Pulmonary tumor embolism is commonly discovered at autopsy, but is rarely suspected ante-mortem. Microangiopathy is an uncommon and distinct form of simple tumor pulmonary embolism. Here, we present a 52-year-old male with tumor thrombotic microangiopathy and pulmonary infarction, which might have originated from intraductal papillary mucinous tumor of the pancreas. Multiple wedge-shaped consolidations were found initially and aggravated with cavitation. These CT features of pulmonary infarction were pathologically confirmed to result from pulmonary tumor thrombotic microangiopathy.
Adenocarcinoma, Mucinous/pathology/radiography ; Humans ; Lung/pathology/*radiography ; Lung Neoplasms/pathology/radiography ; Male ; Middle Aged ; Pancreas/pathology ; Pancreatic Neoplasms/*complications/pathology ; Papilloma, Intraductal/pathology/radiography ; Pulmonary Embolism/pathology/*radiography ; Pulmonary Infarction/pathology/*radiography ; Thrombotic Microangiopathies/diagnosis/*radiography ; Tomography, X-Ray Computed

OBJECTIVE: To assess the value of applying MultiVane to liver T2-weighted imaging (T2WI) compared with conventional T2WIs with emphasis on detection of focal liver lesions. MATERIALS AND METHODS: Seventy-eight patients (43 men and 35 women) with 86 hepatic lesions and 20 pancreatico-biliary diseases underwent MRI including T2WIs acquired using breath-hold (BH), respiratory-triggered (RT), and MultiVane technique at 3T. Two reviewers evaluated each T2WI with respect to artefacts, organ sharpness, and conspicuity of intrahepatic vessels, hilar duct, and main lesion using five-point scales, and made pairwise comparisons between T2WI sequences for these categories. Diagnostic accuracy (Az) and sensitivity for hepatic lesion detection were evaluated using alternative free-response receiver operating characteristic analysis. RESULTS: MultiVane T2WI was significantly better than BH-T2WI or RT-T2WI for organ sharpness and conspicuity of intrahepatic vessels and main lesion in both separate reviews and pairwise comparisons (p < 0.001). With regard to motion artefacts, MultiVane T2WI or BH-T2WI was better than RT-T2WI (p < 0.001). Conspicuity of hilar duct was better with BH-T2WI than with MultiVane T2WI (p = 0.030) or RT-T2WI (p < 0.001). For detection of 86 hepatic lesions, sensitivity (mean, 97.7%) of MultiVane T2WI was significantly higher than that of BH-T2WI (mean, 89.5%) (p = 0.008) or RT-T2WI (mean, 84.9%) (p = 0.001). CONCLUSION: Applying the MultiVane technique to T2WI of the liver is a promising approach to improving image quality that results in increased detection of focal liver lesions compared with conventional T2WI.
Adult ; Aged ; Aged, 80 and over ; Artifacts ; Biliary Tract Diseases/diagnosis/radiography ; Female ; Humans ; Liver Diseases/*diagnosis/radiography ; Liver Neoplasms/*diagnosis/pathology/radiography ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreatic Diseases/diagnosis/radiography ; Retrospective Studies

