Objective To explore the optimal delay time of enhanced scanning with CT based simulation before cyberknife treatment of carcinoma in different positions of the pancreas.Methods Philips 16 large aperture spiral CT scan was applied.Fifty-three patients with carcinoma in the head of the pancreas and 60 pancreatic cancer patients in the body or tail were randomly assigned to three groups with scan delays of 25,45,and 65 seconds in group A (25s group,pancreatic head n =18,pancreatic body or tail n =21);30,50,and 70 seconds in group B (3 0s,pancreatic head n =17,pancreatic body or tail n =19);and 35,55,and 70 seconds in group C (35s,pancreatic head n =18,pancreatic body or tail n =20),respectively.Images were evaluated by three associate professors of radiation oncology based on image quality score scale.The items rating in different time points were compared using a random intercept model of mathematical mean in three groups.Then the items rating of different time points were compared in pairs using the Sidak method.One-way ANOVA was used to compare the optimal time point of each group,so the optimal delay time of enhanced scanning with CT based simulation before cyberknife treatment of pancreatic cancer was obtained.Results The delayed time points with the highest scores for target delineation of the tumor in the pancreatic head and the pancreatic body or tail by CT enhanced scanning in three groups were 45 s/65 s,50 s/50 s,55 s/75 s,respectively.There was no significant difference in the scan time of 45 s,50 s and 55 s for the tumor in the pancreatic head.Similarly,no significant difference could be found in the scan time of 65 s,50 s and 75 s for the tumor in the pancreatic body and tail.Conclusions The recommended delay time interval for localizing the tumor in pancreatic head by CT enhanced scanning was 45 ～ 55 s,and for the tumor in the pancreatic body or tail was 50 ～75 s.

Objective To explore the imaging diagnosis in pancreatic metastasis from clear cell renal carcinoma. Methods Twenty three patients with pancreatic metastasis from clear cell renal carcinoma confirmed by pathology were enrolled during 2007 to 2014,and their clinical sources,images and pathologic findings were reviewed. Twenty three patients underwent CT and 8 patients underwent MRI examinations. Metastatic neoplasm in pancreas were found after nephrectomy from 3 years to 17 years (average 9 years), including17 patients were diagnosed in more than 5 years after nephrectomy. Imaging features were observed.Result Metastatic neoplasms were solitary in 5 patients and multiple in 18 patients. The diameters were from 0.2 to 5.0 cm.CT plain scan demonstrated iso-density or slight hypo-density tumors with clear boundary, without calcification, and significant enhancement. MR demonstrated significantly lower signal on T1WI and high or slightly high signal on T2WI in all metastases.After contrast injection,the metastases were enhanced significantly.In 4 cases,the obstruction of the main pancreatic duct was found. Conclusions Pancreatic metastasis from clear cell renal carcinoma mostly were found in more than 5 years after nephrectomy. The images demonstrated that single or multiple tumors with clear boundary and significant enhancement in pancreas.Medical history is the key to imaging diagnosis.