Differential Diagnosis Of Pancreatic Lesions Research Articles

Role of contrast-enhanced harmonic endoscopic ultrasonography (EUS) and EUS elastography in pancreatic lesions.

Pancreatic cancers have a poor prognosis, and their incident rates have risen. Endoscopic ultrasonography (EUS) is an efficient and reliable diagnostic modality for pancreatic lesions, providing high spatial resolution. However, while EUS helps to detect minor pancreatic lesions, nearly all solid pancreatic lesions are hypoechoic, which creates difficulty in making differential diagnoses of pancreatic lesions. When diagnosing pancreatic lesions, the performance of image-enhanced EUS techniques is essential, such as EUS elastography or contrast-enhanced harmonic EUS (CH-EUS). CH-EUS diagnosis is based on assessing the vascularity of lesions, whereas tissue elasticity is measured via EUS elastography. Elastography is either strain or shear-wave, depending on the different mechanical properties being evaluated. The usefulness of enhanced EUS techniques is demonstrated in this review for the differential diagnosis of pancreatic lesions, including solid and cystic lesions, and pancreatic cancer staging.

Using Fuzzy Mathematical Model in the Differential Diagnosis of Pancreatic Lesions Using Ultrasonography and Echographic Texture Analysis.

Malignant tumors of the pancreas are the fourth leading cause of cancer-related deaths. This is mainly because they are often diagnosed at a late stage. One of the challenges in diagnosing focal lesions in the pancreas is the difficulty in distinguishing them from other conditions due to the unique location and anatomy of the organ, as well as the similarity in their ultrasound characteristics. One of the most sensitive imaging modalities of the pancreas is endoscopic ultrasonography. However, clinicians recognize that EUS is a difficult and highly operator-dependent method, while its results are highly dependent on the experience of the investigator. Hybrid technologies based on artificial intelligence methods can improve the accuracy and objectify the results of endosonographic diagnostics. Endoscopic ultrasonography was performed on 272 patients with focal lesions of the pancreatobiliary zone, who had been treated in the surgical section of the Kursk Regional Clinical Hospital in 2014-2023. The study utilized an Olympus EVIS EXERA II video information endoscopic system, along with an EU-ME1 ultrasound unit equipped with GF UM160 and GF UC140P-AL5 echo endoscopes. Out of the focal formations in the pancreatobiliary zone, pancreatic cancer was detected in 109 patients, accounting for 40.1% of the cases. Additionally, 40 patients (14.7%) were diagnosed with local forms of chronic pancreatitis. The reference sonograms displayed distinguishable focal pancreatic pathologies, leading to the development of hybrid fuzzy mathematical decision-making rules at the South-West State University in Kursk, Russian Federation. This research resulted in the creation of a fuzzy hybrid model for the differential diagnosis of chronic focal pancreatitis and pancreatic cancer. Endoscopic ultrasonography, combined with hybrid fuzzy logic methodology, has made it possible to create a model for differentiating between chronic focal pancreatitis and pancreatic ductal adenocarcinoma. Statistical testing on control samples has shown that the diagnostic model, based on reference endosonograms of the echographic texture of pancreatic focal pathology, has a confidence level of 0.6 for the desired diagnosis. By incorporating additional information about the contours of focal formations obtained through endosonography, the reliability of the diagnosis can be increased to 0.9. This level of reliability is considered acceptable in clinical practice and allows for the use of the developed model, even with data that is not well-structured.

Clinical utility of directional eFLOW compared with contrast-enhanced harmonic endoscopic ultrasound for assessing the vascularity of pancreatic and peripancreatic masses

BackgroundContrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) can be used for the differential diagnosis of pancreatic lesions by evaluating microvascular circulation and patterns of contrast enhancement. However, routine use of CEH-EUS is limited by its high cost, the lack of contrast agent availability and the absence of expertise with this technique. Directional eFLOW (D-eFLOW) (Aloka Co., Ltd., Tokyo, Japan) was introduced as a new high-definition modality that detects blood flow in microvessels. Because it uses built-in functions, it entails no additional cost and reduces time for examination. The present study compared the usefulness of D-eFLOW and CEH-EUS for differential diagnosis of pancreatic and peripancreatic lesions. MethodsThis retrospective study analyzed 130 patients who underwent EUS and D-eFLOW examinations from January 2016 to March 2020 to evaluate pancreatic and peripancreatic masses. ResultsAll 130 patients underwent D-eFLOW and CEH-EUS examinations. Histological diagnoses were confirmed in 130 patients by EUS-FNA and/or surgery. D-eFLOW and CEH-EUS showed good correlation in evaluating the vascularity of pancreatic and peripancreatic tumors (Fisher's exact test, p < 0.05). ConclusionsIn evaluating the characteristics of tumorous lesions, vascularity detected by D-eFLOW showed good correlation with enhancement patterns of CEH-EUS. D-eFLOW can be considered a good alternative to CEH-EUS in diagnosing pancreatic and peripancreatic masses.

