This document discusses pancreatic tumors, focusing on adenocarcinoma and neuroendocrine tumors. Some key points:
- Adenocarcinoma represents over 90% of malignant pancreatic tumors and has a poor prognosis. On imaging, it appears hypodense on arterial phase CT and has poorly defined margins.
- Neuroendocrine tumors are rare but can be functional (e.g. insulinomas) or nonfunctional. Insulinomas tend to be small and highly vascularized. Gastrinomas are often malignant.
- Both tumor types typically enhance strongly on arterial phase imaging and may show calcifications. MRI is also useful for further characterization.
This document contains 16 figures from an atlas showing different diseases that can affect the ileocecal region on computed tomography imaging. The figures demonstrate a variety of pathologies including adenocarcinoma, carcinoid tumor, non-Hodgkin's lymphoma, metastasis, lipoma, mucocele, intussusception, appendicitis, diverticulitis, epiploic appendagitis, Crohn's disease, terminal ileitis, typhlitis, and ischemic necrosis of the cecum. Each figure includes a brief description of the imaging findings and relevant clinical information.
This document provides an overview of magnetic resonance imaging (MRI) findings for various liver conditions. It includes 37 figures showing MRI scans of the liver with different pathologies such as hemorrhage, cysts, abscesses, tumors, and iron/fatty deposition. The images demonstrate how conditions present with different signal intensities on T1-weighted and T2-weighted MRI sequences. Captions provide brief descriptions of the findings in each case.
Presentation2, radiological imaging of gastrointestinal schwannoma.Abdellah Nazeer
This document discusses radiological imaging findings of gastrointestinal schwannomas. Some key points:
- Gastrointestinal schwannomas most commonly occur in the stomach (60-70% of cases). On CT and MRI, they often appear as well-defined, hypodense masses that demonstrate homogeneous enhancement with contrast.
- While radiological imaging findings are nonspecific, gastrointestinal schwannomas typically have the appearance of a solitary mass, and immunohistochemical staining can aid in diagnosis.
- Schwannomas can also occur in rare locations like the pancreas, adrenal gland, retroperitoneum, abdominal wall, pelvis and liver. Imaging characteristics vary depending on the location but may include cystic degeneration
This document discusses various types of focal anechoic (cystic) liver masses that can be identified on ultrasound imaging. It includes 9 figures showing ultrasound images and descriptions of simple hepatic cysts, polycystic liver disease, Caroli's disease, traumatic hematoma, biloma, echinococcal cyst, metastases, biliary cystadenoma, and hepatic artery aneurysm. The images and descriptions provide examples of how the ultrasound appearance can help differentiate these liver masses.
Presentation1, radiological application of diffusion weighted mri in neck mas...Abdellah Nazeer
This document summarizes the potential applications of diffusion-weighted MRI in evaluating neck masses. It discusses how DWI can help differentiate between benign and malignant neck masses based on apparent diffusion coefficient (ADC) values. DWI is also useful for predicting and monitoring treatment response in head and neck tumors by detecting changes in ADC values before changes in tumor size. DWI can help distinguish tumor recurrence from post-treatment changes based on qualitative and quantitative ADC assessments. The document concludes that DWI shows promise for applications in head and neck oncology but larger multicenter studies are still needed.
This document discusses and provides images of different types of focal cystic lesions that can occur in the liver. It describes lesions such as simple hepatic cysts, polycystic disease, bile duct hamartomas, Caroli's disease, undifferentiated embryonal sarcoma, biliary cystadenoma, cystic hepatocellular carcinoma, cystic metastases, pyogenic and amebic abscesses, hydatid cysts, hematomas, bilomas, and intrahepatic pancreatic pseudocysts. For each type of lesion, it highlights imaging features on modalities such as CT and MRI scans that can help differentiate between benign and malignant causes of cystic liver lesions.
Presentation1, radiological imaging of scimitar syndromeAbdellah Nazeer
Scimitar syndrome is characterized by a hypoplastic right lung drained by an anomalous vein into the inferior vena cava, known as a scimitar vein. It presents with a partial anomalous pulmonary venous return most commonly on the right side. Associated findings include congenital heart defects, diaphragmatic anomalies, and vertebral anomalies. Radiological imaging plays an important role in diagnosis, with chest x-rays sometimes showing the scimitar vein and reduced lung volume. CT and MRI are useful to precisely map the anomalous pulmonary vein and associated abnormalities.
Presentation1, role of mri imaging in pulmonary nodules.Abdellah Nazeer
MRI can provide supplemental information to CT for evaluating pulmonary nodules. While MRI detection of nodules is not as sensitive as CT, it offers morphological data without ionizing radiation. Advanced MRI techniques like diffusion weighted imaging can help differentiate benign and malignant lung tumors based on tissue cellularity. DWI may also help predict patient survival and response to chemotherapy. Overall, MRI is a useful adjunct to CT for pulmonary nodule assessment and longitudinal evaluation of lung tumors.
This document contains 16 figures from an atlas showing different diseases that can affect the ileocecal region on computed tomography imaging. The figures demonstrate a variety of pathologies including adenocarcinoma, carcinoid tumor, non-Hodgkin's lymphoma, metastasis, lipoma, mucocele, intussusception, appendicitis, diverticulitis, epiploic appendagitis, Crohn's disease, terminal ileitis, typhlitis, and ischemic necrosis of the cecum. Each figure includes a brief description of the imaging findings and relevant clinical information.
This document provides an overview of magnetic resonance imaging (MRI) findings for various liver conditions. It includes 37 figures showing MRI scans of the liver with different pathologies such as hemorrhage, cysts, abscesses, tumors, and iron/fatty deposition. The images demonstrate how conditions present with different signal intensities on T1-weighted and T2-weighted MRI sequences. Captions provide brief descriptions of the findings in each case.
Presentation2, radiological imaging of gastrointestinal schwannoma.Abdellah Nazeer
This document discusses radiological imaging findings of gastrointestinal schwannomas. Some key points:
- Gastrointestinal schwannomas most commonly occur in the stomach (60-70% of cases). On CT and MRI, they often appear as well-defined, hypodense masses that demonstrate homogeneous enhancement with contrast.
- While radiological imaging findings are nonspecific, gastrointestinal schwannomas typically have the appearance of a solitary mass, and immunohistochemical staining can aid in diagnosis.
- Schwannomas can also occur in rare locations like the pancreas, adrenal gland, retroperitoneum, abdominal wall, pelvis and liver. Imaging characteristics vary depending on the location but may include cystic degeneration
This document discusses various types of focal anechoic (cystic) liver masses that can be identified on ultrasound imaging. It includes 9 figures showing ultrasound images and descriptions of simple hepatic cysts, polycystic liver disease, Caroli's disease, traumatic hematoma, biloma, echinococcal cyst, metastases, biliary cystadenoma, and hepatic artery aneurysm. The images and descriptions provide examples of how the ultrasound appearance can help differentiate these liver masses.
