Thus, this condition is frequently misdiagnosed as pancreatic solid neoplasm. Moreover, splenic cavernous hemangioma is a rare disorder, whereas lesions with a cystic appearance arising from IPAS have not been reported. CASE SUMMARY Herein, we present a case involving a 32-year-old male who had a complex cystic lesion in the tail of the pancreas revealed by conventional ultrasound. The lesion was misdiagnosed as a pancreatic cystadenoma because of its confusing anatomic location, as well as due to its peripheral nodular and internal septal enhancement patterns on contrast-enhanced ultrasound. After multidisciplinary discussion, the patient finally underwent laparoscopic pancreatic body and tail resections. Postoperative pathology demonstrated the lesion to be a cavernous hemangioma arising from the IPAS. CONCLUSION Cavernous hemangioma in the intrapancreatic accessory spleen may mimic pancreatic cystadenoma, which is a condition with the potential to be malignant. Imaging follow-ups or surgical interventions may be helpful for the exclusion of malignant risks in complicated cystic lesions, especially those with parietal and septal enhancements.
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Affiliation(s)
- Jia-Yan Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Rui Yang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Wu Li
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiang Lu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Luo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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TOMURA S, TOSHIMA A, NOMURA A, HIRATA M, YAMAGAMI T, KAGAWA Y, KADOSAWA T. Intrapancreatic accessory spleen mimicking pancreatic insulinoma with intrapancreatic metastasis in a cat. J Vet Med Sci 2022; 84:439-444. [PMID: 35110461 PMCID: PMC8983289 DOI: 10.1292/jvms.21-0584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
An 11-year-old neutered male Domestic Shorthair cat presented with a 3-month history of hypoglycemia, two episodes of seizure, and intermittent tick-like signs. Serum biochemistry revealed severe hypoglycemia associated with high insulin concentrations. Dynamic abdominal computed tomography (CT) indicated two pancreatic masses, which were enhanced most during the late arterial phase but had different degrees and variations of attenuation. Partial pancreatectomy was performed. Histopathology and immunohistochemistry confirmed that one mass was an insulinoma and the other was an ectopic splenic tissue, consistent with the differences in imaging findings. When an intrapancreatic lesion with hyper-attenuation on dynamic abdominal CT is detected, not only insulinoma or metastasis of malignancies but also intrapancreatic accessory spleen (IPAS) should be considered as differential diagnoses.
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Smith HJ. The history of magnetic resonance imaging and its reflections in Acta Radiologica. Acta Radiol 2021; 62:1481-1498. [PMID: 34657480 DOI: 10.1177/02841851211050857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The first reports in Acta Radiologica on magnetic resonance imaging (MRI) were published in 1984, four years after the first commercial MR scanners became available. For the first two years, all MR papers originated from the USA. Nordic contributions started in 1986, and until 2020, authors from 44 different countries have published MR papers in Acta Radiologica. Papers on MRI have constituted, on average, 30%-40% of all published original articles in Acta Radiologica, with a high of 49% in 2019. The MR papers published since 1984 document tremendous progress in several areas such as magnet and coil design, motion compensation techniques, faster image acquisitions, new image contrast, contrast-enhanced MRI, functional MRI, and image analysis. In this historical review, all of these aspects of MRI are discussed and related to Acta Radiologica papers.
