Focal Pancreatitis Research Articles

Chronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach

Certain inflammatory pancreatic abnormalities may mimic pancreatic ductal adenocarcinoma at imaging, which precludes accurate preoperative diagnosis and may lead to unnecessary surgery. Inflammatory conditions that may appear masslike include mass-forming chronic pancreatitis, focal autoimmune pancreatitis, and paraduodenal pancreatitis or "groove pancreatitis." In addition, obstructive chronic pancreatitis can mimic an obstructing ampullary mass or main duct intraductal papillary mucinous neoplasm. Secondary imaging features such as the duct-penetrating sign, biliary or main pancreatic duct skip strictures, a capsulelike rim, the pancreatic duct-to-parenchyma ratio, displaced calcifications in patients with chronic calcific pancreatitis, the "double duct" sign, and vessel encasement or displacement can help to suggest the possibility of an inflammatory mass or a neoplastic process. An awareness of the secondary signs that favor a diagnosis of malignant or inflammatory lesions in the pancreas can help the radiologist to perform the differential diagnosis and determine the degree of suspicion for malignancy. Repeat biopsy or surgical resection may be necessary to achieve an accurate diagnosis and prevent unnecessary surgery for inflammatory conditions. Online supplemental material and DICOM image stacksare available for this article. ©RSNA, 2019.

1315 Groove Pancreatitis as a Rare Complication of TACE

INTRODUCTION: Transarterial chemoembolization (TACE) is often performed for hepatocellular carcinoma. Side effects can occur due to arterial ischemia and cytotoxicity from chemotherapy delivery. TACE can be complicated via inadvertent embolization of arteries supplying the liver, gallbladder, stomach and pancreas. The association of acute pancreatitis with TACE is rare. The proposed mechanism involves regurgitation of embolic beads from the hepatic artery into the arterial supply of the pancreas. Acute pancreatitis can develop up to 15 days after TACE. Herein we present a case of groove pancreatitis occurring after TACE. Groove pancreatitis is a rare variant of focal chronic pancreatitis affecting the area between the head of the pancreas, duodenum, and the common bile duct. Functional and anatomical obstruction of the minor papilla from viscous pancreatic secretions leads to impaired pancreatic enzyme outflow and proliferation of Brunner's glands causing pancreatitis. Imaging may show a submucosal mass which may confound the diagnosis since pathologies including leiomyoma, gastrointestinal stromal tumor and ampullary carcinoma may have similar imaging findings. Groove pancreatitis remains largely unfamiliar to most physicians thus making its true incidence a challenge. CASE DESCRIPTION/METHODS: This is the case of a 69-year-old male patient with multicentric hepatoma secondary to chronic Hepatitis C, status-post TACE who presented to ER with a nine-day history of epigastric abdominal pain and nausea. The patient had received TACE nine days prior and was admitted with the diagnostic impression of acute pancreatitis. The physical exam was remarkable for flank pain, negative murphy's sign. Labs showed stable hemoglobin and platelet levels. Liver chemistry showed a mixed pattern with AST minimally elevated and ALT at 102, Alk Phos at 225, Amylase slightly elevated at 135 and lipase elevated at 161. Imaging studies showed acute pancreatitis with possible necrotic collection of 2.1 cm at the pancreatic head and uncinate process, duodenitis, mild gallbladder wall thickening and no ductal dilation. Likely etiology was pancreatitis secondary to recent TACE. DISCUSSION: Pancreatitis is a rare complication of TACE. Although elevated pancreatic enzymes may be seen in up to 40% of TACE cases, the incidence of symptomatic pancreatitis after TACE is low at 2%-4%. Despite this low incidence, it is a complication that one should be aware of in patients undergoing TACE procedure given its high morbidity and mortality.

Inflammatory mimickers of pancreatic adenocarcinoma

Pancreatic ductal adenocarcinoma can be a difficult imaging diagnosis early in its course given its subtle imaging findings such as focal pancreatic duct dilatation, abrupt duct cut-off, and encasement of vasculature. A variety of pancreatitidies have imaging findings that mimic pancreatic ductal adenocarcinoma and lead to mass formation making diagnosis even more difficult on imaging alone. These conditions include acute focal pancreatitis, chronic pancreatitis, autoimmune pancreatitis, and paraduodenal ("groove") pancreatitis. This review will focus on imaging findings that can help differentiate these inflammatory processes from pancreatic ductal adenocarcinoma.

