Parallels between computed tomography and clinical observations in diagnosing obstructive pancreatic masse

Abstract

Aim. To identify the underlying causes of complications in distinguishing the origin of head masses through a comparative analysis of CT findings and clinical observations.Materials and methods. A retrospective analysis of radiological imaging for pancreatic cancer (36 cases) and chronic pancreatitis (24 cases) was conducted. Pancreaticoduodenectomy was performed in 23 cases (14 for cancer and 9 for chronic pancreatitis), while drainage interventions were carried out in 35 cases.Results. On pre-contrast images, pancreatic cancer appeared isodense in 97 % of cases, while in the arterial phase, it was hypodense in 94 %. For chronic pancreatitis, these percentages were 67 % and 46 %, respectively. The density curves of the pancreatic head and normal parenchyma were nearly identical across all phases, but the density gradient difference was more pronounced in pancreatic cancer (27 HU compared to 15 HU). Bile duct strictures with interruption were observed more frequently in cancer (44 %), along with arterial vessel invasion (25 %). CT signs indicative of chronic pancreatitis included wirsugolithiasis (21 %) and portal hypertension (42 %). Both diseases exhibited similar CT features, such as cystic lesions, peripancreatic tissue infiltration and peripancreatic lymphadenopathy. In six cases of pancreatic head cancer and seven of chronic pancreatitis, identical pathological changes were identified during intraoperative revision: pseudocysts (2 in cancer and 4 in chronic pancreatitis), infected necrosis and abscesses (3 and 2, respectively) and similar views of the head mass cut plane (1 each).Conclusion. The overlap in CT features due to similar pathomorphological changes presents an objective challenge in differentiating pancreatic head masses