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Affiliation(s)
- Hans-Jørgen Smith
- Department of Radiology and Nuclear Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Muehler MR, Rendell VR, Bergmann LL, Winslow ER, Reeder SB. Ferumoxytol-enhanced MR imaging for differentiating intrapancreatic splenules from other tumors. Abdom Radiol (NY) 2021; 46:2003-2013. [PMID: 33377995 PMCID: PMC8131292 DOI: 10.1007/s00261-020-02883-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022]
Abstract
Objectives Ferumoxytol is an ultra-small superparamagnetic iron oxide (USPIO) agent that is taken up by splenic tissue. This study describes our initial institutional experience of ferumoxytol-enhanced MRI (feMRI) for differentiating intrapancreatic splenules (IPS) from other pancreatic lesions. Methods In this retrospective study, patients with computed tomographic imaging that identified small enhancing lesions in the tail of the pancreas subsequently underwent feMRI for further characterization. The feMRI protocol included T2-weighted (T2w) imaging with and without fat suppression (FS), R2* mapping, diffusion-weighted imaging (DWI), and T1-weighted (T1w) imaging with FS, prior to contrast injection. Immediately after slow intravenous infusion with 3 mg/kg body weight ferumoxytol, T1w was repeated. Delayed imaging with all sequences were obtained 24–72 h after ferumoxytol administration. Results Seven patients underwent feMRI. In two patients, the pancreatic lesions were presumed as pancreatic neuroendocrine tumor (PNET) from feMRI and in the remaining 5 IPS. One of the two patients with PNET was symptomatic for NET. In another symptomatic patient with pathologically proven duodenal NET and suspected PNET, the pancreatic lesion was proven to be an IPS on feMRI. IPS demonstrated strong negative enhancement in feMRI on T2w and increased R2* values consistent with splenic tissue, while the presumed PNETs did not enhance. T2w FS was helpful on the pre-contrast images to identify IPS, while R2* did on post-contrast images. Neither DWI nor T1w contributed to differentiating PNETs from IPS. Conclusions This study demonstrates the potential utility of feMRI as a helpful adjunct diagnostic tool for differentiating IPS from other pancreatic lesions. Further studies in larger patient cohorts are needed.
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Affiliation(s)
- M R Muehler
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
- Department of Radiology and Neuroradiology, University Greifswald, Greifswald, Germany.
| | - V R Rendell
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - L L Bergmann
- Department of Radiology, University of Texas Southwestern, Dallas, TX, USA
| | - E R Winslow
- Medstar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, DC, USA
| | - S B Reeder
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
- Department Medical Physics, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
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9
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Tüdös Z, Szász P, Veverková L, Hruška F, Hartmann I, Škarda J, Thomas RP. Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background. Open Med (Wars) 2020; 16:87-94. [PMID: 33392391 PMCID: PMC7764737 DOI: 10.1515/med-2021-0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/14/2020] [Accepted: 11/06/2020] [Indexed: 11/24/2022] Open
Abstract
Foci of splenic tissue separated from the spleen can occur as a congenital anomaly. Isolated nodules of splenic tissue are called accessory spleens or spleniculli. However, nodules of splenic tissue can merge with other organs during embryonic development, in which case we speak of spleno-visceral fusions: most often, they merge with the tail of the pancreas (thus forming spleno-pancreatic fusion or an intrapancreatic accessory spleen), with the reproductive gland (i.e., spleno-gonadal fusion), or with the kidney (i.e., spleno-renal fusion). Our case report describes the fusion of heterotopic splenic tissue with the right adrenal gland, which was misinterpreted as a metastasis of a renal cell carcinoma. To the best of our knowledge, this is the first reported case of spleno-adrenal fusion. Spleno-visceral fusions usually represent asymptomatic conditions; their main clinical significance lies in the confusion they cause and its misinterpretation as tumors of other organs. We believe that the cause of retroperitoneal spleno-visceral fusions is the anomalous migration of splenic cells along the dorsal mesentery to the urogenital ridge, together with primitive germ cells, at the end of the fifth week and during the sixth week of embryonic age. This theory explains the possible origin of spleno-visceral fusions, their different frequency of occurrence, and the predominance of findings on the left side.