Differentiation of focal autoimmune pancreatitis from pancreatic ductal adenocarcinoma

Autoimmune pancreatitis (AIP) is an inflammatory process of the pancreas that occurs most commonly in elderly males and clinically can mimic pancreatic adenocarcinoma and present with jaundice, weight loss, and abdominal pain. Mass-forming lesions in the pancreas are seen in the focal form of AIP and both clinical and imaging findings can overlap those ofpancreatic cancer. The accurate distinction of AIP from pancreatic canceris of utmost importance as it means avoiding unnecessary surgery in AIP cases or inaccurate steroid treatment in patients with pancreatic cancer. Imaging concomitantly with serological examinations (IgG4 and Ca 19-9) plays an important role inthe distinction between these entities. Characteristic extra-pancreatic manifestations as well as favorable good response to treatment with steroids are characteristic of AIP. This paper will review current diagnostic parameters useful in differentiating between focal AIP and pancreatic adenocarcinoma.

MON-132 DKA Accompanied with Concomitant Hypertriglyceridemia-Induced Acute Pancreatitis as Initial Presentation of Ketosis-Prone Diabetes

Background: Ketosis-prone diabetes (KPD) or Flatbush diabetes has been reported as an initial presentation of DKA; There are, however, limited presentations of this phenomenon with co-existing hypertriglyceridemia-induced acute pancreatitis with normal serum lipase. Clinical Case: A 29-year-old African-American man presented with a 2-week history of epigastric pain, nausea, and vomiting. Associated symptoms included nocturnal polyuria and polydipsia and 10 lbs unintentional wt loss. He had no previous known history of diabetes; no current use of medications and past medical history was significant for medically-complicated obesity. Vital signs were remarkable for BMI of 43.3. Physical exam was mostly unrevealing except for decreased skin turgor and dry oral mucosa. Baseline chemistry and serology showed HbA1c of 11.1%, blood glucose of 910 mg/dl, serum Bicarbonate 16 mg/dl, Potassium 5.7 mmol/K, Anion Gap 19 mEq/L, with positive serum and urinary ketones. Serum lipase of 100 U/L (0-160 U/L), triglycerides of 1575 mg/dL (<150 mg/dL). Additional work-up revealed fasting C-peptide level of 2.09 (1.1−4.4 ng/mL), GAD-65 Ab titers: <5.0 U/mL (0.0−5.0 units/mL), and negative ICA (<1.1). CT Abdomen and Pelvis was remarkable for focal pancreatitis with thickening in the peripancreatic space. Biochemical testing and clinical picture were consistent with ketosis-prone T2DM. Conclusions: KPD is a different subset of diabetes, characterized by unprovoked ketosis or new-onset DKA. However, patients lack the standard phenotypes of T1DM or LADA. The underlying pathophysiology of KPD is thought to be due to β-islet cell dysfunction. Phenotypes of KPD may be further broken down via the presence or absence of β-islet cell autoantibodies, as well as long-term β-cell reserve. In our case described, the patient had negative autoantibodies and residual β-cell function, which is classified as KPD subtype A−β+. Furthermore, free fatty acidbreakdown by pancreatic lipases results in hypertriglyceridemia or lipotoxicity resulting in acute pancreatitis. Initially, management is the same as for those with T1DM with ketoacidosis, and all patients should be maintained on insulin until C-peptide levels can then be retested in 2 to 10 weeks to assess trajectory and determine transient vs. long-term insulin requirements and dependency.