OBJECTIVE: To investigate the image quality (IQ) and apparent diffusion coefficient (ADC) of reduced field-of-view (FOV) di-ffusion-weighted imaging (DWI) of pancreas in comparison with full FOV DWI. MATERIALS AND METHODS: In this retrospective study, 2 readers independently performed qualitative analysis of full FOV DWI (FOV, 38 × 38 cm; b-value, 0 and 500 s/mm²) and reduced FOV DWI (FOV, 28 × 8.5 cm; b-value, 0 and 400 s/mm²). Both procedures were conducted with a two-dimensional spatially selective radiofrequency excitation pulse, in 102 patients with benign or malignant pancreatic diseases (mean size, 27.5 ± 14.4 mm). The study parameters included 1) anatomic structure visualization, 2) lesion conspicuity, 3) artifacts, 4) IQ score, and 5) subjective clinical utility for confirming or excluding initially considered differential diagnosis on conventional imaging. Another reader performed quantitative ADC measurements of focal pancreatic lesions and parenchyma. Wilcoxon signed-rank test was used to compare qualitative scores and ADCs between DWI sequences. Mann Whitney U-test was used to compare ADCs between the lesions and parenchyma. RESULTS: On qualitative analysis, reduced FOV DWI showed better anatomic structure visualization (2.76 ± 0.79 at b = 0 s/mm² and 2.81 ± 0.64 at b = 400 s/mm²), lesion conspicuity (3.11 ± 0.99 at b = 0 s/mm² and 3.15 ± 0.79 at b = 400 s/mm²), IQ score (8.51 ± 2.05 at b = 0 s/mm² and 8.79 ± 1.60 at b = 400 s/mm²), and higher clinical utility (3.41 ± 0.64), as compared to full FOV DWI (anatomic structure, 2.18 ± 0.59 at b = 0 s/mm² and 2.56 ± 0.47 at b = 500 s/mm²; lesion conspicuity, 2.55 ± 1.07 at b = 0 s/mm² and 2.89 ± 0.86 at b = 500 s/mm²; IQ score, 7.13 ± 1.83 at b = 0 s/mm² and 8.17 ± 1.31 at b = 500 s/mm²; clinical utility, 3.14 ± 0.70) (p < 0.05). Artifacts were significantly improved on reduced FOV DWI (2.65 ± 0.68) at b = 0 s/mm² (full FOV DWI, 2.41 ± 0.63) (p < 0.001). On quantitative analysis, there were no significant differences between the 2 DWI sequences in ADCs of various pancreatic lesions and parenchyma (p > 0.05). ADCs of adenocarcinomas (1.061 × 10⁻³ mm²/s ± 0.133 at reduced FOV and 1.079 × 10⁻³ mm²/s ± 0.135 at full FOV) and neuroendocrine tumors (0.983 × 10⁻³ mm²/s ± 0.152 at reduced FOV and 1.004 × 10⁻³ mm²/s ± 0.153 at full FOV) were significantly lower than those of parenchyma (1.191 × 10⁻³ mm²/s ± 0.125 at reduced FOV and 1.218 × 10⁻³ mm²/s ± 0.103 at full FOV) (p < 0.05). CONCLUSION: Reduced FOV DWI of the pancreas provides better overall IQ including better anatomic detail, lesion conspicuity and subjective clinical utility.
Adult ; Aged ; Artifacts ; Diagnosis, Differential ; *Diffusion Magnetic Resonance Imaging ; *Echo-Planar Imaging ; Female ; Humans ; Male ; Middle Aged ; Pancreas/*radiography ; Pancreatic Diseases/pathology/*radiography ; Pancreatic Neoplasms/pathology/radiography ; Retrospective Studies

The role of neoadjuvant chemoradiation therapy in locally advanced pancreatic cancer (LAPC) is still controversial. The aim of this study was to evaluate surgical downstaging after concurrent chemoradiation therapy (CCRT) for LAPC by measuring the objective changes after treatment. From January 2003 through July 2011, 54 patients with LAPC underwent neoadjuvant CCRT. Computed tomography findings of the tumor size, including major vessel invasion, were analyzed before and after CCRT. Among the total recruited patients, 14 had borderline resectable malignancy and another 40 were unresectable before CCRT. After CCRT, a partial response was achieved in four patients. Stable disease and further disease progression were achieved in 36 and 14 patients, respectively. Tumor size showed no significant difference before and after CCRT (3.6 +/- 1.1 vs. 3.6 +/- 1.0 cm, P = 0.61). Vessel invasion showed improvement in two patients, while 13 other patients showed further tumor progression. Thirty-nine patients with unresectable malignancy and 11 patients with borderline resectable malignancy at time of initial diagnosis remained unchanged after CCRT. Four patients with borderline pancreatic malignancy progressed to an unresectable stage, whereas one unresectable pancreatic malignancy improved to a borderline resectable stage. Only one patient with borderline resectable disease underwent operation after CCRT; however, curative resection failed due to celiac artery invasion and peritoneal seeding. The adverse events associated with CCRT were tolerable. In conclusion, preoperative CCRT in LAPC rarely leads to surgical downstaging, and it could lower resectability rates.
Adenocarcinoma/radiography/therapy ; Adult ; Aged ; Aged, 80 and over ; Antimetabolites, Antineoplastic/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Capecitabine/therapeutic use ; Carcinoma, Pancreatic Ductal/*radiography/*therapy ; Chemoradiotherapy/adverse effects/*methods ; Combined Modality Therapy ; Deoxycytidine/analogs & derivatives/therapeutic use ; Disease Progression ; Female ; Fluorouracil/therapeutic use ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Pancreas/blood supply/pathology ; Pancreatic Neoplasms/*radiography/*therapy ; Retrospective Studies ; Treatment Outcome

