SpringerLink
Log in

Common and uncommon pitfalls in pancreatic imaging: it is not always cancer

  • Pictorial Essay
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Despite advances in multimodality imaging of pancreas, there is still overlap between imaging findings of several pancreatic/peripancreatic disease processes. Pancreatic and peripancreatic non-neoplastic entities may mimic primary pancreatic neoplasms on ultrasound, CT, and MRI. On the other hand, primary pancreatic cancer may be overlooked on imaging because of technical and inherent factors. The purpose of this pictorial review is to describe and illustrate pancreatic imaging pitfalls and highlight the basic radiological features for proper differential diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17

Similar content being viewed by others

References

  1. Matos C, Cappeliez O, Winant C, et al. (2002) MR imaging of the pancreas: a pictorial tour. Radiographics 22(1):e2. doi:10.1148/radiographics.22.1.g02jae2e2

    Article  PubMed  Google Scholar 

  2. McNulty NJ, Francis IR, Platt JF, et al. (2001) Multi-detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 220(1):97–102. doi:10.1148/radiology.220.1.r01jl1897

    Article  CAS  PubMed  Google Scholar 

  3. Fattahi R, Balci NC, Perman WH, et al. (2009) Pancreatic diffusion-weighted imaging (DWI): comparison between mass-forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging 29(2):350–356. doi:10.1002/jmri.21651

    Article  PubMed  Google Scholar 

  4. Sandrasegaran K, Lin C, Akisik FM, Tann M (2010) State-of-the-art pancreatic MRI. AJR Am J Roentgenol 195(1):42–53. doi:10.2214/ajr.195.3_supplement.0s42

    Article  PubMed  Google Scholar 

  5. Dimcevski G, Erchinger FG, Havre R, Gilja OH (2013) Ultrasonography in diagnosing chronic pancreatitis: new aspects. World J Gastroenterol 19(42):7247–7257. doi:10.3748/wjg.v19.i42.7247

    Article  PubMed Central  PubMed  Google Scholar 

  6. Atri M, Nazarnia S, Mehio A, Reinhold C, Bret PM (1994) Hypoechogenic embryologic ventral aspect of the head and uncinate process of the pancreas: in vitro correlation of US with histopathologic findings. Radiology 190(2):441–444. doi:10.1148/radiology.190.2.8284396

    Article  CAS  PubMed  Google Scholar 

  7. Al-Hawary MM, Kaza RK, Azar SF, Ruma JA, Francis IR (2013) Mimics of pancreatic ductal adenocarcinoma. Cancer Imaging 13(3):342–349. doi:10.1102/1470-7330.2013.9012

    Article  PubMed Central  PubMed  Google Scholar 

  8. Kim JK, Altun E, Elias J Jr, et al. (2007) Focal pancreatic mass: distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo MRI. J Magn Reson Imaging 26(2):313–322. doi:10.1002/jmri.21010

    Article  PubMed  Google Scholar 

  9. Ichikawa T, Sou H, Araki T, et al. (2001) Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 221(1):107–116. doi:10.1148/radiol.2211001157

    Article  CAS  PubMed  Google Scholar 

  10. Lee SS, Byun JH, Park BJ, et al. (2008) Quantitative analysis of diffusion-weighted magnetic resonance imaging of the pancreas: usefulness in characterizing solid pancreatic masses. J Magn Reson Imaging 28(4):928–936. doi:10.1002/jmri.21508

    Article  PubMed  Google Scholar 

  11. Gerritsen A, Molenaar IQ, Bollen TL, et al. (2014) Preoperative characteristics of patients with presumed pancreatic cancer but ultimately benign disease: a multicenter series of 344 pancreatoduodenectomies. Ann Surg Oncol 21(12):3999–4006. doi:10.1245/s10434-014-3810-7

    Article  PubMed  Google Scholar 

  12. To’o KJ, Raman SS, Yu NC, et al. (2005) Pancreatic and peripancreatic diseases mimicking primary pancreatic neoplasia. Radiographics 25(4):949–965. doi:10.1148/rg.254045167

    Article  PubMed  Google Scholar 

  13. Raimondi S, Lowenfels AB, Morselli-Labate AM, Maisonneuve P, Pezzilli R (2010) Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Pract Res Clin Gastroenterol 24(3):349–358. doi:10.1016/j.bpg.2010.02.007

    Article  PubMed  Google Scholar 

  14. Matsubayashi H, Kakushima N, Takizawa K, et al. (2014) Diagnosis of autoimmune pancreatitis. World J Gastroenterol 20(44):16559–16569. doi:10.3748/wjg.v20.i44.16559