3 T MR perfusion of solid pancreatic lesions using dynamic contrast-enhanced DISCO sequence: Usefulness of qualitative and quantitative analyses in a pilot study

PurposeTo assess the usefulness of qualitative and quantitative analyses of pancreatic focal diseases by using the dynamic contrast-enhanced Differential Subsampling with Cartesian Ordering (DISCO) sequence at 3 T MR device. Materials and methodsTen patients without pancreatic diseases and twenty-five patients with pathologically confirmed pancreatic focal disease (ductal adenocarcinoma, n = 14; endocrine tumour, n = 8; focal chronic pancreatitis, n = 3), underwent MRI by 3 T-device. Multiphasic contrast-enhanced MR perfusion, consisting of a 3D axial navigator, based free-breathing T1-weighted DISCO sequence, was repeated for 5 min. A dose of 0.1 mL/kg of Gadobutrolo with a 20 mL saline flush was injected at a flow rate of 5 mL/s. Perfusion MRI were processed using a dedicated software package (GeniQ; GE Healthcare), obtaining both a time-signal-intensity curve (TSIC) and perfusion maps for each healthy pancreatic parenchyma and focal disease. The TSIC were grouped into four types according to their shapes and the MR perfusion parameters (Ktrans, Kep, Ve, IAUGC) were calculated.The one-way analysis of variance and the Student's t-test were used to correlate the quantitative and qualitative parameters with the tissue histology. ResultsAll 10 patients with healthy pancreas presented a TSIC-type 1; TSIC-type 2 was observed in all 14 ductal adenocarcinomas and in one neuroendocrine tumour; TSIC-type 3 was recognized in the remaining 7 neuroendocrine neoplasms; TSIC-type 4 was identified in all 3 focal chronic pancreatitis. All perfusion parameters were significantly different (p < 0.0001) for each type of lesion. Furthermore, Ve was also very useful to discriminate between normal and pathological tissues (p = 0.0005). ConclusionQualitative and quantitative analyses of contrast-enhanced 3 T MR perfusion, using the dynamic contrast-enhanced DISCO sequence, could be considered an interesting tool to improve the diagnosis of focal pancreatic diseases, of solid lesions in particular. Further investigations with prospective larger sample studies are required to confirm these preliminary results.

Role of Magnetic Resonance Imaging in the Diagnosis of Different Pancreatic Lesions

AbstractBackground: Pancreatic cancer is one of the most lethal human cancers that requires early diagnosis. Ultrasound, CT and MRI are different imaging modalities used for diagnosis of pancreatic masses. Diffusion-Weighted Imaging (DWI) and Time-signal Intensity Curve (TIC) can add to the diagnosis of pancreatic masses.Aim of Study: The aim of this study was to evaluate the role of magnetic resonance imaging in the diagnosis of different pancreatic lesions.Patients and Methods: Twenty-three patients were divided into 4 groups, group A (Acute Pancreatitis) (AP), group B (pancreatic cysts) which subdivided into malignant and benign cysts, group C (adenocarcinoma) and group D (Focal Pancre-atitis) (FP), all patients groups were compared to the control group. MRI protocol included MRI-c (T1WI, T1 Fat Suppres-sion (FS), T2WI, T2FS and IV dynamic contrast study) and DWI which performed on (1.5 Tesla) Magnet Unit General Electric (GE). TIC was obtained from the dynamic study and the results were divided into three patterns of curves.Results: Control group demonstrated type-I TIC, group (A & D) demonstrated type-II and group C demonstrated type-III.The mean Apparent Diffusion Coefficient (ADC) values were significant lower (p<0.001) in (A & C) groups, statically different (p<0.02) between benign and malignant cysts. Stat-ically different (p<0.001) between control and patients' groups. The sensitivity, specificity, accuracy, positive and negative predictive values of DWI and MRI-c were 92.3%, 90%, 91.3%, 92.3%, 90% and 100%, 90%, 95.7%, 92.9%, 100%, respec-tively.Conclusion: DWI and TIC were useful tools in diagnosis, characterization and differentiation between pancreatic lesions.