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Affiliation(s)
- Zbyněk Tüdös
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, I. P. Pavlova 6, 77900 Olomouc, Czech Republic
| | - Paulína Szász
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, I. P. Pavlova 6, 77900 Olomouc, Czech Republic
| | - Lucia Veverková
- Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, I. P. Pavlova 6, 77900 Olomouc, Czech Republic
| | - František Hruška
- Department of Urology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, I. P. Pavlova 6, 77900 Olomouc, Czech Republic
| | - Igor Hartmann
- Department of Urology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, I. P. Pavlova 6, 77900 Olomouc, Czech Republic
| | - Jozef Škarda
- Department of Clinical and Molecular Pathology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 3, 775 15 Olomouc, Czech Republic
| | - Rohit Philip Thomas
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University, Baldingerstrasse, 35043 Marburg, Germany
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Abstract
Neuroendocrine tumors are rare solid tumors with an estimated 12,000 people in the United States diagnosed each year. Neuroendocrine tumors can occur in any part of the body. There is a wide spectrum of disease, ranging from slow-growing and indolent tumors found incidentally to highly aggressive malignancies with a poor prognosis. Knowledge of neuroendocrine tumor pathology is essential in the diagnostic workup of these patients. This article focuses on the evaluation, detection, and staging of common neuroendocrine tumors with multiple imaging modalities; the information gained with a multimodality approach is often complementary and leads to image-guided treatment decision making.
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Affiliation(s)
- Samuel J Galgano
- Department of Radiology, Section of Abdominal Imaging, University of Alabama at Birmingham, 619 19th Street South, JT N325, Birmingham, AL 35249, USA; Department of Radiology, Section of Molecular Imaging & Therapeutics, University of Alabama at Birmingham, 619 19th Street South, JT N325, Birmingham, AL 35249, USA.
| | - Kedar Sharbidre
- Department of Radiology, Section of Abdominal Imaging, University of Alabama at Birmingham, 619 19th Street South, JT N325, Birmingham, AL 35249, USA
| | - Desiree E Morgan
- Department of Radiology, Section of Abdominal Imaging, University of Alabama at Birmingham, 619 19th Street South, JT N325, Birmingham, AL 35249, USA
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Huang HT, Ling Q. Is an accessory nipple associated with an intrapancreatic accessory spleen? Hepatobiliary Pancreat Dis Int 2019; 18:596-597. [PMID: 31610990 DOI: 10.1016/j.hbpd.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/24/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Hai-Tao Huang
- Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Qi Ling
- Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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Ishigami K, Nishie A, Nakayama T, Asayama Y, Kakihara D, Fujita N, Ushijima Y, Okamoto D, Ohtsuka T, Mori Y, Ito T, Mochidome N, Honda H. Superparamagnetic iron-oxide-enhanced diffusion-weighted magnetic resonance imaging for the diagnosis of intrapancreatic accessory spleen. Abdom Radiol (NY) 2019; 44:3325-3335. [PMID: 31420705 DOI: 10.1007/s00261-019-02189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of superparamagnetic iron-oxide (SPIO)-enhanced diffusion-weighted image (DWI) for distinguishing an intrapancreatic accessory spleen from pancreatic tumors. MATERIALS AND METHODS Twenty-six cases of intrapancreatic accessory spleen and nine cases of pancreatic tail tumors [neuroendocrine tumor (n = 8) and pancreatic adenocarcinoma (n = 1)] were analyzed. Two blind reviewers retrospectively reviewed the SPIO-enhanced magnetic resonance imaging (MRI) scans. The lesion visibility grades were compared and the diagnostic performance of SPIO-enhanced DWI was compared to those of SPIO-enhanced T2WI and T2*WI with the use of a receiver operating characteristic (ROC) analysis. RESULTS The grade of lesion visibility was the highest on DWI [mean ± standard deviation (SD): 2.8 ± 0.3] followed by T2WI (2.3 ± 0.7, p < 0.001) and T2*WI (2.1 ± 0.7, p < 0.0001). Reviewers 1 and 2 correctly characterized the presence or absence of SPIO uptake in 34 of 35 cases (97.1%) on DWI, 24 (68.6%) and 25 (71.4%) cases on T2WI, respectively, and 16 (45.7%) and 17 (48.6%) cases on T2*WI. The area under the ROC curve (AUC) of DWI was 0.974 and 0.989 for reviewers 1 and 2, respectively. For Reviewer 1, the AUC of DWI was significantly higher than that of T2*WI (0.756, p < 0.01), although it was not significantly different from that of T2WI (0.868, p = 0.0857). For Reviewer 2, the AUC of DWI was significantly higher than those of T2WI (0.846, p < 0.05) and T2*WI (0.803, p < 0.01). CONCLUSION The diagnostic performance of SPIO-enhanced DWI was better than those of SPIO-enhanced T2*WI and T2WI for the diagnosis of intrapancreatic accessory spleen.