Presentation1, radiological application of diffusion weighted mri in neck mas...Abdellah Nazeer
This document summarizes the potential applications of diffusion-weighted MRI in evaluating neck masses. It discusses how DWI can help differentiate between benign and malignant neck masses based on apparent diffusion coefficient (ADC) values. DWI is also useful for predicting and monitoring treatment response in head and neck tumors by detecting changes in ADC values before changes in tumor size. DWI can help distinguish tumor recurrence from post-treatment changes based on qualitative and quantitative ADC assessments. The document concludes that DWI shows promise for applications in head and neck oncology but larger multicenter studies are still needed.
This document discusses and provides images of different types of focal cystic lesions that can occur in the liver. It describes lesions such as simple hepatic cysts, polycystic disease, bile duct hamartomas, Caroli's disease, undifferentiated embryonal sarcoma, biliary cystadenoma, cystic hepatocellular carcinoma, cystic metastases, pyogenic and amebic abscesses, hydatid cysts, hematomas, bilomas, and intrahepatic pancreatic pseudocysts. For each type of lesion, it highlights imaging features on modalities such as CT and MRI scans that can help differentiate between benign and malignant causes of cystic liver lesions.
Presentation1, radiological imaging of scimitar syndromeAbdellah Nazeer
Scimitar syndrome is characterized by a hypoplastic right lung drained by an anomalous vein into the inferior vena cava, known as a scimitar vein. It presents with a partial anomalous pulmonary venous return most commonly on the right side. Associated findings include congenital heart defects, diaphragmatic anomalies, and vertebral anomalies. Radiological imaging plays an important role in diagnosis, with chest x-rays sometimes showing the scimitar vein and reduced lung volume. CT and MRI are useful to precisely map the anomalous pulmonary vein and associated abnormalities.
Presentation1, role of mri imaging in pulmonary nodules.Abdellah Nazeer
MRI can provide supplemental information to CT for evaluating pulmonary nodules. While MRI detection of nodules is not as sensitive as CT, it offers morphological data without ionizing radiation. Advanced MRI techniques like diffusion weighted imaging can help differentiate benign and malignant lung tumors based on tissue cellularity. DWI may also help predict patient survival and response to chemotherapy. Overall, MRI is a useful adjunct to CT for pulmonary nodule assessment and longitudinal evaluation of lung tumors.
Infiltrating ductal adenocarcinoma is a type of pancreatic carcinoma. It typically presents as an ill-defined mass located in the head, body, or tail of the pancreas on gross examination. Microscopically, it consists of poorly formed glands within a desnely fibrotic stroma and inflammatory cells. The diagnosis involves clinical features and confirmation through biopsy while treatment options exist though prognosis remains poor.
Pancreatic Biliary Cancer by Dr Mahipal reddyguest407122
The document discusses pathology, risk factors, clinical presentation, diagnosis, staging, and treatment options for pancreatic cancer and cholangiocarcinoma. For pancreatic cancer, the most common type is infiltrating ductal adenocarcinoma. Risk factors include age, smoking, diabetes, and diet. Symptoms include abdominal pain and weight loss. Diagnosis involves imaging like CT/MRI and biopsy. Treatment involves surgical resection if possible or chemotherapy with gemcitabine if unresectable. For cholangiocarcinoma, risk factors include inflammation and parasites. Symptoms are usually painless jaundice. Diagnosis involves imaging and ERCP. Surgery is the main treatment if resectable but prognosis is unclear
2nd Single Theme Conference on
Pancreatic Cancer
Web Conference on
Minimally Invasive Approach to
Pancreatic Cancer
1st & 2nd July 2016
Venue: Your Office / Home
This document contains 21 figures showing various computed tomography (CT) scans of the pancreas depicting different pathologies. The figures show examples of pancreatic carcinoma, insulinoma, vipoma, islet cell tumors, solid and papillary epithelial neoplasms, metastatic renal cell carcinoma, lymphoma, acute and chronic pancreatitis, pancreatic abscesses, cystic fibrosis, pancreatic cystosis, annular pancreas, venous thrombosis, carcinoid tumors, desmoid tumors, and gastric GISTs. The CT scans demonstrate features of these conditions such as enhancing masses, necrosis, duct dilation, fatty replacement, and extrapancreatic lesions impinging on the pancreas.
Interpretation and Management of Pancreatic cancerBibin Mathew
This document is a project work on the interpretation and management of pancreatic cancer submitted for the Bachelor of Pharmacy degree. It discusses pancreatic cancer in depth, including its types, causes, signs and symptoms, diagnosis, stages of progression, and current management approaches. The key points covered are: pancreatic cancer arises from cells in the pancreas and is usually adenocarcinoma; risk factors include smoking and genetic disorders; signs appear at later stages and include abdominal pain, weight loss, and jaundice; diagnosis uses imaging techniques and biopsies; progression is described by TNM and stage models; and management involves surgery, chemotherapy, radiation, and newer targeted and immune therapies.
This study aimed to determine the normal range of dimensions for the liver, spleen, and kidney in healthy neonates, infants, and children using sonography. The study involved 307 pediatric subjects aged 5 days to 16 years who had normal physical and sonographic findings. At least two dimensions were obtained for each organ. Dimensions of the measured organs did not differ between boys and girls. Longitudinal dimensions of all three organs showed the best correlation with age, body weight, height, and body surface area, with height showing the strongest correlation. This study provides reference data on the normal dimensions of the liver, spleen, and kidney in children applicable to routine sonography evaluations.
1. A 47-year-old male presented with abdominal pain, back pain, weight loss, and worsening diabetes. Imaging showed ill-defined masses in the pancreas. Differential considerations included pancreatic malignancy or autoimmune pancreatitis.
2. Endoscopic ultrasound-guided fine needle aspiration of the masses was nondiagnostic but showed no malignancy. Surgery found an infiltrative pancreatic mass but biopsy again showed no malignancy.
3. Follow up showed jaundice and imaging characteristics suggestive of autoimmune pancreatitis. Histopathology and elevated IgG4 supported a diagnosis of type 1 autoimmune pancreatitis. The patient was started
IgG4-Related Disease is a fibroinflammatory condition characterized by elevated serum IgG4 levels that can affect nearly any organ. It was first described in the early 20th century but is now recognized more frequently. The pathogenesis involves IgG4 antibody production triggered by innate immune signals, leading to a TH2/Treg cytokine response and tissue fibrosis. It occurs worldwide with variable incidence rates reported in different regions. Affected individuals can experience swelling of involved organs and elevated serum IgG4 levels. Treatment involves glucocorticoids which can improve organ function, though relapses are common upon tapering of medication.