Usefulness of non-contrast MR imaging in distinguishing pancreatic ductal adenocarcinoma from focal pancreatitis

BackgroundAccurate differentiation between pancreatic adenocarcinoma and focal pancreatitis is challenging. PurposeTo investigate the usefulness of non-contrast MRI by comparing with multidetector row CT (MDCT) and gadoxetic acid-enhanced MRI in the discrimination of pancreatic ductal adenocarcinoma (PDAC) and focal pancreatitis (FP). Materials and methodsThis retrospective study included 187 patients (116 with PDACs and 71 with FP) who underwent gadoxetic acid-MRI and MDCT prior to surgical resection or biopsy. The MRI features of PDAC and FP were compared by two radiologists. Then, two observers independently reviewed the three imaging sets: MDCT, non-contrast MRI (T1-, T2-weighted, and diffusion-weighted images), and MRI with and without gadoxetic acid to determine the diagnostic performances of each imaging modality in the discrimination of PDAC and FP. ResultsThe significant features on non-contrast MRI for diagnosis of PDAC included peritumoral cyst, pancreatic duct cut-off, clear hypointensity on T1WI, and bile duct dilatation (P < 0.05). Presence of peritumoural cyst showed the highest odds ratio for predicting PDAC. Non-contrast MRI was superior to MDCT in differentiating PDAC from FP with regard to accuracy (84.5% vs 95.5% for observer 1; 85.8% vs. 96.0% for observer 2), sensitivity (83.6% vs. 98.3%; 84.5% vs 97.8%), and negative predictive value (76.3% vs. 97.0%; 77.6% vs 96.4%) (P < 0.05). We found similar diagnostic values between the non-contrast MRI and MRI with and without contrast (P > 0.05) for both observers. ConclusionNon-contrast MRI is better than MDCT and comparable to MRI with and without gadoxetic acid in differentiating PDAC from FP.

The importance of pancreatic inflammation in endosonographic diagnostics of solid pancreatic masses

Endosonography (EUS) is one of the main diagnostic tools for the differential diagnosis of pancreatic masses. Theaim of our study was to describe the value of this technique in the work-up of solid pancreatic lesions, considering the influenceof the morphological evidence of pancreatic inflammation in the diagnostic process. Retrospectiveanalysis of prospectively collected data in our tertiary University center. From March 2007 to October 2015, 218 patientsunderwent EUS for a suspected solid pancreatic neoplasm (based on previous cross-sectional imaging results, idiopatic acutepancreatitis, weight loss, pancreatic hyperenzymemia, painless jaundice or elevated Ca 19-9 values). Malignantlesions were diagnosed in 98 (45%) patients. Sensitivity of EUS for malignancy was 91% and specificity 89.2%. Signs ofpancreatic inflammation in the surrounding pancreatic parenchyma around the focal lesion were present in 97 patients (44.4%)(more often in men, smokers and drinkers, and the most common etiology was focal chronic pancreatitis) and in these patientsthe sensitivity and sensibility dropped to 44% and 87.1%, respectively. In patients without signs of pancreatic inflammation,the pancreatic focal lesions were adenocarcinoma, neuroendocrine tumor, ventral/dorsal split, non-pancreatic pathology, pancreaticlipomatosis and autoimmune pancreatitis. Pancreatic inflammation (either focal or involving the wholegland) lowers the diagnostic sensibility of EUS in the work- up of pancreatic masses suspected for cancer, requiring furtherinvasive diagnostic methods. Focal autoimmune pancreatitis and paraduodenal pancreatitis are still confused with pancreaticcancer, even in the absence of pancreatic inflammation.

A Rare Case of B-Cell Lymphoma Presenting as a Large Solid Pancreatic Mass: A Case Report