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Affiliation(s)
- Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Akihiro Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomohiro Nakayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshiki Asayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Kakihara
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takao Ohtsuka
- Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuhisa Mori
- Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tetsuhide Ito
- Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Naoki Mochidome
- Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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13
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Diagnosis of intrapancreatic accessory spleen by endoscopic ultrasound-guided fine-needle aspiration mimicking a pancreatic neoplasm: a case report and review of literature. Clin J Gastroenterol 2019; 13:287-297. [DOI: 10.1007/s12328-019-01045-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/11/2019] [Indexed: 12/14/2022]
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14
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Zurek Munk-Madsen M, Zakarian K, Sandor Oturai P, Hansen CP, Federspiel B, Fallentin E, Linno Willemoe G. Intrapancreatic accessory spleen mimicking malignant tumor: three case reports. Acta Radiol Open 2019; 8:2058460119859347. [PMID: 31285851 PMCID: PMC6600498 DOI: 10.1177/2058460119859347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022] Open
Abstract
Intrapancreatic hypervascular lesions may represent metastases, neuroendocrine
tumors, or intrapancreatic accessory spleens. The benign intrapancreatic
accessory spleen can be difficult to separate from a malignant neuroendocrine
tumor or metastasis. We report three cases of pancreatic lesions that underwent
pancreatic surgery due to suspicion of malignancy on imaging; all cases were
histologically intrapancreatic accessory spleens. Our cases point to the
importance of performing single-photon emission computed tomography with
heat-damaged Tc-99m-pertechnetate labelled erythrocytes to identify splenic
tissue, even though small lesions can show a false-negative result.
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Affiliation(s)
- Maria Zurek Munk-Madsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kristine Zakarian
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Sandor Oturai
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Federspiel
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Eva Fallentin
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gro Linno Willemoe
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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15
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Lin X, Xu L, Wu A, Guo C, Chen X, Wang Z. Differentiation of intrapancreatic accessory spleen from small hypervascular neuroendocrine tumor of the pancreas: textural analysis on contrast-enhanced computed tomography. Acta Radiol 2019; 60:553-560. [PMID: 30086651 DOI: 10.1177/0284185118788895] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Intrapancreatic accessory spleens (IPASs) are usually misdiagnosed as pancreatic neuroendocrine tumors (PNETs). Texture analysis is valuable in tumor detection, diagnosis, and staging. PURPOSE To identify the potential of texture features in differentiating IPASs from small hypervascular PNETs. MATERIAL AND METHODS Twenty-one patients with PNETs and 13 individuals with IPASs who underwent pretreatment dynamic contrast-enhanced computed tomography (CT) were retrospectively analyzed. The routine imaging features-such as location, size, margin, cystic or solid appearance, enhancement degree and pattern, and lymph node enlargement-were recorded. Texture features, such as entropy, skewness, kurtosis, and uniformity, on contrast-enhanced images were analyzed. Receiver operating characteristic (ROC) analysis was performed to differentiate IPASs from PNETs. RESULTS No significant differences were observed in margin, enhancement degree (arterial and portal phase), lymph node enlargement, or size between PNETs and IPASs (all P > 0.05). However, IPASs usually showed heterogeneous enhancement at the arterial phase and the same degree of enhancement as the spleen at the portal phase, both of which were greater than those of PNETs (69% vs. 35%, P = 0.06; 100% vs. 29%, P = 0.04). Entropy and uniformity were significantly different between IPASs and PNETs at moderate (1.5) and high sigma values (2.5) (both P < 0.01). ROC analysis showed that uniformity at moderate and high sigma had the highest area under the curve (0.82 and 0.89) with better sensitivity (85.0-95.0%) and acceptable specificity (75.0-83.3%) for differentiating IPASs from PNETs. CONCLUSIONS Texture parameters have potential in differentiating IPASs from PNETs.