Accuracy of quantitative diffusion-weighted imaging for differentiating benign and malignant pancreatic lesions: a systematic review and meta-analysis.

A variety of imaging techniques can be used to evaluate diffusion characteristics to differentiate malignant and benign pancreatic lesions. The diagnostic performance of diffusion parameters has not been systematic assessed. We aimed to investigate the diagnostic efficacy of quantitative diffusion-weighted imaging (DWI) for pancreatic lesions. A literature search was conducted using the PubMed, Embase, and Cochrane Library databases for studies from inception to March 30, 2020, which involves the quantitative diagnostic performance of diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) in the pancreas. Studies were reviewed according to inclusion and exclusion criteria. The quality of articles was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUATAS-2). A bivariate random-effects model was used to evaluate pooled sensitivities and specificities. Univariable meta-regression analysis was used to test the effects of factors that contributed to the heterogeneity. A total of 31 studies involving 1558 patients were ultimately eligible for data extraction. The lowest heterogeneity was found in specificity of perfusion fraction (f) with the I2 value was 17.97% and Cochran p value was 0.28. However, high heterogeneities were found for the other parameters (all I2 > 50%). There was no publication bias found in funnel plot (p = 0.30) for the apparent diffusion coefficient (ADC) parameter. The pooled sensitivities for ADC, f, pure diffusion coefficient (D), and pseudo diffusivity coefficient (D*) were 83%, 81%, 76%, and 84%, respectively. The pooled specificities for ADC, f, D, and D* were 87%, 83%, 69%, and 81% respectively. The areas under the curves for ADC, f, D, and D* were 0.92, 0.87, 0.79, and 0.87 respectively. Quantitative DWI and IVIM have a good diagnostic performance for differentiating malignant and benign pancreatic lesions. • IVIM has high sensitivity and specificity (84% and 83%, respectively) for differential diagnosis of pancreatic lesions, which is comparable to that of the ADC (83% and 87%, respectively). • The ADC has an excellent diagnostic performance for differentiating malignant from benign IPMNs (sensitivity, 0.83; specificity, 0.92); the f has the best diagnostic performance for differentiating pancreatic carcinoma from PNET (sensitivity, 0.85; specificity, 0.85). • For the ADC, using a maximal b value < 800 s/mm2 has a higher diagnostic accuracy than ≥ 800 s/mm2; performing in a high field strength (3.0 T) system has a higher diagnostic accuracy than a low field strength (1.5 T) for pancreatic lesions.

Mesenchymal Tumors Involving the Pancreas: A Clinicopathologic Analysis and Review of the Literature.

Most pancreatic tumors are epithelial, and, among these, more than 90% are of ductal origin. However, a variety of mesenchymal tumors may involve the pancreas and may manifest different clinicopathological characteristics. The literature on mesenchymal tumors in the pancreas is largely limited to individual case reports or analyses of small series, predominantly focusing on radiologic features. Authors' institutional and consultation databases were reviewed to identify the mesenchymal tumors involving the pancreas. Forty cases were identified; twenty-five (63%) tumors were benign/borderline, and the remaining fifteen (37%) were malignant. Of the benign/borderline tumors; 9 were solitary fibrous tumors, 6 gastrointestinal stromal tumors (GISTs), 4 schwannomas, 2 desmoid type fibromatosis, 1 lymphangioma, 1 ganglioneuroma, 1 inflammatory myofibroblastic tumor, and 1 low grade mesenchymal neoplasm. Malignant tumors included 6 cases of leiomyosarcomas, 4 liposarcomas, 2 rhabdomyosarcomas, 1 epithelioid angiosarcoma, 1 malignant peripheral nerve sheet tumor, and 1 undifferentiated pleomorphic sarcoma. Four cases (multicystic schwannoma, desmoid fibromatosis, lymphangioma and inflammatory myofibroblastic tumor) were preoperatively misdiagnosed as a primary epithelial tumor of the pancreas. Mesenchymal tumors rarely involve the pancreas. They are usually benign/borderline neoplasms but may be diagnostically challenging, especially clinically/radiologically, as they may form cystic and/or large lesions in the pancreas. Mesenchymal tumors should be considered in both the clinical/radiological and pathological differential diagnosis of pancreatic lesions.