The differential diagnosis of a pancreatic mass is categorized into cystic and solid lesions. Cystic pancreatic lesions include non-neoplastic cysts and pancreatic cystic neoplasms. Possible differential diagnoses for a solid pancreatic mass include primary exocrine pancreatic cancer, pancreatic neuroendocrine tumors, metastatic cancer, focal chronic pancreatitis, and autoimmune pancreatitis. We are presenting a rare case of B cell lymphoma presenting as a large solid pancreatic mass. A 62-year-old female with past medical history of type II diabetes and hypertension presented to University Medical Center (UMC) hospital in Las Vegas emergency room with four days of epigastric abdominal pain associated with jaundice. She reported unintentional weight loss, but no fever or night sweats. She had no history of pancreatic disease or malignancies. She denied smoking or alcohol use. Physical exam was significant for scleral icterus and a palpable epigastric mass. Initial liver function panel showed AST 189, ALT 213, ALP 140, total bilirubin 7.4 with direct bilirubin 6.2, Albumin 2.9 g/dl, Lipase 63, Lactate dehydrogenase 1,008 and CEA 12.6. Autoimmune panel was sent including antinuclear antibodies, antimitochondrial antibodies, anti-LKM antibodies, IgA, IgG and IgM levels. All were found to be unremarkable. CT of the abdomen and pelvis with IV contrast showed a 5.5 x 3.7 x 3.0 cm mass in the pancreatic tail encasing the splenic vein with splenic vein thrombosis in addition to enlarged retroperitoneal lymph nodes (figure 1). Gastroenterology was consulted and an endoscopic ultrasound with fine needle aspiration was subsequently performed. Tissue pathology revealed aggressive B cell lymphoma. A consult was made with oncology for further management. Hematologic malignancies can often manifest in extranodal locations. We present a rare case of aggressive B cell lymphoma presenting as a large pancreatic mass. Rare cases of hematologic malignancies presenting as pancreatic masses have been reported in the past. Early diagnosis is of primary importance so as to avoid unnecessary surgical resection. Clues suggesting the possibility of a primary hematologic malignancy include constitutional symptoms (weight loss, fever, and night sweats), an elevated serum lactate dehydrogenase (LDH) or beta-2 microglobulin level and a normal serum carbohydrate antigen 19-9 (CA 19-9).1429.tif Figure 1: 5.5 x 3.7 x 3.0 cm mass in the pancreatic tail encasing the splenic vein with splenic vein thrombosis in addition to enlarged retroperitoneal lymph nodes

When Focal Pancreatitis Bounces From the Head to the Tail

When Focal Pancreatitis Bounces From the Head to the Tail

Focal Chronic Pancreatitis Mimicking Early Pancreatic Ductal Adenocarcinoma: A Report of Case

Focal Chronic Pancreatitis Mimicking Early Pancreatic Ductal Adenocarcinoma: A Report of Case

3:27 PM Abstract No. 402 Partial splenic artery embolization in 35 cancer patients

Thrombocytopenia in cancer patients often contraindicates chemotherapy and/or surgery leading to suboptimal therapy and decreased overall survival. The purpose of our study was to determine safety and efficacy of partial splenic embolization to improve platelet count and to establish a standardized treatment plan to achieve ideal embolization endpoint and minimize postprocedural complications. Medical records of 35 cancer patients who underwent 39 splenic artery embolizations with 300-500 μm Embospheres were analyzed. The target embolization endpoint was 50-70% splenic infarct. Celiac plexus block was performed following 25 procedures for pain control. The spleen volumes were 1337 ± 1038 mL. The embolization led to 59 ± 16% splenic infarct. One mL of microspheres resulted in 272 ± 107 mL splenic infarct in patients with chemotherapy- or portal hypertension-induced splenomegaly and 582 ± 3 45 mL infarct in patients with hematologic malignancies. The spleen volumes decreased by 40.5 ± 11% in 1 year. The platelet count increased from 63.9 ± 29.6 (mean ± SD) to peak platelet count of 248 ± 118 in 2-4 weeks after embolization. Patients with follow-up period of >1 year had the last platelet count of 174 ± 113 (n = 12). The most common complication was moderate/severe pain which occurred in 92% of patients without celiac block and in 20% of patients with celiac block. There was non-occlusive portal vein thrombus in 2 patients, pulmonary embolus in 1 patient, focal pancreatitis in 1 patient, and increased ascites and pleural effusion in 7 patients. Procedure-related 30–day mortality was 25% amongst patients with hematologic malignancies and 0% amongst patients with chemotherapy- or portal hypertension-induced splenomegaly. Partial splenic embolization is effective to correct thrombocytopenia in cancer patients and provides improved platelet count for long-term. It is a low risk procedure in patients with chemotherapy- or portal hypertension-induced splenomegaly, but has high mortality in hematologic malignancies. The postprocedural pain was significantly reduced by celiac plexus block. Based on our data the required amount of beads can be calculated to achieve target splenic infarct.