The document is the NCCN Clinical Practice Guidelines in Oncology for Pancreatic Adenocarcinoma from 2009. It provides guidelines for the diagnosis, staging, treatment and management of pancreatic cancer. The guidelines are developed by the NCCN Pancreatic Adenocarcinoma Panel and are intended to help clinicians individualize treatment for each patient based on clinical circumstances.
This document contains 24 figures from an atlas showing examples of fatty lesions found in the abdomen and pelvis on computed tomography scans. The figures show a variety of fatty lesions including hepatic angiomyolipomas, focal fatty infiltration of the pancreas, lipomas of the pancreas, pancreatic lipomatosis, fatty replacement of the pancreas, colonic lipomas, epiploic appendagitis, intussusception led by a lipoma, mesenteric panniculitis, cavitating mesenteric lymph nodes, omental infarction, inguinal hernias, adrenal myelolipomas, adrenal adenomas, renal angiomyolipomas, renal lipomas, renal sinus lipomatosis,
This document contains 10 figures showing various ultrasound images of pancreatic masses. The images show masses including carcinomas, metastases, islet cell tumors, mucinous cystic neoplasms, serous cystadenomas, pseudocysts, phlegmons, and changes seen in cystic fibrosis. The ultrasound findings of various pancreatic pathologies are demonstrated.
Michael Landon, Luciano Pavarotti, Patrick Swayze, and Joan Crawford all died of pancreatic cancer. Pancreatic cancer has a very poor prognosis, with most patients dying within a year of diagnosis. Risk factors include smoking, obesity, family history, and certain genetic conditions. Treatment options depend on how advanced the cancer is and may include surgery, chemotherapy, radiation, and targeted therapies. However, pancreatic cancer remains very difficult to treat due to late diagnosis and lack of effective therapies.
Pancreatic neoplasms can be either solid tumors like adenocarcinomas or cystic neoplasms. Pancreatic adenocarcinoma has an extremely low 5-year survival rate of only 6% and is usually diagnosed at an advanced stage. Risk factors include smoking, chronic pancreatitis, diabetes and family history. Imaging tests like CT, MRI and EUS are used to stage the cancer and determine resectability. Surgical resection through a pancreatoduodenectomy or distal pancreatectomy offers the only chance for cure if the cancer is localized.
Pancreatic cystic neoplasm - Dr Dheeraj Yadavdheeraj_maddoc
This document discusses pancreatic cystic neoplasms, which are relatively rare pancreatic tumors. It describes the main types - serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), and intraductal papillary mucinous neoplasms (IPMNs). SCNs are usually benign and contain clear fluid, while MCNs and IPMNs have higher malignant potential and are often lined with mucin-secreting cells. Imaging plays an important role in diagnosis, with CT and MRI identifying characteristics such as central scarring in SCNs. Complete surgical resection is typically recommended for suspected malignant neoplasms.
Comprehensive preoperative assessment of pancreatic carcinoma Dr. Muhammad Bi...Dr. Muhammad Bin Zulfiqar
Comprehensive preoperative assessment of pancreatic carcinoma Dr. Muhammad Bin Zulfiqar
here we will discuss the the resectability of the pancreatic tumors preoperatively using 16 slice MDCT
This document provides information on pancreatic neoplasms. It begins with the anatomy of the pancreas and its blood supply. It then discusses the different types of pancreatic neoplasms, including cystic neoplasms and ductal adenocarcinoma. Risk factors for ductal adenocarcinoma are outlined. The pathogenesis and molecular progression of pancreatic cancer from pancreatic intraepithelial neoplasia to invasive cancer is described. Clinical presentation, diagnostic imaging modalities, staging, treatment options including surgery and adjuvant therapy, palliative care, and recent advances are summarized. Finally, cystic neoplasms of the pancreas including mucinous cystic neoplasms are briefly covered.
Pancreatic cancer has a low survival rate due to most cases being diagnosed at late stages. This study evaluated using health history questionnaires, doctors' charts, and genetic counselor assessments to classify patients' risk levels to help identify high-risk individuals for early screening. Results found health history questionnaires provided the most detailed demographic information. Genetic counselors provided more comprehensive family cancer histories. Combining health history questionnaires with genetic counseling may help identify more high-risk patients for screening.
This document discusses a case of a 67-year-old man presenting with weight loss, jaundice, and a pancreatic head mass found on imaging. Initial FNA was nondiagnostic. The document then reviews epidemiology, presentations, imaging features, and histology of various solid pancreatic lesions. It discusses evaluating the findings to determine if the mass is neoplastic or non-neoplastic such as autoimmune pancreatitis. EUS with FNA was repeated and found to be consistent with autoimmune pancreatitis, confirmed with elevated IgG4 levels. The patient responded well to steroid treatment.
- Pancreatic cancer is often called the "silent killer" as it is usually asymptomatic until late stages, making early diagnosis difficult. It has a very poor survival rate of only 3-20 months on average.
- It is currently the 4th leading cause of cancer deaths but is projected to become the 2nd leading cause by 2030. Risk factors include age, smoking, obesity, and genetics.
- Surgery offers the only chance of cure, but only 20-30% of patients are candidates due to late stage at diagnosis. Novel diagnostic tests and therapeutic strategies like immunotherapy and targeted therapies are being studied to improve outcomes.
The document provides information about normal and abnormal bile duct anatomy and pathology as seen on various medical imaging modalities like CT, MRI, MRCP, and ultrasound. It includes images and descriptions of normal bile ducts, gallbladder anatomy, choledochal cysts, Caroli's disease, gallstones, sclerosing cholangitis, biliary hamartomas, cholangiocarcinoma, and hilar cholangiocarcinoma. Complications from gallstones like pancreatitis and suppurative cholangitis are also discussed.
This document discusses several types of congenital heart diseases that cause cyanosis, including transposition of the great arteries, truncus arteriosus, total anomalous pulmonary venous connection, single ventricle, and double outlet right ventricle. Imaging modalities like CT and MRI play an important role in the diagnosis and surgical planning of these conditions by precisely demonstrating vascular anatomy and associated anomalies.
Infiltrating ductal adenocarcinoma is a type of pancreatic carcinoma. It typically presents as an ill-defined mass located in the head, body, or tail of the pancreas on gross examination. Microscopically, it consists of poorly formed glands within a desnely fibrotic stroma and inflammatory cells. The diagnosis involves clinical features and confirmation through biopsy while treatment options exist though prognosis remains poor.