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Affiliation(s)
- Xubo Lin
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, PR China
| | - Lei Xu
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, PR China
| | - Aiqin Wu
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, PR China
| | - Chuangen Guo
- Department of Radiology, the First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, PR China
| | - Xiao Chen
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, PR China
| | - Zhongqiu Wang
- Department of Radiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, PR China
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16
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Baugh KA, Villafane N, Farinas C, Dhingra S, Silberfein EJ, Massarweh NN, Cao HT, Fisher WE, Van Buren G. Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens. J Surg Res 2019; 236:144-152. [DOI: 10.1016/j.jss.2018.11.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/01/2018] [Accepted: 11/19/2018] [Indexed: 12/21/2022]
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17
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Siddiqui N, Vendrami CL, Chatterjee A, Miller FH. Advanced MR Imaging Techniques for Pancreas Imaging. Magn Reson Imaging Clin N Am 2019; 26:323-344. [PMID: 30376973 DOI: 10.1016/j.mric.2018.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Advances in MR imaging with optimization of hardware, software, and techniques have allowed for an increased role of MR in the identification and characterization of pancreatic disorders. Diffusion-weighted imaging improves the detection and staging of pancreatic neoplasms and aides in the evaluation of acute, chronic and autoimmune pancreatitis. The use of secretin-enhanced MR cholangiography improves the detection of morphologic ductal anomalies, and assists in the characterization of pancreatic cystic lesions and evaluation of acute and chronic pancreatitis. Emerging MR techniques such as MR perfusion, T1 mapping/relaxometry, and MR elastography show promise in further evaluating pancreatic diseases.
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Affiliation(s)
- Nasir Siddiqui
- Department of Radiology, DuPage Medical Group, 430 Warrenville Road, Lisle, IL 60532, USA
| | - Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street Suite 800, Chicago, IL 60611, USA
| | - Argha Chatterjee
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street Suite 800, Chicago, IL 60611, USA.
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18
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Li BQ, Lu J, Seery S, Guo JC. Epidermoid cyst in intrapancreatic accessory spleen: A systematic review. Pancreatology 2019; 19:10-16. [PMID: 30366677 DOI: 10.1016/j.pan.2018.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/16/2018] [Accepted: 10/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Due to its rarity, epidermoid cyst in intrapancreatic accessory spleen (ECIPAS) is still a diagnostic dilemma during clinical practice. The aim of this review was to summarize the epidemiologic features and management of ECIPAS. METHODS MEDLINE and EMBASE were searched for English articles reporting on ECIPAS up to April 30th, 2018 following the methodology suggested by the PRISMA guidelines. Categorical variables were reported as frequency and percentage. Continuous variables were reported as median (range). RESULTS A total of 56 patients from 47 full articles were included for the final data synthesis. More than half of the ECIPASs (59%) were found incidentally. The female/male ratio was 1.33. ECIPAS is typically a single mono-/multi-lobular cystic lesions in the pancreatic tail with thickened cystic wall or various amount of solid component which had identical density/signal to the spleen on imaging examinations. The cyst is filled with serous or non-serous fluid. Recognition of the surrounding ectopic splenic tissue is the key point to diagnose ECIPAS. However, no preoperative examination was able to make a definite diagnosis. Almost all the patients (96%) received surgical treatment, due to the suspicion of pancreatic malignant or potentially malignant cystic tumor, especially mucinous cystic neoplasm (MCN). CONCLUSIONS Although seldom encountered, ECIPAS should be considered as a differential diagnosis for pancreatic cystic lesions, especially when solid component was detected. As a benign disease, unnecessary surgery should be avoided. Because it is difficult to make a definite diagnosis preoperatively by one single examination, multiple modalities may be required.