Focal Chronic Pancreatitis Mimicking Early Pancreatic Ductal Adenocarcinoma: A Report of Case

Focal Chronic Pancreatitis Mimicking Early Pancreatic Ductal Adenocarcinoma: A Report of Case

Common and Uncommon Benign Pancreatic Lesions Mimicking Malignancy: Imaging Update and Review

There is a broad range of inflammatory, pseudotumoral, and benign lesions that may masquerade as pancreatic malignancies, often representing a challenge to the radiologist. Unawareness of these entities can lead to inadequate differential diagnoses or misdiagnosis, with important prognostic and therapeutic consequences. The purpose of this article is to revisit a spectrum of lesions, varying from common to exceedingly rare nonmalignant, that may mimic malignant pancreatic neoplasms on imaging, identifying relevant features that may contribute to reaching the correct diagnosis. Representative cases include focal fatty replacement, intrapancreatic accessory spleen, pancreatic lobulation, lipoma, autoimmune pancreatitis, focal pancreatitis, eosinophilic pancreatitis, groove pancreatitis, hemangioma, intrapancreatic aneurysm, tuberculosis, and Castleman's disease.

Парадуоденальний (groove) панкреатит. Термінологія, етіопатогенез, патоморфологія

Парадуоденальний, або groove панкреатит, рідкісний тип фокального хронічного запалення підшлункової залози, що переважно вражає ‘‘борозну‘‘ –анатомічний простір між дорсокраніальною частиною головки підшлункової залози, дванадцятипалою кишкою та загальною жовчною протокою. В літературі зустрічається під такими синонімами: дуоденальна дистрофія гетеротопічної підшлункової залози, панкреатична гамартома дванадцятипалої кишки, міоаденоматоз. Спірним залишається питання патогенезу парадуоденального панкреатиту. Основними етіопатогенетичними факторами захворювання є анатомічні особливості протокової системи підшлункової залози та підвищення в'язкості панкреатичного соку, які призводять до хронічного персистуючого запалення в ділянці ‘‘борозни‘‘ з наступним втягненням в патологічний процес головки підшлункової залози, двадцятипалої кишки та термінального відділу холедоха. Тяжкість диференціації groove панкреатиту з пухлинами періампулярної ділянки створює певні діагностичні труднощі для клініцистів та патоморфологів, що вимагає проведення операційного лікування для верифікації остаточного діагнозу. Дане повідомлення описує основні етіологічні, патофізіологічні та морфологічні зміни, які виникають при парадуоденальному панкреатиті.

Utility of contrast-enhanced harmonic EUS for evaluating the effects of steroid therapy in a case of immunoglobulin G4–negative focal autoimmune pancreatitis

Utility of contrast-enhanced harmonic EUS for evaluating the effects of steroid therapy in a case of immunoglobulin G4–negative focal autoimmune pancreatitis

Contrast-enhanced harmonic endoscopic ultrasonography in gallbladder cancer and pancreatic cancer.

Endoscopic ultrasonography (EUS) plays a major role in diagnosing gallbladder (GB) cancer and pancreatic cancer (PC). In cases of GB cancer, EUS allows for precise observations of morphology and wall layers. However, proficiency is required for the morphologic diagnosis of GB tumors. Therefore, contrast-enhanced harmonic EUS (CH-EUS) began to be performed to diagnose GB lesions. CH-EUS enables real-time observation of the hemodynamics of GB tumors. The enhanced patterns generated by CH-EUS improve precision in the diagnosis of such tumors.PC appears as a hypoechoic mass on EUS. However, distinguishing between PC and mass-forming pancreatitis or focal autoimmune pancreatitis (AIP) is difficult via conventional EUS. CH-EUS allows for differentiating among these diseases (PC is hypoenhanced and heterogeneously enhanced, pancreatitis is isoenhanced, and a pancreatic neuroendocrine tumor is hyperenhanced). EUS-guided fine needle aspiration (EUS-FNA) also contributes to pathological diagnoses of pancreatic lesions. However, certain PC patients cannot be diagnosed via EUS-FNA. PC is heterogeneously enhanced on CH-EUS, and unenhanced regions have been reported to be areas of fibrosis or necrosis. CH-EUS-guided fine needle aspiration (CH-EUS-FNA) permits puncturing of the enhanced area while avoiding necrotic and fibrotic regions. Moreover, as CH-EUS findings have been quantitatively analyzed, a time-intensity curve (TIC) has become usable for diagnosing solid pancreatic lesions. CH-EUS-related techniques have been developed and increasingly utilized in the pancreaticobiliary area.