Pancreatic Biliary Cancer by Dr Mahipal reddyguest407122
The document discusses pathology, risk factors, clinical presentation, diagnosis, staging, and treatment options for pancreatic cancer and cholangiocarcinoma. For pancreatic cancer, the most common type is infiltrating ductal adenocarcinoma. Risk factors include age, smoking, diabetes, and diet. Symptoms include abdominal pain and weight loss. Diagnosis involves imaging like CT/MRI and biopsy. Treatment involves surgical resection if possible or chemotherapy with gemcitabine if unresectable. For cholangiocarcinoma, risk factors include inflammation and parasites. Symptoms are usually painless jaundice. Diagnosis involves imaging and ERCP. Surgery is the main treatment if resectable but prognosis is unclear
2nd Single Theme Conference on
Pancreatic Cancer
Web Conference on
Minimally Invasive Approach to
Pancreatic Cancer
1st & 2nd July 2016
Venue: Your Office / Home
This document contains 21 figures showing various computed tomography (CT) scans of the pancreas depicting different pathologies. The figures show examples of pancreatic carcinoma, insulinoma, vipoma, islet cell tumors, solid and papillary epithelial neoplasms, metastatic renal cell carcinoma, lymphoma, acute and chronic pancreatitis, pancreatic abscesses, cystic fibrosis, pancreatic cystosis, annular pancreas, venous thrombosis, carcinoid tumors, desmoid tumors, and gastric GISTs. The CT scans demonstrate features of these conditions such as enhancing masses, necrosis, duct dilation, fatty replacement, and extrapancreatic lesions impinging on the pancreas.
Interpretation and Management of Pancreatic cancerBibin Mathew
This document is a project work on the interpretation and management of pancreatic cancer submitted for the Bachelor of Pharmacy degree. It discusses pancreatic cancer in depth, including its types, causes, signs and symptoms, diagnosis, stages of progression, and current management approaches. The key points covered are: pancreatic cancer arises from cells in the pancreas and is usually adenocarcinoma; risk factors include smoking and genetic disorders; signs appear at later stages and include abdominal pain, weight loss, and jaundice; diagnosis uses imaging techniques and biopsies; progression is described by TNM and stage models; and management involves surgery, chemotherapy, radiation, and newer targeted and immune therapies.
This study aimed to determine the normal range of dimensions for the liver, spleen, and kidney in healthy neonates, infants, and children using sonography. The study involved 307 pediatric subjects aged 5 days to 16 years who had normal physical and sonographic findings. At least two dimensions were obtained for each organ. Dimensions of the measured organs did not differ between boys and girls. Longitudinal dimensions of all three organs showed the best correlation with age, body weight, height, and body surface area, with height showing the strongest correlation. This study provides reference data on the normal dimensions of the liver, spleen, and kidney in children applicable to routine sonography evaluations.
1. A 47-year-old male presented with abdominal pain, back pain, weight loss, and worsening diabetes. Imaging showed ill-defined masses in the pancreas. Differential considerations included pancreatic malignancy or autoimmune pancreatitis.
2. Endoscopic ultrasound-guided fine needle aspiration of the masses was nondiagnostic but showed no malignancy. Surgery found an infiltrative pancreatic mass but biopsy again showed no malignancy.
3. Follow up showed jaundice and imaging characteristics suggestive of autoimmune pancreatitis. Histopathology and elevated IgG4 supported a diagnosis of type 1 autoimmune pancreatitis. The patient was started
IgG4-Related Disease is a fibroinflammatory condition characterized by elevated serum IgG4 levels that can affect nearly any organ. It was first described in the early 20th century but is now recognized more frequently. The pathogenesis involves IgG4 antibody production triggered by innate immune signals, leading to a TH2/Treg cytokine response and tissue fibrosis. It occurs worldwide with variable incidence rates reported in different regions. Affected individuals can experience swelling of involved organs and elevated serum IgG4 levels. Treatment involves glucocorticoids which can improve organ function, though relapses are common upon tapering of medication.
The document is the NCCN Clinical Practice Guidelines in Oncology for Pancreatic Adenocarcinoma from 2009. It provides guidelines for the diagnosis, staging, treatment and management of pancreatic cancer. The guidelines are developed by the NCCN Pancreatic Adenocarcinoma Panel and are intended to help clinicians individualize treatment for each patient based on clinical circumstances.
This document contains 24 figures from an atlas showing examples of fatty lesions found in the abdomen and pelvis on computed tomography scans. The figures show a variety of fatty lesions including hepatic angiomyolipomas, focal fatty infiltration of the pancreas, lipomas of the pancreas, pancreatic lipomatosis, fatty replacement of the pancreas, colonic lipomas, epiploic appendagitis, intussusception led by a lipoma, mesenteric panniculitis, cavitating mesenteric lymph nodes, omental infarction, inguinal hernias, adrenal myelolipomas, adrenal adenomas, renal angiomyolipomas, renal lipomas, renal sinus lipomatosis,
This document contains 10 figures showing various ultrasound images of pancreatic masses. The images show masses including carcinomas, metastases, islet cell tumors, mucinous cystic neoplasms, serous cystadenomas, pseudocysts, phlegmons, and changes seen in cystic fibrosis. The ultrasound findings of various pancreatic pathologies are demonstrated.
Michael Landon, Luciano Pavarotti, Patrick Swayze, and Joan Crawford all died of pancreatic cancer. Pancreatic cancer has a very poor prognosis, with most patients dying within a year of diagnosis. Risk factors include smoking, obesity, family history, and certain genetic conditions. Treatment options depend on how advanced the cancer is and may include surgery, chemotherapy, radiation, and targeted therapies. However, pancreatic cancer remains very difficult to treat due to late diagnosis and lack of effective therapies.
Pancreatic neoplasms can be either solid tumors like adenocarcinomas or cystic neoplasms. Pancreatic adenocarcinoma has an extremely low 5-year survival rate of only 6% and is usually diagnosed at an advanced stage. Risk factors include smoking, chronic pancreatitis, diabetes and family history. Imaging tests like CT, MRI and EUS are used to stage the cancer and determine resectability. Surgical resection through a pancreatoduodenectomy or distal pancreatectomy offers the only chance for cure if the cancer is localized.
Pancreatic cystic neoplasm - Dr Dheeraj Yadavdheeraj_maddoc
This document discusses pancreatic cystic neoplasms, which are relatively rare pancreatic tumors. It describes the main types - serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), and intraductal papillary mucinous neoplasms (IPMNs). SCNs are usually benign and contain clear fluid, while MCNs and IPMNs have higher malignant potential and are often lined with mucin-secreting cells. Imaging plays an important role in diagnosis, with CT and MRI identifying characteristics such as central scarring in SCNs. Complete surgical resection is typically recommended for suspected malignant neoplasms.