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Affiliation(s)
- Bing-Qi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Jun Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Jun-Chao Guo
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
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19
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Li BQ, Xu XQ, Guo JC. Intrapancreatic accessory spleen: a diagnostic dilemma. HPB (Oxford) 2018; 20:1004-1011. [PMID: 29843985 DOI: 10.1016/j.hpb.2018.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/17/2018] [Accepted: 04/29/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND As intrapancreatic accessory spleen (IPAS) is rarely encountered during clinical practice, the aim of this review was to summarize the epidemiologic features, the diagnosis and treatment of IPAS. METHODS MEDLINE and EMBASE were searched for articles reporting on IPAS. Categorical variables were reported as frequency and percentage. Continuous variables were reported as median (range). RESULTS A total of 105 patients were included, of which 73% were detected incidentally. The male/female ratio was 1.23. The size of IPAS in patients who had previously undergone splenectomy was larger than that of patients without prior splenectomy (2.5 cm vs 1.5 cm; p = 0.020). No preoperative examination was able to make a definite diagnosis for all IPASs. More than half of the patients (55%) received surgical treatment, most of which (87%) were suspected as pancreatic neuroendocrine tumors (p-net) preoperatively. CONCLUSIONS Although rare, IPAS should be considered in the differential of patients with suspected incidental p-net, especially if there has been a past history of splenectomy. Preoperative diagnosis is important as unnecessary surgery can be avoided. As it is difficult to make a definite diagnosis of IPAS by one single examination, multiple techniques may be required.
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Affiliation(s)
- Bing-Qi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Xie-Qun Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Jun-Chao Guo
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
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20
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Lo GC, Kambadakone A. MR Imaging of Pancreatic Neuroendocrine Tumors. Magn Reson Imaging Clin N Am 2018; 26:391-403. [DOI: 10.1016/j.mric.2018.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Abstract
OBJECTIVE The purpose of this article is to discuss the advances in CT acquisition and image postprocessing as they apply to imaging the pancreas and to conceptualize the role of radiogenomics and machine learning in pancreatic imaging. CONCLUSION CT is the preferred imaging modality for assessment of pancreatic diseases. Recent advances in CT (dual-energy CT, CT perfusion, CT volumetry, and radiogenomics) and emerging computational algorithms (machine learning) have the potential to further increase the value of CT in pancreatic imaging.
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22
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Issa M, Bradshaw L, Loveluck M, Nickless D, Yong TL. Laparoscopic distal pancreatectomy for intrapancreatic accessory spleen: a case report. ANZ J Surg 2017; 89:781-782. [PMID: 29232771 DOI: 10.1111/ans.14309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 10/21/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Issa
- Department of Surgery, The Northern Hospital, Melbourne, Victoria, Australia
| | - Luke Bradshaw
- Department of Surgery, The Northern Hospital, Melbourne, Victoria, Australia
| | - Maree Loveluck
- Department of Surgery, The Northern Hospital, Melbourne, Victoria, Australia
| | - David Nickless
- Department of Surgery, The Northern Hospital, Melbourne, Victoria, Australia
| | - Tuck Leong Yong
- Department of Surgery, The Northern Hospital, Melbourne, Victoria, Australia
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23
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Accuracy of apparent diffusion coefficient in differentiating pancreatic neuroendocrine tumour from intrapancreatic accessory spleen. Eur Radiol 2017; 28:1560-1567. [PMID: 29134352 DOI: 10.1007/s00330-017-5122-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 12/26/2022]
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24
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Taron J, Martirosian P, Kuestner T, Schwenzer NF, Othman A, Weiß J, Notohamiprodjo M, Nikolaou K, Schraml C. Scan time reduction in diffusion-weighted imaging of the pancreas using a simultaneous multislice technique with different acceleration factors: How fast can we go? Eur Radiol 2017; 28:1504-1511. [DOI: 10.1007/s00330-017-5132-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/12/2017] [Accepted: 10/11/2017] [Indexed: 12/13/2022]