Endoscopic ultrasonography for pancreatic solid lesions.

The incidence and mortality rates of pancreatic cancer, which has a poor prognosis, are rising rapidly. Endoscopic ultrasonography (EUS) provides superior spatial resolution compared with other imaging modalities such as transabdominal ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), and it is considered among the most reliable and efficient diagnostic modalities for pancreatic diseases. In this review, we show that EUS is useful for detection of pancreatic solid lesions and staging of pancreatic cancer. EUS also plays an important role in screening patients with high-risk factors for pancreatic cancer. Although EUS is useful for detection of small pancreatic lesions, pancreatic lesions are difficult to characterize using this modality, because most pancreatic solid lesions appear hypoechoic on EUS. From this point of view, contrast-enhanced harmonic EUS (CH-EUS) plays an important role in the differential diagnosis of pancreatic lesions. EUS and CH-EUS are also useful for staging pancreatic cancer. Moreover, EUS-guided fine-needle aspiration (EUS-FNA) is superior to other modalities in terms of cytopathological diagnosis. Although EUS-FNA has a high diagnostic ability for pancreatic cancer, the combination of EUS-FNA and CH-EUS improves the diagnostic ability by decreasing the number of false-negative cases. Thus, conventional EUS, EUS-FNA, and CH-EUS are essential in clinical practice for the diagnosis of pancreatic solid lesions.

The imaging features of epidermoid cyst within intrapancreatic accessory spleen

Objective To investigate the imaging features of epidermoid cyst within intrapancreatic accessory spleen (ECIPAS) to make benefits for differential diagnosis of pancreatic lesions. Methods We retrospectively reviewed the clinicalradiological and pathological data of 7 patients with pathologically confirmed ECIPAS.All the cases underwent plain and contrast enhanced CT scan,2 cases underwent magnetic resonance cholangiopancreatography (MRCP), and 5 cases underwent ultrasonic examination. The imaging features of the lesions were analyzed. Results CT showed that 5 lesions were situated in the pancreatic tail while the other two located in the neck.The mean size of the lesions was (2.8±1.2) cm,ranging from 1.5 to 4.8 cm. The cysts appeared multiocular in 2 cases. On plain CT, 2 cases showed well-defined low density foci, while 2 cases showed slightly high density. Calcification can be found in 2 cases. In 4 cases, the solid component surrounding the cyst displayed progressive enhancement on postcontrast CT. The enhancement was higher than the pancreatic parenchymaand similar to the spleen during both arterial and portal venous phases. On MRCP,no expansion was shown in pancreatic duct andit had no relationship with cyst in both 2 cases while slightly hypointensity could be found at the back and it pancreatic neck and body in 1 case. Five lesions were hypoechoic or anechoic and irregular-shaped on ultrasound. Conclusion ECIPAS is a rare benign lesion and the typical imaging manifestation is a cyst with surrounding solid component with enhancement similar to the spleen while higher than pancreas. Key words: Pancreas; Accessory spleen; Tomography, X-ray computed; Magnetic resonance imaging

Поиск новых подходов к дифференциальной диагностике заболеваний поджелудочной железы

Поиск новых подходов к дифференциальной диагностике заболеваний поджелудочной железы

THE POSSIBILITIES OF ENDOSCOPIC ULTRASONOGRAPHY IN THE DIAGNOSTICS OF SOLID PANCREATIC NEOPLASMS

Endosonography takes a leading role in solid pancreatic neoplasms diagnostics. This article presents the main indicators of diagnostics efficiency of the method depending on the nosology of a tumor. The article describes the research results of domestic and foreign authors about the possibility of endoscopic ultrasonography in determining the resectability of solid pancreatic neoplasms based on the diagnostics of biliopancreatoduodenal zone blood vessels invasion. We consider the auxiliary techniques of endosonography, particularly, their role and informative value in differential diagnosis of pancreatic lesions.