Comprehensive preoperative assessment of pancreatic carcinoma Dr. Muhammad Bi...Dr. Muhammad Bin Zulfiqar
Comprehensive preoperative assessment of pancreatic carcinoma Dr. Muhammad Bin Zulfiqar
here we will discuss the the resectability of the pancreatic tumors preoperatively using 16 slice MDCT
This document provides information on pancreatic neoplasms. It begins with the anatomy of the pancreas and its blood supply. It then discusses the different types of pancreatic neoplasms, including cystic neoplasms and ductal adenocarcinoma. Risk factors for ductal adenocarcinoma are outlined. The pathogenesis and molecular progression of pancreatic cancer from pancreatic intraepithelial neoplasia to invasive cancer is described. Clinical presentation, diagnostic imaging modalities, staging, treatment options including surgery and adjuvant therapy, palliative care, and recent advances are summarized. Finally, cystic neoplasms of the pancreas including mucinous cystic neoplasms are briefly covered.
Pancreatic cancer has a low survival rate due to most cases being diagnosed at late stages. This study evaluated using health history questionnaires, doctors' charts, and genetic counselor assessments to classify patients' risk levels to help identify high-risk individuals for early screening. Results found health history questionnaires provided the most detailed demographic information. Genetic counselors provided more comprehensive family cancer histories. Combining health history questionnaires with genetic counseling may help identify more high-risk patients for screening.
This document discusses a case of a 67-year-old man presenting with weight loss, jaundice, and a pancreatic head mass found on imaging. Initial FNA was nondiagnostic. The document then reviews epidemiology, presentations, imaging features, and histology of various solid pancreatic lesions. It discusses evaluating the findings to determine if the mass is neoplastic or non-neoplastic such as autoimmune pancreatitis. EUS with FNA was repeated and found to be consistent with autoimmune pancreatitis, confirmed with elevated IgG4 levels. The patient responded well to steroid treatment.
- Pancreatic cancer is often called the "silent killer" as it is usually asymptomatic until late stages, making early diagnosis difficult. It has a very poor survival rate of only 3-20 months on average.
- It is currently the 4th leading cause of cancer deaths but is projected to become the 2nd leading cause by 2030. Risk factors include age, smoking, obesity, and genetics.
- Surgery offers the only chance of cure, but only 20-30% of patients are candidates due to late stage at diagnosis. Novel diagnostic tests and therapeutic strategies like immunotherapy and targeted therapies are being studied to improve outcomes.
The document provides information about normal and abnormal bile duct anatomy and pathology as seen on various medical imaging modalities like CT, MRI, MRCP, and ultrasound. It includes images and descriptions of normal bile ducts, gallbladder anatomy, choledochal cysts, Caroli's disease, gallstones, sclerosing cholangitis, biliary hamartomas, cholangiocarcinoma, and hilar cholangiocarcinoma. Complications from gallstones like pancreatitis and suppurative cholangitis are also discussed.
This document discusses several types of congenital heart diseases that cause cyanosis, including transposition of the great arteries, truncus arteriosus, total anomalous pulmonary venous connection, single ventricle, and double outlet right ventricle. Imaging modalities like CT and MRI play an important role in the diagnosis and surgical planning of these conditions by precisely demonstrating vascular anatomy and associated anomalies.
Phình tách vách đgm mạc treo tràng trên, Dr LÊ VĂN TÀIhungnguyenthien
- The patient is a 50-year-old man from Trà Vinh province with a history of hypertension who presented with long-term upper abdominal pain. Imaging studies revealed a dissection of the superior mesenteric artery (SMA).
- SMA dissection is uncommon but can occur due to atherosclerosis, cystic medial necrosis, or connective tissue disorders. Patients usually present with acute epigastric pain or abdominal symptoms within 4 weeks.
- Treatment options range from conservative management to surgical revascularization to endovascular therapy depending on the severity of the case. The prognosis can vary but SMA dissection can sometimes prove fatal if not properly treated.
Presentation1, radiological imaging of tuberous sclerosis.Abdellah Nazeer
Cortical or subependymal tubers and white matter abnormalities, renal angiomyolipomas, and cardiac rhabdomyomas are the most common radiographic manifestations of tuberous sclerosis. Neurological manifestations include calcified cortical/subcortical tubers seen on CT and MRI. Renal angiomyolipomas appear as fat-containing lesions on CT or MRI. Cardiac rhabdomyomas are seen in around half of patients and typically regress by age 4.
Presentation1.pptx, radiological imaging of cholangiocarcinoma.Abdellah Nazeer
This document discusses radiological imaging techniques for cholangiocarcinoma (bile duct cancer). It provides details on:
- Ultrasound, CT, MRI, MRCP, and ERCP are discussed for imaging bile duct cancer. Each modality has benefits for assessing tumor location and extent.
- Peripheral, hilar, and intrahepatic cholangiocarcinoma are described along with the Bismuth-Corlette classification system for hilar tumors.
- Imaging features of peripheral, hilar, intrahepatic cholangiocarcinoma are shown including enhancement patterns and involvement of bile ducts.
This document provides information about cholangiocarcinoma, a malignant tumor arising from the biliary tree. It discusses the incidence, clinical presentation, locations, growth patterns, staging, and radiographic features. Cholangiocarcinoma is usually seen in the elderly and presents with painless jaundice. It can be located in the hilar region or peripherally. On imaging, it may appear as a mass, infiltrate along bile ducts, or have an intraductal growth pattern. Staging uses the Bismuth-Corlette classification. Key radiographic findings include dilated intrahepatic ducts, hilar lesions causing central obstruction without a clear mass, and encasement of portal veins
This document provides an overview of esophageal carcinoma staging based on the 7th edition of the TNM classification system. It discusses key features of T4 tumors, lymph node classification (N stages), and factors for determining tumor location and staging of esophagogastric junction tumors. Examples of imaging findings corresponding to various T, N, and M stages are presented along with discussions of mediastinal and aortic invasion, synchronous cancers, adenocarcinoma, cervical esophageal cancer, and difficulties assessing response to neoadjuvant therapy.
The document discusses various types of anterior and posterior mediastinal masses. In the anterior mediastinum, it describes thymic masses such as thymic cysts and thymomas. It also discusses intrathoracic thyroid masses and teratomas. In the posterior mediastinum, it summarizes peripheral nerve sheath tumors, neurogenic tumors, bronchogenic cysts, esophageal duplication cysts, and neurenteric cysts. The document provides imaging characteristics to help differentiate these various mediastinal masses.
This document summarizes various imaging techniques used to evaluate hepatic inflammatory and infectious diseases. It discusses ultrasound, CT, and MRI features of conditions like viral hepatitis, alcoholic hepatitis, radiation hepatitis, peliosis hepatis, tuberculosis, sarcoidosis, pyogenic liver abscess, amebic liver abscess, fungal infections, and hydatid disease. Imaging can demonstrate findings of liver inflammation or infection including periportal cuffing, gallbladder wall thickening, hypodense lesions, enhancing abscess walls, and cystic appearances of conditions like amebic abscess or hydatid disease.