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25
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Lee JE, Shin SS, Kim SJ, Heo SH, Lim HS, Kim JW, Jeong YY. A pictorial review of diagnostic pitfalls of developmental anomalies and variants in pancreatic imaging. Clin Imaging 2017; 48:32-39. [PMID: 29028511 DOI: 10.1016/j.clinimag.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022]
Abstract
Developmental anomalies and anatomic variants of the pancreas vary widely, and most of them are encountered incidentally during radiologic evaluation. However, some of these anomalies and variants are potentially pathologic and may cause various clinical presentations in childhood or adulthood. The early identification of these entities in various imaging modalities including ultrasound, computed tomography (CT), and magnetic resonance (MR) imaging would be valuable in making correct diagnoses and, in turn, preventing unnecessary additional procedures. In order to differentiate these entities, it is fundamental to understand the embryologic development and normal anatomical structure of the pancreas. In this article, we review the embryology and normal anatomy of the pancreas, and diagnostic pitfalls of developmental anomalies and anatomic variants in various pancreatic imaging modalities.
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Affiliation(s)
- Jong Eun Lee
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea; Center for Aging and Geriatrics, Chonnam National University Medical School, Gwangju, South Korea.
| | - Shin Jung Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jin Woong Kim
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
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26
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Vikse J, Sanna B, Henry BM, Taterra D, Sanna S, Pękala PA, Walocha JA, Tomaszewski KA. The prevalence and morphometry of an accessory spleen: A meta-analysis and systematic review of 22,487 patients. Int J Surg 2017; 45:18-28. [DOI: 10.1016/j.ijsu.2017.07.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022]
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27
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Kim B, Lee SS, Sung YS, Cheong H, Byun JH, Kim HJ, Kim JH. Intravoxel incoherent motion diffusion-weighted imaging of the pancreas: Characterization of benign and malignant pancreatic pathologies. J Magn Reson Imaging 2016; 45:260-269. [PMID: 27273754 DOI: 10.1002/jmri.25334] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/23/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To evaluate the diagnostic value of apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM) parameters in differentiating patients with either a normal pancreas (NP), pancreatic ductal adenocarcinoma (PDAC), neuroendocrine tumor (NET), solid pseudopapillary tumor (SPT), acute pancreatitis (AcP), vs. autoimmune pancreatitis (AIP). MATERIALS AND METHODS In all, 84 pathologically confirmed pancreatic tumors (60 PDACs, 15 NETs, 9 SPTs), 20 pancreatitis (13 AcPs, 7 AIPs), and 30 NP subjects underwent IVIM diffusion-weighted imaging using 10 b-values (0-900 sec/mm2 ) at 1.5T. The ADC, pure molecular diffusion coefficient (Dslow ), perfusion fraction (f), and perfusion-related diffusion coefficient (Dfast ) were calculated and compared using a Kruskal-Wallis test and post-hoc Dunn procedure. Receiver operating characteristic (ROC) analysis was performed to assess diagnostic performance. RESULTS The f and Dfast of the PDAC were significantly lower than that of the NP (f = 0.10 vs. 0.24; Dfast = 42.21 vs. 71.74 × 10-3 mm2 /sec; P < 0.05). In ROC analysis, f showed the best diagnostic performance (area-under-the-curve, 0.919) among all parameters in differentiating PDAC from NP (P ≤ 0.001). The f values of AcP (0.11) and AIP (0.13) and the Dfast values of SPT (20.48 × 10-3 mm2 /sec) and AcP (24.49 × 10-3 mm2 /sec) were significantly lower compared with NP (f = 0.24; Dfast = 71.74 × 10-3 mm2 /sec; P < 0.05). For NET, the f (0.21) was significantly higher than that of PDAC (0.10, P < 0.01). CONCLUSION Perfusion-related parameters f and Dfast are more helpful in characterizing pancreatic diseases than ADC or Dslow . The PDCA, SPT, AcP, and AIP were characterized by reduced f and Dfast values compared with normal pancreas. The f value might help in differentiating between PDAC and NET. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:260-269.