No abstract available.
Biopsy ; Blood Glucose/metabolism ; C-Peptide/blood ; Calcium Gluconate/administration & dosage/*diagnostic use ; Female ; Humans ; Immunohistochemistry ; Injections, Intra-Arterial ; Insulin/blood ; Insulinoma/blood/*blood supply/pathology/surgery ; Middle Aged ; Pancreatic Neoplasms/blood/*blood supply/pathology/surgery ; Pancreaticoduodenectomy ; Splenic Artery/*radiography ; *Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Markers, Biological/blood

OBJECTIVETo discuss the feasibility and safety of different approaches for CT-guided percutaneous needle biopsy and subsequent iodine-125 seed interstitial implantation for pancreatic cancer.

METHODSA retrospective study was carried out on the complete data of 35 patients with pancreatic cancer who have received CT-guided percutaneous needle biopsy with or without subsequent iodine-125 seed interstitial implantation. There were 9 lesions located in the head of pancreas, 20 located in the body, and 6 in the tail. The maximum diameter of the lesions varied from 12 mm to 60 mm (mean 37.1 mm). The patients were treated with a needle in diameter of 16-21G. Operations were undertaken via anterior, posterior and lateral approaches.

RESULTSThirty-five patients underwent 43 times of CT-guided percutaneous needle biopsies. Thirty-one cases were pathologically diagnosed as cancer, 2 cases inflammatory lesions, and 2 were suspected tumors (one of which was finally diagnosed as cancer, while another was pancreatic pseudocyst). The ratio of correct diagnosis was 94.3%. Fourteen patients were treated subsequently with CT-guided iodine-125 seed interstitial implantation therapy, with a total of 65 times of needle puncture. The operations were performed via direct approach to the tumor in 18 cases, transhepatic approach in 2 cases, transgastric approach in 4 cases, transintestinal approach in 10 cases, and through mesenteric vessels in one case. Incidence of complications in the biopsy group was 2.32% (1/43), and in the implantation group was 6.15% (4/65), with a statistically non-significant difference (P = 0.600) between the two groups. Incidence of complications in the group using 16-18G needle was 4.65% (4/86), while in the group using 20-21G needle was 4.55% (1/22), also with a non-significant difference (P = 0.064). The accuracy rate of needle biopsy in this study was 94.28% (33/35).

CONCLUSIONCT-guided percutaneous needle biopsy and subsequent iodine-125 seed interstitial implantation are both feasible and safe for pancreatic cancer.