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Manfredi R, Graziani R, Cicero C, et al. (2008) Autoimmune pancreatitis: CT patterns and their changes after steroid treatment. Radiology 247(2):435–443. doi:10.1148/radiol.2472070598

    Article  PubMed  Google Scholar 

  16. Negrelli R, Manfredi R, Pedrinolla B, et al. (2015) Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings. Eur Radiol 25(2):359–367. doi:10.1007/s00330-014-3371-y

    Article  PubMed  Google Scholar 

  17. Hur BY, Lee JM, Lee JE, et al. (2012) Magnetic resonance imaging findings of the mass-forming type of autoimmune pancreatitis: comparison with pancreatic adenocarcinoma. J Magn Reson Imaging 36(1):188–197. doi:10.1002/jmri.23609

    Article  PubMed  Google Scholar 

  18. Borghei P, Sokhandon F, Shirkhoda A, Morgan DE (2013) Anomalies, anatomic variants, and sources of diagnostic pitfalls in pancreatic imaging. Radiology 266(1):28–36. doi:10.1148/radiol.12112469

    Article  PubMed  Google Scholar 

  19. Griffin N, Yu D, Alexander Grant L (2013) Magnetic resonance cholangiopancreatography: pearls, pitfalls, and pathology. Semin Ultrasound CT MR 34(1):32–43. doi:10.1053/j.sult.2012.11.003

    Article  PubMed  Google Scholar 

  20. Katz DS, Hines J, Math KR, et al. (1999) Using CT to reveal fat-containing abnormalities of the pancreas. AJR Am J Roentgenol 172(2):393–396. doi:10.2214/ajr.172.2.9930790

    Article  CAS  PubMed  Google Scholar 

  21. Pokharel SS, Macura KJ, Kamel IR, Zaheer A (2013) Current MR imaging lipid detection techniques for diagnosis of lesions in the abdomen and pelvis. Radiographics 33(3):681–702. doi:10.1148/rg.333125068

    Article  PubMed  Google Scholar 

  22. Isserow JA, Siegelman ES, Mammone J (1999) Focal fatty infiltration of the pancreas: MR characterization with chemical shift imaging. AJR Am J Roentgenol 173(5):1263–1265. doi:10.2214/ajr.173.5.10541101

    Article  CAS  PubMed  Google Scholar 

  23. Klein KA, Stephens DH, Welch TJ (1998) CT characteristics of metastatic disease of the pancreas. Radiographics 18(2):369–378. doi:10.1148/radiographics.18.2.9536484

    Article  CAS  PubMed  Google Scholar 

  24. Ng CS, Loyer EM, Iyer RB, et al. (1999) Metastases to the pancreas from renal cell carcinoma: findings on three-phase contrast-enhanced helical CT. AJR Am J Roentgenol 172(6):1555–1559. doi:10.2214/ajr.172.6.10350288

    Article  CAS  PubMed  Google Scholar 

  25. Kim SH, Lee JM, Han JK, et al. (2008) Intrapancreatic accessory spleen: findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol 9(2):162–174. doi:10.3348/kjr.2008.9.2.162

    Article  PubMed Central  PubMed  Google Scholar 

  26. Unver Dogan N, Uysal II, Demirci S, Dogan KH, Kolcu G (2011) Accessory spleens at autopsy. Clin Anat 24(6):757–762. doi:10.1002/ca.21146

    Article  PubMed  Google Scholar 

  27. Kawamoto S, Johnson PT, Hall H, et al. (2012) Intrapancreatic accessory spleen: CT appearance and differential diagnosis. Abdom Imaging 37(5):812–827. doi:10.1007/s00261-011-9830-x

    Article  PubMed  Google Scholar 

  28. Coquia SF, Kawamoto S, Zaheer A, et al. (2014) Intrapancreatic accessory spleen: possibilities of computed tomography in differentiation from nonfunctioning pancreatic neuroendocrine tumor. J Comput Assist Tomogr 38(6):874–878. doi:10.1097/RCT.0000000000000127

    Article  PubMed Central  PubMed  Google Scholar 

  29. Jang KM, Kim SH, Song KD, et al. (2015) Differentiation of solid-type serous cystic neoplasm from neuroendocrine tumour in the pancreas: value of abdominal MRI with diffusion-weighted imaging in comparison with MDCT. Clin Radiol 70(2):153–160. doi:10.1016/j.crad.2014.10.010