Accessory spleen mimicking a pancreatic neuroendocrine tumor.

A 60-year-old man underwent computed tomography as part of colorectal cancer follow-up. A hypervascular nodule was found within the pancreatic tail and subsequently proved to be positive on [111In] DTPA-octreotide scan. A neuroendocrine tumor of the pancreas was supposed and a distal pancreatectomy performed. Heterotopic splenic tissue was finally proved by pathological examination. The present case suggests that intrapancreatic accessory spleen be considered in the differential diagnosis of pancreatic lesions positive on [111In] DTPA-octreotide scan.

Feasibility of domestic (18)F-DOPA PET/CT scanning in the differential diagnosis of pancreatic lesions in children with hyperinsulinemic hypoglycemia

Objective: To study the feasibility of (18)F-fluoro-L-dihydroxyphenylalanine positron emission tomography/Computed tomography ((18)F-DOPA PET/CT) scanning in the localization and differential diagnosing of focal versus diffuse form of pancreas lesions in patients with hyperinsulinemic hypoglycemia (HH). Method: Twenty-four patients were diagnosed with HH between January, 2016 and February, 2017 in the Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University using an integrated clinical and biochemical diagnostic protocol, domestic (18)F-DOPA PET/CT imaging technique were applied after MRI and ultrasound failed to detect pancreas lesions. Pancreas (18)F-DOPA standardized uptake values (SUV) were measured, and pancreas' lesions were dually analyzed via visual method and pancreas percentage SUV method. Among these patients, 9 patients received surgical pancreatic lesion resections, the correlations among surgical outcomes, histopathological findings and (18)F-DOPA PET/CT scan results were analyzed. Result: Seven patients were detected with focal form of pancreas lesions, the mean peak of SUV was 4.7±1.7(2.6-7.1), and 17 patients were found to have diffuse form lesions after (18)F-DOPA-PET/CT scanning. Among the 24 cases, 9 patients (7 showed focal and 2 showed diffuse (18)F-DOPA PET/CT pancreatic uptake)were euglycemic without any medical support after surgery; the resected pancreatic tissue histopathological results were consistent with that of PET/CT imaging. Only one patient, who responded to medical treatment before surgery, had temporary hyperglycemia after operation. Conclusion: Domestic (18)F-DOPA PET/CT could successfully locate and differentiate the pancreatic lesions and thus improve the success of surgery.

Groove Pancreatitis Vs Pancreatic Adenocarcinoma: A Review of 8 Cases

IntroductionGroove pancreatitis (PS) is an uncommon clinical situation and radiologically it can mimic carcinoma of the periampullary area. The aim of this paper is to study a series of 8 patients who underwent surgery with preoperative diagnosis of pancreatic head mass and subsequent pathological diagnosis of PS. MethodsIn our series, 6 were men and 2 were women, with an average age of 51.9 years. Before surgery, all patients had epigastric abdominal pain requiring analgesia at high doses. The preoperative analytical CEA and Ca 19.9 were normal in all patients. Imaging studies showed intrapancreatic solid lesions in 6 of the 8 patients, and in the remaining 2 one papillary mass of 5 and 6cm, respectively, that caused stenosis in the duodenal luz. EUS neoplastic cells were negative in all patients. ResultsThe immediate postoperative evolution was satisfactory, there are no complications. In our series, no patients have died. The long-term follow-up, in 7 of the 8 patients, has been excellent with disappearance of abdominal pain and improvement of nutritional status. The remaining patient had frequent recurrent episodes of acute pancreatitis, and at 60 months, presented a pseudocyst that has required a Roux-en-Y cystojejunostomy. ConclusionsPS must be included in the differential diagnosis of pancreatic lesions, which may include carcinoma of the periampullary area and other causes of chronic pancreatitis.