Comparative Evaluation of Ultrasonography and Computed Tomography in Pancreatic Lesions

Background: Aims and Objectives - 1) to do a comparative evaluation of ultrasonography and computed tomography in pancreatic lesions and assess their role as a useful diagnostic tool. 2) To correlate the USG and CT findings with fine needle aspiration cytology (FNAC)/ histopathological findings/ laboratory tests / therapeutic follow up wherever performed,Material and Methods: The present study was carried out in the Department of Radio-diagnosis, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. Thirty patients presenting with signs and symptoms of suspected pancreatic lesions referred from various wards and outpatient departments were included in the study.Results: On USG, inflammatory lesions were diagnosed in 15 cases (50%), and on CT scan, the diagnosis was made in 18 patients (60%). Combining the USG &amp; CT findings of inflammatory lesions, the provisional radiological diagnosis of focal pancreatitis was made in 1 case but it was proven to be adenocarcinoma on FNAC. Provisional diagnosis of adenocarcinoma was made in 8 cases, lymphoma in 2 cases, macrocystic adenoma in 1 case and cystadenocarcinoma in 1 case on both USG and CT scan. However on FNAC, adenocarcinoma was proved in 10 patients, lymphoma was found in one case. Thus the provisional radiological diagnosis was correct in 28 patients (93.7%).Conclusion: Sonography detected pancreatic pathology in 27 cases (90%) but CT scan detected pancreatic lesions in all the 30 patients (100%). Present study had been undertaken to do a comparative evaluation of ultrasonography and computed tomography in pancreatic lesions and correlated the findings with fine needle aspiration cytology (FNAC) / HPE / laboratory tests / therapeutic follow up wherever performed. A need thus exists for multiple studies to produce significant in – road towards the appropriate imaging diagnosis of pancreatic pathologies as despite the rapid advances in imaging techniques, the overall impact of these modalities on the management and outcome of patients is still debatableJ MEDICINE July 2016; 17 (2) : 66-78

Differentiation of pancreatic carcinoma and mass-forming focal pancreatitis: qualitative and quantitative assessment by dynamic contrast-enhanced MRI combined with diffusion-weighted imaging.

Differentiation between pancreatic carcinoma (PC) and mass-forming focal pancreatitis (FP) is invariably difficult. For the differential diagnosis, we qualitatively and quantitatively assessed the value of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in PC and FP in the present study. This study included 32 PC and 18 FP patients with histological confirmation who underwent DCE-MRI and DWI. The time-signal intensity curve (TIC) of PC and FP were classified into 5 types according to the time of reaching the peak, namely, type I, II, III, IV, and V, respectively, and two subtypes, namely, subtype-a (washout type) and subtype-b (plateau type) according to the part of the TIC profile after the peak. Moreover, the mean and relative apparent diffusion coefficient (ADC) value between PC and FP on DWI were compared. The type V TIC was only recognized in PC group (P < 0.01). Type IV b were more frequently observed in PC (P = 0.036), while type- IIa (P < 0.01), type- Ia (P = 0.037) in FP. We also found a significant difference in the mean and relative ADC value between PC and FP. The combined image set of DCE-MRI and DWI yielded an excellent sensitivity, specificity, and diagnostic accuracy (96.9%, 94.4%, and 96.0%). The TIC of DCE-MRI and ADC value of DWI for pancreatic mass were found to provide reliable information in differentiating PC from FP, and the combination of DCE-MRI and DWI can achieve a higher sensitivity, specificity, and diagnostic accuracy.