Clinical Significance of Imaging Abnormalities of the Pancreas with CT Scan

Abstract

Context: Abnormal radiographic imaging of gastrointestinal organs such as the pancreas is commonly reported on CT Scans. Further evaluation of these abnormalities is most likely warranted to investigate potential pathology. Endoscopic ultrasound has a proven role for improved pancreatic imaging and therefore could prove useful as an adjunct diagnostic modality in these cases of abnormal pancreatic imaging. Objectives: Evaluate the correlation between abnormal findings of the pancreas seen on CT Scan with follow up diagnostic imaging by endoscopic ultrasound at Scott and White Memorial Hospital and Clinic. Design, Setting, Patients: Using Scott and White's integrated electronic medical records from 01/01/1999 to 12/31/2004, a total of 747 patient records were analyzed. The criterion for patient selection were all patients undergoing CT of the chest or abdomen for miscellaneous causes such as abdominal pain, weight loss, jaundice, etc., who subsequently underwent endoscopic ultrasonography. Of the 747 patient charts that were reviewed, 307 patients met our criteria of abnormal pancreatic findings further evaluated by EUS. Patients with known pancreatic diseases were excluded. Results: Out of the 307 patients, a total of 101 (33%) malignancies were confirmed, 82 (27%) of those being pancreatic malignancies. There were 37 benign lesions identified, such as cystic neoplasms or pseudocysts, and 176 irrelevant or other findings, mainly resulting from the lesion not being identified on EUS. The CT findings were further classified into six different categories, including solid mass or enhancement, cystic mass, stranding, atrophy, PD dilatation, and peri-pancreatic nodes. Of these radiographic classifications, the enhancing mass category carried the biggest risk of malignancy (38%). Pancreatic stranding had the least incidence of malignancy (3%). Conclusions: Abnormal pancreatic findings are often identified on abdominal CT scans, and have varying radiographic descriptions. Based on our study, further evaluation of these lesions with endoscopic ultrasound is warranted, as a more accurate assessment of the lesion can be made. Paramount to this is the ability to biopsy or aspirate the lesions found during EUS. The most worrisome type of lesion for malignancy is described as an enhancing mass on CT.