Pancreatitis del surco versus adenocarcinoma de páncreas: a propósito de 8 casos

IntroductionGroove pancreatitis (PS) is an uncommon clinical situation and radiologically it can mimic carcinoma of the periampullary area. The aim of this paper is to study a series of 8 patients who underwent surgery with preoperative diagnosis of pancreatic head mass and subsequent pathological diagnosis of PS. MethodsIn our series, 6 were men and 2 women, with an average age of 51,9 years. Before surgery, all patients had epigastric abdominal pain requiring analgesia at high doses. The preoperative analytical CEA and Ca 19.9 were normal in all patients. Imaging studies showed intrapancreatic solid lesions in 6 of the 8 patients, and in the remaining 2 one papillary mass of 5 and 6cm, respectively, that caused stenosis in the duodenal luz. EUS neoplastic cells were negative in all patients. ResultsThe immediate postoperative evolution was satisfactory, there are no complications. In our series, no patients have died. The long-term follow-up, in 7 of the 8 patients, has been excellent with disappearance of abdominal pain and improvement of nutritional status. The remaining patient had frequent recurrent episodes of acute pancreatitis, and at 60 months, presented a pseudocyst that has required a Roux-en-Y cystojejunostomy. ConclusionsPS must be included in the differential diagnosis of pancreatic lesions, which may include carcinoma of the periampullary area and other causes of chronic pancreatitis.

Tu1665 Utility of Contrast Enhanced Endoscopic Ultrasound (CE-EUS) in the Evaluation of Solid-Appearing Cystic Neoplasms and Suspected Mural Nodules in Intraductal Papillary Mucinous Neoplasms (IPMN) of the Pancreas

EUS is a valuable tool in the evaluation of suspected pancreatic cystic neoplasms, but diagnostic yields of cyst fluid biomarkers and cytology by EUS fine needle aspiration (FNA) are often suboptimal. CE-EUS has been reported as a useful adjunct for the differential diagnosis of pancreatic lesions. This study aims to examine the role of CE-EUS in the evaluation of solid-appearing cystic neoplasms and suspected mural nodules in IPMN of the pancreas.

PANCREATIC SCHWANNOMA: CASE REPORT

Pancreatic schwannoma is a rare neoplasm. By 2012, there were only 47 cases reported on pancreatic schwannoma in the English literature to the best of our knowledge. Hereby, we report a 37-year-old Caucasian male with a cystic schwannoma in the head of the pancreas. The patient, complaining of vague abdominal pain and pruritus underwent a computed tomography (CT) scan of the abdomen. The CT scan of the abdomen revealed a cystic lesion in the head of the pancreas. Initially, a cystic mucinous tumor of the pancreas was suspected. Whipple’s procedure was undertaken. The histopathologic evaluation of the specimen revealed a pancreatic schwannoma. The patient did well postoperatively. Even rarely seen, pancreatic schwannoma should be taken into account in the differential diagnosis of pancreatic lesions.

Hydatid cyst of the pancreas mimicking neoplasm.

Hydatid disease is a cyclozoonotic infection caused by the cestode genus Echinococcus. It occurs throughout the world and is especially common in sheep- and cattle-raising regions of Africa, Australia, New Zealand, India, the Middle East, South America, and the Mediterranean. The incidence of humans infected with hydatid disease is approximately 1-2:1000. It is higher in rural areas. Infection occurs via ingestion of infected meat. Hydatidosis is caused by sheep and cattle ingesting tapeworm eggs in dog feces. These eggs hatch in the duodenum and invade the liver, lungs, or bones of sheep and cattle. Humans are infected by ingesting the infected meat from these animals. In the organs, the embryo transforms into a cyst, which develops the germinal epithelium that produces capsules, larval forms, and eventually the infectious scolices. Although hydatid cyst of the pancreas is rare, it must be considered in the differential diagnosis of pancreatic lesions. We present a rare case.

A scoring system for differential diagnosis of benign and malignant pancreatic lesions：establishment and validation

Objective To develop a scoring system for differential diagnosis of benign and malignant pancreatic lesions and to evaluate its diagnostic efficiency.Methods We retrospectively analyzed the medical records of patients with pancreatic lesions(with pathologically confirmed diagnosis);the patients were treated in Changhai Hospital from November 2008to May2013.A differential diagnosis model was created using multiple logistic regression analysis.A scoring system for differential diagnosis of benign and malignant pancreatic lesions was established based on each regression coefficient,and then was externally validated.The differential diagnosis efficiency of the scoring system was assessed by its consistency,differential ability and accuracy.Results A total of 1 000eligible participants were included in our research.The scoring system,which was scored from 0to 14points,comprised 4variables:age,anorexia,diabetes history and serum CA19-9.The system had good consistency(P=0.13),agood differential ability(area under the receiver operating characteristic[ROC]curve=0.82,95%confidence interval[CI]:0.79-0.86,P0.001).When score 2 was used as the predictive cut-off value,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio were 81.46%,66.88%,77.86%,88.26%,54.12%,2.46,and 0.28,respectively.The risk(88.26%)ofmalignant pancreatic lesions in patients with high-risk scores(2)was significantly higher than that(45.88%)in patients with low-scores(≤2)(P0.001).External validation results showed the scoring system had good differential ability(area under the ROC curve=0.81,95%CI:0.76-0.86,P0.001)and consistency(P=0.716).Conclusion The prediction model and its scoring system is of great value for risk stratification of benign and malignant pancreatic lesions,which may be serve as an initial evidence for differential diagnosis of pancreatic lesions.

