Parallels between computed tomography and clinical observations in diagnosing obstructive pancreatic masse
https://doi.org/10.5922/2223-2427-2024-9-1-1
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
About the Authors
G. M. Barvanyan
Komi Republican Clinical Hospital; Syktyvkar State University
Russian Federation
Russian Federation
George M. Barvanyan, Asssociate Professor
114 Pushkina St, Syktyvkar, 167004
55 Starovskogo St, Syktyvkar, 167000
M. V. Morozova
Komi Republican Clinical Hospital
Russian Federation
Russian Federation
Marina V. Morozova, Radiologist, Deartment of Radiology
114 Pushkina St, Syktyvkar, 167004
A. A. Tsert
Komi Republican Clinical Hospital
Russian Federation
Russian Federation
Anastasiya A. Tsert, Surgeon
114 Pushkina St, Syktyvkar, 167004
M. I. Belolikov
Komi Republican Clinical Hospital
Russian Federation
Russian Federation
Mikhail I. Belolikov, Surgeon
114 Pushkina St, Syktyvkar, 167004
References
1. Dutta AK, Chacko A. Head mass in chronic pancreatitis: Inflammatory or malignant. World J Gastrointest Endosc. 2015 Mar 16;7(3):258—64. https://doi.org/10.4253/wjge.v7.i3.258
2. Manikkavasakar S, AlObaidy M, Busireddy KK, Ramalho M, Nilmini V, Alagiyawanna M, Semelka RC. Magnetic resonance imaging of pancreatitis: an update. World J Gastroenterol. 2014 Oct 28;20(40):14760— 77. https://doi.org/10.3748/wjg.v20.i40.14760
3. Jiang S, Li Y. A comparative analysis of CT and MRI in differentiating pancreatic cancer from mass pancreatitis. Am J Transl Res. 2021 Jun 15;13(6):6431—6438.
4. Zakharova OP, Kubyshkin VA, Karmazanovskiĭ GG. The requirement for the CT-scan protocol for the proper assessment of pancreatic tumors resectability. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N. I. Pirogova. 2012;(8):44—50 (in Russ.).
5. Chai L, Zhu N, Wang Q, Wang T, Chai W. Assessment of Malignancy Potential in Intraductal Papillary Mucinous Neoplasms of the Pancreas on MDCT. Acad Radiol. 2021 May;28(5):679—686. https://doi.org/10.1016/j.acra.2020.03.042
6. Kamei N, Yamada Y, Hijiya N, Takaji R, Kiyonaga M, Hongo N, Ohta M, Hirashita T, Inomata M, Matsumoto S. Invasive intraductal papillary mucinous neoplasms of the pancreas: relationships between mural nodules detected on thin-section contrast-enhanced MDCT and invasive components. Abdom Radiol (NY). 2019 Sep;44(9):3139—3147. https://doi.org/10.1007/s00261-019-02084-2
7. Kim JH, Park SH, Yu ES, Kim MH, Kim J, Byun JH, Lee SS, Hwang HJ, Hwang JY, Lee SS, Lee MG. Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology. 2010 Oct;257(1):87—96. https://doi.org/10.1148/radiol.10100015
8. Karmazanovskiy GG, Akhlynova OIu. The role of contrast enhancement in the computed tomography for pancreas cancer diagnostics. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N. I. Pirogova. 2009;(1):60—67 (in Russ.).
9. Seo W, Kim YC, Min SJ, Lee SM. Enhancement parameters of contrast-enhanced computed tomography for pancreatic ductal adenocarcinoma: Correlation with pathologic grading. World J Gastroenterol. 2020 Jul 28;26(28):4151—4158. doi: 10.3748/wjg.v26.i28.4151
10. Kawaji Y, Yoshikawa T, Nakagawa K, Emori T, Nuta J, Tamura T, Hatamaru K, Yamashita Y, Itonaga M, Ashida R, Terada M, Kawai M, Sonomura T, Kitano M. Computed tomography findings for predicting the future occurrence of pancreatic cancer: value of pancreatic volumetry. Int J Clin Oncol. 2021 Jul;26(7):1304—1313. doi: 10.1007/s10147-021-01915-x
11. Ruan Z, Jiao J, Min D, Qu J, Li J, Chen J, Li Q, Wang C. Multi-modality imaging features distinguish pancreatic carcinoma from mass-forming chronic pancreatitis of the pancreatic head. Oncol Lett. 2018 Jun;15(6):9735—9744. https://doi.org/10.3892/ol.2018.8545
12. Wang ZQ, Li JS, Lu GM, Zhang XH, Chen ZQ, Meng K. Correlation of CT enhancement, tumor angiogenesis and pathologic grading of pancreatic carcinoma. World J Gastroenterol. 2003 Sep;9(9):2100—4. https:// doi.org/10.3748/wjg.v9.i9.2100
13. Zaky AM, Wolfgang CL, Weiss MJ, Javed AA, Fishman EK, Zaheer A. Tumor-Vessel Relationships in Pancreatic Ductal Adenocarcinoma at Multidetector CT: Different Classification Systems and Their Influence on Treatment Planning. Radiographics. 2017 Jan-Feb;37(1):93—112. https://doi.org/10.1148/rg.2017160054
14. Hattori Y, Gabata T, Matsui O, Mochizuki K, Kitagawa H, Kayahara M, Ohta T, Nakanuma Y. Enhancement patterns of pancreatic adenocarcinoma on conventional dynamic multi-detector row CT: correlation with angiogenesis and fibrosis. World J Gastroenterol. 2009 Jul 7;15(25):3114—21. https://doi.org/10.3748/wjg.15.3114
15. Gündüz N, Buyuker F, Seneldir H, Durukan G, Alimoglu O, Kabaalioglu A. Computed Tomography-based Morphological Differences between Histologic Subtypes of Periampullary Ductal Adenocarcinoma. J Coll Physicians Surg Pak. 2021 Aug;31(8):959—964. https://doi.org/10.29271/jcpsp.2021.08.959
16. Chen PT, Chang D, Yen H, Liu KL, Huang SY, Roth H, Wu MS, Liao WC, Wang W. Radiomic Features at CT Can Distinguish Pancreatic Cancer from Noncancerous Pancreas. Radiol Imaging Cancer. 2021 Jul;3(4):e210010. https://doi.org/10.1148/rycan.2021210010
Review
For citations:
Barvanyan G.M., Morozova M.V., Tsert A.A., Belolikov M.I. Parallels between computed tomography and clinical observations in diagnosing obstructive pancreatic masse. Surgical practice (Russia). 2024;(1):6-18. (In Russ.) https://doi.org/10.5922/2223-2427-2024-9-1-1
Views:
487
Email this article 