    Article  CAS  PubMed  Google Scholar 

  30. Kalb B, Sarmiento JM, Kooby DA, Adsay NV, Martin DR (2009) MR imaging of cystic lesions of the pancreas. Radiographics 29(6):1749–1765. doi:10.1148/rg.296095506

    Article  PubMed  Google Scholar 

  31. Palmucci S, Mauro LA, Milone P, et al. (2010) Diagnosis of ruptured superior mesenteric artery aneurysm mimicking a pancreatic mass. World J Gastroenterol 16(18):2298–2301

    Article  PubMed Central  PubMed  Google Scholar 

  32. Messina LM, Shanley CJ (1997) Visceral artery aneurysms. Surg Clin N Am 77(2):425–442

    Article  CAS  PubMed  Google Scholar 

  33. Vilgrain V, Condat B, O’Toole D, et al. (2009) Pancreatic portal cavernoma in patients with cavernous transformation of the portal vein: MR findings. Eur Radiol 19(11):2608–2613. doi:10.1007/s00330-009-1459-6

    Article  PubMed  Google Scholar 

  34. Macaluso FS, Maida M, Dioguardi Burgio M, Brancatelli G (2013) Education and imaging: hepatobiliary and pancreatic—portal hypertensive biliopathy presenting as acute cholangitis. J Gastroenterol Hepatol 28(8):1257. doi:10.1111/jgh.12295

    Article  CAS  PubMed  Google Scholar 

  35. Lawler LP, Horton KM, Fishman EK (2003) Peripancreatic masses that simulate pancreatic disease: spectrum of disease and role of CT. Radiographics 23(5):1117–1131. doi:10.1148/rg.235035013

    Article  PubMed  Google Scholar 

  36. Hariri A, Siegelman SS, Hruban RH (2005) Duodenal diverticulum mimicking a cystic pancreatic neoplasm. Br J Radiol 78(930):562–564. doi:10.1259/bjr/52543195

    Article  CAS  PubMed  Google Scholar 

  37. Moriya T, Kimura W, Hirai I, et al. (2012) Pancreatic schwannoma: case report and an updated 30-year review of the literature yielding 47 cases. World J Gastroenterol 18(13):1538–1544. doi:10.3748/wjg.v18.i13.1538

    Article  PubMed Central  PubMed  Google Scholar 

  38. Ahn SS, Kim MJ, Choi JY, et al. (2009) Indicative findings of pancreatic cancer in prediagnostic CT. Eur Radiol 19(10):2448–2455. doi:10.1007/s00330-009-1422-6

    Article  PubMed  Google Scholar 

  39. Prokesch RW, Chow LC, Beaulieu CF, Bammer R, Jeffrey RB Jr (2002) Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 224(3):764–768. doi:10.1148/radiol.2243011284

    Article  PubMed  Google Scholar 

  40. Gangi S, Fletcher JG, Nathan MA, et al. (2004) Time interval between abnormalities seen on CT and the clinical diagnosis of pancreatic cancer: retrospective review of CT scans obtained before diagnosis. AJR Am J Roentgenol 182(4):897–903. doi:10.2214/ajr.182.4.1820897

    Article  PubMed  Google Scholar 

  41. Ichikawa T, Haradome H, Hachiya J, et al. (1997) Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging. Radiology 202(3):655–662. doi:10.1148/radiology.202.3.9051012

    Article  CAS  PubMed  Google Scholar 

  42. Bronstein YL, Loyer EM, Kaur H, et al. (2004) Detection of small pancreatic tumors with multiphasic helical CT. AJR Am J Roentgenol 182(3):619–623. doi:10.2214/ajr.182.3.1820619

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Radiology -Di.Bi.Med., University of Palermo, Palermo, Italy

    F. Vernuccio, M. Dioguardi Burgio, M. Midiri & G. Brancatelli

  2. Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    A. A. Borhani & A. Furlan

Authors
  1. F. Vernuccio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. A. Borhani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Dioguardi Burgio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Midiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Furlan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Brancatelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Dioguardi Burgio.

Ethics declarations

Conflict of interest

Furlan A.: Research Grant with General Electric; Elsevier/Amirsys author. The other authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vernuccio, F., Borhani, A.A., Dioguardi Burgio, M. et al. Common and uncommon pitfalls in pancreatic imaging: it is not always cancer. Abdom Radiol 41, 283–294 (2016). https://doi.org/10.1007/s00261-015-0557-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-015-0557-y

Keywords

Search

Navigation