Presentation1.pptx, abdominal film reading, lecture 11.Abdellah Nazeer
1) The document discusses diagnostic imaging of various splenic diseases. It provides details on primary and secondary splenic diseases including tumors, infections, inflammation, and vascular disorders.
2) Specific diseases and conditions covered include hemangioma, lymphoma, cysts, abscesses, histoplasmosis, sarcoidosis, infarction, splenic artery aneurysms, and splenic vein thrombosis.
3) For each condition, the document describes imaging appearance on modalities such as CT, MRI, and angiography and provides examples of images showing characteristic findings.
MRI of Spine and very easy details of spssuserc66686
The document discusses various neurological conditions that can be seen on CT and MRI imaging of the brain and spine. It provides examples of imaging findings for tumors such as meningiomas, medulloblastomas, ependymomas, glioblastomas, and metastases. It also reviews imaging appearances of conditions like cerebral abscesses, multiple sclerosis, cavernomas, spinal tuberculosis, and spondylitis. Key distinguishing radiological features of different lesions are highlighted.
1. Benign liver masses in children include infantile hemangioendothelioma, mesenchymal hamartoma, focal nodular hyperplasia, and hepatocellular adenoma.
2. Infantile hemangioendothelioma is the most common benign liver tumor in infants and presents as asymptomatic abdominal masses, high output cardiac failure, or coagulopathy.
3. Mesenchymal hamartoma appears as mixed cystic and solid masses on imaging and commonly causes abdominal distension. Focal nodular hyperplasia and hepatocellular adenoma are seen more often in older children and adolescents.
The document discusses the anatomy, imaging appearance, and pathologies of the buccal space. It describes the buccal space as a deep facial space bounded by muscles and containing the parotid duct and minor salivary glands. A variety of developmental lesions, infections, neoplasms and other conditions can involve the buccal space. The document outlines the imaging characteristics of common benign and malignant tumors, such as pleomorphic adenoma and adenoid cystic carcinoma, as well as infectious processes and metastatic diseases that may affect this region.
Presentation1 radiological film reading of wrist joint.Abdellah Nazeer
This document summarizes different types of wrist injuries seen on radiological films and MRI images. It describes various classifications of triangular fibrocartilage complex (TFCC) tears and discusses injuries to other ligaments including the scapholunate, lunotriquetral, and extrinsic ligaments. Common wrist abnormalities like scapholunate dissociation, SLAC wrist, and DISI/VISI deformities are also reviewed along with corresponding imaging findings. The document serves as a reference for interpreting radiological studies of the wrist joint and identifying associated ligament and cartilage injuries.
This document discusses and provides images of various neoplastic lesions of the vertebrae that can be seen on magnetic resonance imaging. It includes summaries and images of common lesions such as hemangioma, osteoblastoma, aneurysmal bone cyst, giant cell tumor, sacral teratoma, Langerhans cell histiocytosis, chordoma, lymphoma, and metastases. The images demonstrate how MRI can help identify these lesions and delineate their relationship to nearby structures like the spinal cord and vertebral bones.
This document describes various imaging modalities and techniques used to examine the petrous bone and inner ear anatomy. It outlines CT and MRI sequences that can be used and discusses what structures like the external auditory canal, middle ear, semicircular canals and cochlea appear as on different scans. It also provides examples of pathologies that can be imaged in the temporal bone like cholesteatoma, otitis media, fractures and tumors.
Presentation1, radiological imaging of lateral hindfoot impingement.Abdellah Nazeer
This document discusses radiological imaging of lateral hindfoot impingement. It provides illustrations and images showing normal hindfoot anatomy as well as examples of talocalcaneal impingement, subfibular impingement, and combined impingement. MRI and CT images demonstrate bone marrow edema, cystic changes, sclerosis, and soft tissue swelling associated with impingement between the talus, calcaneus, and fibula. Measurements of hindfoot valgus angle are also shown on imaging to evaluate impingement and alignment. Case studies with patients presenting lateral ankle pain further demonstrate imaging findings of extra-articular hindfoot impingement.
This document provides an overview of CT/PET-CT imaging for lung cancer. It begins with disclaimers and then covers reading chest x-rays, the author's workflow, brightness and contrast adjustments, lung and vessel anatomy identification, incidental findings, lymph node stations, the proximal bronchial tree contouring, esophagus, lung and cord delineation, great vessel delineation, new TNM staging criteria, imaging features of various tumor sizes and node involvement, characteristics of lung cancer histologies including adenocarcinoma and squamous cell carcinoma, metastatic disease patterns, post-radiation changes, differentiating atelectasis from tumor, the role of PET-CT in staging and treatment planning, and situations where imaging may
O documento discute vários tipos de encefalopatias tóxicas, nutricionais e neurometabólicas adquiridas, incluindo intoxicações por drogas, álcool, monóxido de carbono e solventes. Detalha os achados clínicos e de imagem característicos de cada condição, enfatizando a importância da ressonância magnética no diagnóstico. Recomenda os protocolos de imagem iniciais de acordo com os sintomas apresentados.
Lesões císticas intracranianas não neoplásicasNorberto Werle
Lesões Císticas Intracranianas Não-Neoplásicas
Este documento resume as principais lesões císticas intracranianas não-neoplásicas, incluindo cistos aracnoide, dermóides, epidermóides e colóides. Detalha suas características clínicas, de imagem e recomendações de tratamento.
Lesões císticas intracranianas não neoplásicasNorberto Werle
Este documento resume as principais características de lesões císticas intracranianas não-neoplásicas. O documento discute cistos aracnoides congênitos e adquiridos, cistos leptomeningeos, cistos dermóides, epidermóides e colóides, abordando aspectos como localização, achados de imagem e recomendações de tratamento.
O documento discute malformações do desenvolvimento cortical, incluindo:
1) Displasia cortical focal causa importante de epilepsia na infância e pode ser diagnosticada por RM de alta resolução;
2) Hemimegalencefalia causa macrocefalia, epilepsia refratária e atraso do desenvolvimento e apresenta espessamento cortical irregular na RM;
3) Heterotopia são nódulos ou faixas de neurônios fora de sua localização normal e podem ser periventriculares ou subcorticais.
O documento discute a neuroanatomia dos sulcos, giros e tratos de substância branca do encéfalo humano. Ele descreve as principais estruturas do cérebro, incluindo os maiores sulcos como o central e lateral, e os principais giros como o frontal, parietal e temporal. Também discute os principais tratos de associação e projeção, como o trato longitudinal superior e as radiações ópticas.
