Enhanced CT and CT virtual endoscopy in diagnosis of heterotopic pancreas

Abstract

To improve the diagnosis of heterotopic pancreas by the use of contrast-enhanced computed tomography (CT) imaging and CT virtual endoscopy (CTVE). A total of six patients with heterotopic pancreas, as confirmed by clinical pathology and immunohistochemistry in the Sixth Affiliated People's Hospital of Shanghai Jiao Tong University, Shanghai, China, were included. Non-enhanced CT and enhanced CT scanning were performed, and the resulting images were reviewed and analyzed using three-dimensional post-processing software, including CTVE. Four males and two females were enrolled. Several heterotopic pancreas sites were involved; three occurred in the stomach, including the gastric antrum (n = 2) and lesser curvature (n = 1), and two were in the duodenal bulb. Only one case of heterotopic pancreas lesion occurred in the mesentery. Four cases had a solid yet soft tissue density that had a homogeneous pattern when viewed by enhanced CT. Additionally, their CT values were similar to that of the pancreas. The ducts of the heterotopic pancreas tissue, one of the characteristic CT features of heterotopic pancreas tissue, were detected in the CT images of two patients. CTVE images showed normal mucosa around the tissue, which is also an important indicator of a heterotopic pancreas. However, none of the CTVE images showed the typical signs of central dimpling or umbilication. CT, enhanced CT and CTVE techniques provide useful information about the location, growth pattern, vascularity, and condition of the gastrointestinal wall around heterotopic pancreatic tissue.