Waldenstrom macroglobulinemia presenting with pancreatic mass: a case report and review of literature.

Waldenstrom macroglobulinemia is a rare lymphoplasmacytic lymphoma characterized by a wide range of clinical presentations related to direct tumor infiltration and the production of IgM. Most commonly it presents with cytopenia, hepatosplenomegaly, lymphadenopathy, constitutional symptoms, and hyperviscosity syndrome.We report a case of Waldenstrom macroglobulinemia in an 60-year-old female who initially presented with intermittent abdominal pain. The patient had no peripheral lymphadenopathy. On extensive investigation she was found to have pancreatic mass. The diagnosis of Waldenstrom macroglobulinemia was established after cytomorphology and immunohistochemical analysis of the patient's bone marrow revealed the presence of a lymphoid/lymphoplasmacytoid-like bone marrow infiltrate along with an elevated serum IgM level. The patient responded both clinically and serologically to chemotherapy. This case is unusual because the patient lacked all common clinical features of Waldenstrom macroglobulinemia with exception of anemia.To our knowledge this is the first report of a patient with Waldenstrom macroglobulinemia presenting with a pancreatic mass adding to the spectrum of clinical presentations seen in this disease. This adds to the wide variety of gastrointestinal related clinical presentations of Waldenstrom macroglobulinemia and points to the need for considering Waldenstrom macroglobulinemia along with other lymphoid neoplasms in the differential diagnosis of pancreatic lesions.

The role of endoscopic ultrasound (EUS) in relation to other imaging modalities in the differential diagnosis between mass forming chronic pancreatitis, autoimmune pancreatitis and ductal pancreatic adenocarcinoma

Differential diagnosis of solid pancreatic lesions remains as an important clinical challenge, mainly for the differentiation between mass forming chronic pancreatitis, autoimmune pancreatitis and pancreatic adenocarcinoma. Endoscopic ultrasound (EUS), computed tomography (CT) and magnetic resonance imaging (MRI) can all provide valuable and complementary information in this setting. Among them, EUS has the unique ability to obtain specimens for histopathological diagnosis and can therefore play a crucial role in the evaluation patients with inconclusive findings on initial examinations. Nowadays, new developed techniques associated to EUS, like elastography and contrast enhancement, have shown promising results for the differential diagnosis of these pancreatic lesions.

MR imaging versus PET/CT for evaluation of pancreatic lesions

PurposeTo retrospectively determine the diagnostic accuracy of magnetic resonance imaging (MRI) and combined positron emission tomography/computed tomography (PET/CT) in the differential diagnosis of benign and malignant pancreatic lesions. Materials and methodsTwenty-seven patients (15 women/12 men, mean age 56.5 years) with MR imaging and PET/CT studies performed to differentiate benign and malignant pancreatic lesions were identified between October 2008 and October 2010. Both MR and PET/CT data sets were retrospectively and blindly evaluated by two independent readers (4 readers total) with different degrees of experience, using a visual five-point score system. The results were correlated with final diagnosis obtained by histopathology. Results17 patients had malignant diseases and 10 patients had benign diseases. Depending on the observer, the sensitivity, specificity, positive predictive value and negative predictive value of MRI varied between 88–94%, 50–80%, 75–89% and 71–89% respectively. Sensitivities, specificities, positive predictive values and negative predictive values of PET/CT were 73%, 56%, 73% and 56% respectively. The diagnostic accuracy of MR for the differential diagnosis of pancreatic lesions was 74–89%, compared with 67% for PET/CT. The weighted Cohen's kappa coefficient was 0.47 at MR and 0.53 at PET/CT. ConclusionMRI achieved higher sensitivity and specificity in the differential diagnosis of pancreatic lesions.