O documento resume as principais características do baço e pâncreas vistas por imagem, incluindo achados normais, inflamatórios e neoplásicos. É descrito o aspecto de esplenomegalia, cistos, tumores, infecções, pancreatite e neoplasias pancreáticas como adenocarcinoma ductal. Complicações como abscessos e pseudocistos também são abordadas.
O documento discute diagnóstico por imagem do fígado, abordando tipos de lesões focais e difusas. As lesões focais incluem hemangioma, hiperplasia nodular focal, adenoma hepático e cistos simples. As lesões difusas podem apresentar distribuição homogênea, segmentar ou nodular, e incluem esteatose hepática, doença do depósito de glicogênio e sobrecarga de ferro. Técnicas de imagem como ultrassom, TC e RM são discutidas.
Este caso sugere uma ruptura esplênica após trauma direto no quadrante superior esquerdo do abdome. A paciente apresenta sinais clássicos como dor abdominal aguda de forte intensidade, rigidez abdominal, astenia e náuseas, sugerindo um abdome agudo hemorrágico. Deve-se suspeitar de ruptura esplênica devido ao mecanismo de trauma e localização da dor, sendo necessária tomografia de abdome para confirmação do diagnóstico.
Uma adolescente de 16 anos apresentou dor abdominal aguda no quadrante superior esquerdo após queda, sugerindo possível lesão no baço frágil. Exames de imagem podem ser necessários para avaliar a extensão da lesão e a necessidade de tratamento cirúrgico.
Uma adolescente de 16 anos apresentou dor abdominal aguda no quadrante superior esquerdo após sofrer uma queda, sugerindo possível lesão no baço frágil. Exames de imagem serão necessários para avaliar a extensão da lesão e orientar o tratamento.
O documento resume as principais características do fígado e vias biliares, incluindo sua anatomia, subdivisão funcional em lobos e segmentos, vasos sanguíneos e ductos biliares. As técnicas de imagem como ultrassonografia, tomografia computadorizada e colangiografia endoscópica são descritas como formas de avaliar essas estruturas.
O documento resume as principais características do fígado e vias biliares, incluindo sua anatomia, subdivisão funcional em lobos e segmentos, vasos sanguíneos e ductos biliares. As técnicas de imagem mais usadas para avaliar o fígado e vias biliares são também descritas, com destaque para o ultrassom como principal método.
Este documento apresenta um caso de toxoplasmose cerebral em um paciente portador de HIV. Os exames de tomografia computadorizada mostraram lesão cerebral com realce anelar, confirmando o diagnóstico. Após tratamento com antibióticos, novos exames mostraram redução do edema cerebral e resolução da lesão, indicando melhora do paciente.
Este documento descreve várias doenças pulmonares caracterizadas por opacificação do parênquima, incluindo pneumonite por hipersensibilidade, doença pulmonar eosinofílica, bronquiolite obliterante com PNM em organização, pneumonia intersticial inespecífica, entre outras. Ele fornece detalhes sobre os achados de raio-x e tomografia computadorizada de cada doença, com imagens ilustrativas. O documento é dividido didaticamente em duas aulas para facilitar o ensino sobre essas patolog
Este documento descreve várias doenças pulmonares caracterizadas por opacificação do parênquima, incluindo pneumonite por hipersensibilidade, doença pulmonar eosinofílica, bronquiolite obliterante com pneumonia em organização, pneumonia intersticial inespecífica, entre outras. Ele fornece detalhes sobre os achados radiológicos característicos de cada doença na radiografia de tórax e na tomografia computadorizada de alta resolução.
Radiografia, tomografia computadorizada e ultrassonografia são os principais métodos de imagem discutidos no documento. A radiografia fornece imagens dos ossos e pulmões utilizando radiação ionizante. A tomografia computadorizada permite imagens transversais detalhadas com o uso de contraste, porém com maior dose de radiação. A ultrassonografia é um método não invasivo que utiliza ondas sonoras.
O documento apresenta informações sobre exames de imagem do SNC e coluna cervical. Discute tomografia computadorizada, ressonância magnética e ultrassom, destacando suas indicações e achados comuns como hematomas, AVE e hidrocefalia. Também aborda anatomia da coluna cervical e doenças degenerativas, ilustrando achados de raios-X.
Doenças caracterizadas principalmente por opacidades lineares e reticularesNorberto Werle
O documento descreve doenças caracterizadas por opacidades lineares e reticulares nos pulmões, incluindo fibrose pulmonar idiopática, pneumonias intersticiais idiopáticas, doenças do colágeno vascular e asbestose. As principais características descritas são a presença de fibrose e anormalidades lineares nos pulmões.
O documento descreve as principais massas encontradas no mediastino anterior, incluindo linfomas, tumores de células germinativas e lesões tímicas. É destacada a importância da tomografia computadorizada no diagnóstico destas lesões.
O mediastino é a região do tórax entre os pulmões e contém estruturas vitais como o coração, grandes vasos e traqueia. É dividido em superior, inferior e médio. O documento descreve as principais estruturas encontradas em cada região do mediastino e fornece detalhes anatômicos das mesmas.
2. ADENOCARCINOMA
-Representa mais de 90% dos tumores malignos do pâncreas
-5º maior maior causa de morte por câncer.
-2/3 deles ocorrem na cabeça com intensa reação desmoplásica, medindo em
média 2-3cm.
-Clínica: astenia, perda de peso, dor abdominal, DM(10%), icterícia
-CA 19.9 raramente é positivo em tumores < 1cm.
-A ressecçao cirurgica é o melhor tratamento curativo, porém menos de 20%
dos pacientes candidatos a cirurgia.
- A probabilidade de invasão vascular é menor do que 3%, quando a
superfície de contato com o vaso for inferior a 90º
-Irressecabilidade: invasão extrapancreática de grandes vasos e metástase a
distância.
-Invasão parcial da VMS pode ser ressecável
-Quimioterapia apresenta apenas pequena vantagem em termos de
sobrevida.
3. ADENOCARCINOMA
-TCMD: 1ª escolha para diagnóstico.
- Arterial 30-40s e porta 60-70s - 150 ml
- Adenocarcinoma aparece hipodenso na fase arterial
- Nos casos de massas isoatenuadas, deve-se buscar sinais
indiretos
-RM: 2ª escolha
- É uma técnica complementar quando a tc é inconclusiva.
- Hipo em T1 e variável em T2
- Colangio RM
- Detecção e caracterização de implantes hepáticos e peritoneais
-PET-TC: pâncreas não capta, importância no estadiamento e
diferenciação com pancreatite formadora de massa.