Adult ; Aged ; Aged, 80 and over ; Biopsy, Needle ; methods ; Brachytherapy ; methods ; Female ; Follow-Up Studies ; Humans ; Iodine Radioisotopes ; therapeutic use ; Male ; Middle Aged ; Pancreatic Neoplasms ; diagnostic imaging ; pathology ; radiotherapy ; Radiography, Interventional ; methods ; Retrospective Studies ; Tomography, X-Ray Computed

Percutaneous access to the surgical bed after pancreaticoduodenectomy can be a challenge, due to the post-operative anatomy alteration. However, immediate complications, such as surgical bed abscess or suspected tumor recurrence, are often best accessed percutaneously, as open surgical or endoscopic approaches are often difficult, if not impossible. We, hereby, describe a safe approach that is highly replicable, in accessing the surgical bed for percutaneous intervention, following pancreaticoduodenectomy.
Abscess/radiography/therapy ; Bile Duct Neoplasms/pathology/radiography ; Biopsy/methods ; Catheterization/*methods ; Cholangiocarcinoma/pathology/radiography ; Drainage/instrumentation/*methods ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology/radiography ; Pancreatic Diseases/radiography/therapy ; *Pancreaticoduodenectomy ; Postoperative Complications/radiography/*therapy ; Radiography, Interventional/methods ; Retroperitoneal Space

A solid-pseudopapillary tumor (SPT) of the pancreas is known as a low grade malignant tumor with a good prognosis; therefore, surgical intervention is necessary. A 14-year-old boy presented with a large pancreatic SPT and three hepatic metastases. The patient and his family refused surgery. Two serial follow-up CT scans over a period of 13 years demonstrated almost complete disappearance of the pancreatic tumor and three hepatic metastases without relevant treatment. Although there have been a few reports of spontaneous healing of SPT, there has been no report regarding spontaneous disappearance of SPT and distant metastasis. Herein, we report on the spontaneous regression of a large SPT and the disappearance of three hepatic metastases.
Adolescent ; Carcinoma, Papillary/radiography/*secondary ; Humans ; Liver Neoplasms/radiography/*secondary ; Male ; Pancreatic Neoplasms/*pathology/radiography ; Remission, Spontaneous ; Tomography, X-Ray Computed

Acinar cystic transformation of the pancreas is also known as acinar cell cystadenoma (ACC), and this is an extremely rare benign lesion that was first described in April 2002. We report here on a case of a previously asymptomatic patient with pancreatic ACC and this was diagnosed by computed tomography (CT) and magnetic resonance imaging (MRI). To the best of our knowledge, there is no previous report concerning the CT or MRI features of ACC in the medical literature. We present here the CT, MRI and pathological findings of pancreatic ACC.
Cystadenoma/pathology/*radiography ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/pathology/*radiography

OBJECTIVE: To determine whether or not detailed cystic feature analysis on CT scans can assist in the differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) from serous cystadenoma (SCN), mucinous cystadenoma (MCN), and a pseudocyst. MATERIALS AND METHODS: This study received Institutional Review Board approval and informed patient consent was waived. Electronic radiology and pathology databases were searched to identify patients with PDAC (n = 19), SCN (n = 26), MCN (n = 20) and a pseudocyst (n = 23) who underwent pancreatic CT imaging. The number, size, location, and contents of cysts, and the contour of the lesions were reviewed, in addition to the wall thickness, enhancement patterns, and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 82) or on a combination of cytological findings, biochemical markers, and tumor markers (n = 6). Fisher's exact test was used to analyze the results. RESULTS: A combination of the CT findings including irregular contour, multiple cysts, mural nodes, and localized thickening, had a relatively high sensitivity (74%) and specificity (75%) for differentiating PDAC from SCN, MCN, and pseudocysts (p < 0.05). Other CT findings such as location, greatest dimension, or the presence of calcification were not significantly different. CONCLUSION: The CT findings for PDAC are non-specific, but perhaps helpful for differentiation. PDAC should be included in the general differential diagnosis of pancreatic cystic neoplasms.
Adenocarcinoma/pathology/*radiography ; Adolescent ; Adult ; Aged ; Cystadenocarcinoma, Serous/pathology/*radiography ; Cystadenoma, Mucinous/pathology/*radiography ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Pancreatic Neoplasms/pathology/*radiography ; Retrospective Studies ; Sensitivity and Specificity ; *Tomography, X-Ray Computed ; Tumor Markers, Biological/analysis