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Affiliation(s)
- Bohyun Kim
- Department of Radiology, Ajou University Hospital, Suwon, South Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunhee Cheong
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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28
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Abstract
Pancreatic neuroendocrine tumors are rare tumors that present many imaging challenges, from detecting small functional tumors to fully staging large nonfunctioning tumors, including identifying all sites of metastatic disease, particularly nodal and hepatic, and depicting vascular involvement. The correct choice of imaging modality requires knowledge of the tumor type (eg, gastrinoma versus insulinoma), and also the histology (well vs poorly differentiated). Evolving techniques in computed tomography (CT), MRI, endoscopic ultrasonography, and nuclear medicine, such as dual-energy CT, diffusion-weighted MRI, liver-specific magnetic resonance contrast agents, and new nuclear medicine agents, offer new ways to visualize, and ultimately manage, these tumors.
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29
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Baur ADJ, Pavel M, Prasad V, Denecke T. Diagnostic imaging of pancreatic neuroendocrine neoplasms (pNEN): tumor detection, staging, prognosis, and response to treatment. Acta Radiol 2016; 57:260-70. [PMID: 25855665 DOI: 10.1177/0284185115579932] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/01/2015] [Indexed: 12/25/2022]
Abstract
Pancreatic neuroendocrine neoplasms (pNEN) are rare malignancies arising from neuroendocrine cells of the pancreas. Functional tumors can present with specific clinical syndromes due to hormonal secretion. These tumors can present as incidental findings on imaging performed for unrelated purposes or they are diagnosed when workup is initiated in patients with specific syndromes or metastases. This article presents an overview of available imaging techniques focusing on computed tomography and magnetic resonance imaging. Recommendations regarding examination protocols are given. Typical imaging features of pNEN and metastases are described. Their potential value for the evaluation of prognosis as well as tumor response under treatment is discussed.
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Affiliation(s)
- Alexander DJ Baur
- Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marianne Pavel
- Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie (einschl. Arbeitsbereich Stoffwechselerkrankungen), Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vikas Prasad
- Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Timm Denecke
- Klinik für Strahlenheilkunde, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
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30
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Noda Y, Kanematsu M, Goshima S, Horikawa Y, Takeda J, Kondo H, Watanabe H, Kawada H, Kawai N, Tanahashi Y, Bae KT. Diffusion kurtosis imaging of the pancreas for the assessment of HbA1c levels. J Magn Reson Imaging 2015; 43:159-65. [DOI: 10.1002/jmri.24982] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 12/18/2022] Open
Affiliation(s)
- Yoshifumi Noda
- Department of Radiology; Gifu University Hospital; Gifu Japan
| | - Masayuki Kanematsu
- Department of Radiology; Gifu University Hospital; Gifu Japan
- Department of Radiology Services; Gifu University Hospital; Gifu Japan
| | - Satoshi Goshima
- Department of Radiology; Gifu University Hospital; Gifu Japan
| | - Yukio Horikawa
- Department of Diabetes and Endocrinology; Gifu University Hospital; Gifu Japan
| | - Jun Takeda
- Department of Diabetes and Endocrinology; Gifu University Hospital; Gifu Japan
| | - Hiroshi Kondo
- Department of Radiology; Gifu University Hospital; Gifu Japan
| | - Haruo Watanabe
- Department of Radiology; Gifu University Hospital; Gifu Japan
| | - Hiroshi Kawada
- Department of Radiology; Gifu University Hospital; Gifu Japan
| | - Nobuyuki Kawai
- Department of Radiology; Gifu University Hospital; Gifu Japan
| | | | - Kyongtae T Bae
- Department of Radiology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania USA
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