4. Adenocarcinoma of the pancreas. Axial contrast-enhanced pancreatic-phase image shows a poorly defined area of hypodensity in the neck and body of the pancreas (white arrow), infiltrating the retroperitoneum. The superior
mesenteric vein is severely reduced in caliber, is circumscribed by the lesion for more than 180 degrees, and is teardrop shaped (black arrow), suggesting infiltration.
5. Adenocarcinoma of the pancreas. Axial contrast-enhanced portal venous—phase image shows a mass (arrows) in the neck and body of the pancreas, with poorly defined and infiltrating margins. The
mass exhibits reduced and inhomogeneous contrast enhancement, and there is upstream dilation of the pancreatic duct (single arrowhead). The mass surrounds the superior mesenteric artery (wavy
arrow). Peritoneal fluid and thickening (two arrowheads) represent metastatic implants.
6. Adenocarcinoma of the pancreas. Coronal contrast-enhanced (A) and coronal MIP (B) MDCT images demonstrate a mass in the head and uncinate process of the
pancreas (white arrows). It appears hypodense after contrast administration, exhibits poorly defined margins, infiltrates surrounding fat tissue, and reduces the
caliber of the superior mesenteric artery (SMA) (arrowheads). Multiple small, rounded, hypodense metastatic foci are seen in the liver (black arrows in A)
7. Adenocarcinoma of the pancreas. A, Coronal portal venous—phase MDCT demonstrates a mass in the head and uncinate process of the pancreas (short
arrows), infiltrating the third portion of the duodenum (long arrow), and surrounding the superior mesenteric artery (arrowhead). Coronal (B) and axial (C) curved
reformatted images of the same patient display the tumor (arrows) and dilation of the main pancreatic duct (arrowheads), which abruptly terminates in the mass. A
biliary stent is seen in situ (asterisk).
8.
9. Adenocarcinoma of the pancreas. Curved reformatted MDCT shows an oval mass in the tail of the pancreas, with ill-defined margins and poor enhancement (arrow).
10. Adenocarcinoma of the pancreas. Axial contrast-enhanced pancreatic-phase MDCT (A) and curved reformatted MDCT (B) along the course of the main pancreatic duct display a
hypodense mass in the body of the pancreas (arrows), with upstream dilation of the main pancreatic duct (arrowheads).
11. Adenocarcinoma of the pancreas. Coronal oblique MRCP (A), axial T1-weighted image (B), axial T2-weighted image (C), axial contrast-enhanced T1-weighted
image in the arterial phase (D), and axial pancreatic-phase MDCT (E) display the “double duct” sign, consisting of common bile duct and pancreatic duct dilation
(arrowheads in A). A biliary stent is in situ (thin arrow). An abrupt biliary tree and pancreatic duct obstruction (thick arrows in A) caused by the cancer (wavy arrow) is
observed.
12. Adenocarcinoma of the pancreas. Coronal oblique MRCP (A), axial T1-weighted image (B), axial T2-weighted image (C), axial contrast-enhanced T1-weighted
image in the arterial phase (D), and axial pancreatic-phase MDCT (E) display the “double duct” sign, consisting of common bile duct and pancreatic duct dilation
(arrowheads in A). A biliary stent is in situ (thin arrow). An abrupt biliary tree and pancreatic duct obstruction (thick arrows in A) caused by the cancer (wavy arrow) is
observed.
13. Adenocarcinoma of the pancreas. Coronal oblique MRCP (A), axial T1-weighted image (B), axial T2-weighted image (C), axial contrast-enhanced T1-weighted image (D), and axial MDCT pancreatic-
phase image (E) demonstrate the “double duct” sign (arrowheads in A) and a head—uncinate process mass that appears ill-defined and hypointense on the T1-weighted image, hyperintense on the T2-
weighted image, and poorly enhancing after the administration of gadolinium and iodinated contrast material (arrow in B to E).
14. Adenocarcinoma of the pancreas. Coronal oblique MRCP (A), axial T1-weighted image (B), axial T2-weighted image (C), axial contrast-enhanced T1-weighted image (D), and axial MDCT pancreatic-
phase image (E) demonstrate the “double duct” sign (arrowheads in A) and a head—uncinate process mass that appears ill-defined and hypointense on the T1-weighted image, hyperintense on the T2-
weighted image, and poorly enhancing after the administration of gadolinium and iodinated contrast material (arrow in B to E).
15. Adenocarcinoma of the pancreas. Coronal single-shot FSE T2-weighted image (A), axial T1-weighted image (B), axial T2-weighted image (C), axial contrast-enhanced T1-weighted image in the
pancreatic phase (D), delayed contrast-enhanced T1-weighted image (E), and axial contrast-enhanced MDCT (F) show dilation and distal stenosis of the pancreatic duct (arrow in A), displacement and
stenosis of the common hepatic duct (arrowhead in A), and a contour-deforming mass in the head of the pancreas (arrows in B to F) that appears poorly defined and hypointense on the T1-weighted
image, hyperintense on the T2-weighted image, and poorly enhancing after contrast administration. It diffusely infiltrates the adjacent retroperitoneum (arrowheads in E and F). A necrotic metastatic node
is indicated by the wavy arrow in E and F.
16. Adenocarcinoma of the pancreas. Coronal single-shot FSE T2-weighted image (A), axial T1-weighted image (B), axial T2-weighted image (C), axial contrast-enhanced T1-weighted image in the
pancreatic phase (D), delayed contrast-enhanced T1-weighted image (E), and axial contrast-enhanced MDCT (F) show dilation and distal stenosis of the pancreatic duct (arrow in A), displacement and
stenosis of the common hepatic duct (arrowhead in A), and a contour-deforming mass in the head of the pancreas (arrows in B to F) that appears poorly defined and hypointense on the T1-weighted
image, hyperintense on the T2-weighted image, and poorly enhancing after contrast administration. It diffusely infiltrates the adjacent retroperitoneum (arrowheads in E and F). A necrotic metastatic node
is indicated by the wavy arrow in E and F.
17. Adenocarcinoma of the pancreas. Coronal single-shot FSE T2-weighted image (A), axial T1-weighted image (B), axial T2-weighted image (C), axial contrast-enhanced T1-weighted image in the
pancreatic phase (D), delayed contrast-enhanced T1-weighted image (E), and axial contrast-enhanced MDCT (F) show dilation and distal stenosis of the pancreatic duct (arrow in A), displacement and
stenosis of the common hepatic duct (arrowhead in A), and a contour-deforming mass in the head of the pancreas (arrows in B to F) that appears poorly defined and hypointense on the T1-weighted
image, hyperintense on the T2-weighted image, and poorly enhancing after contrast administration. It diffusely infiltrates the adjacent retroperitoneum (arrowheads in E and F). A necrotic metastatic node
is indicated by the wavy arrow in E and F.
18. TUMORES ENDÓCRINOS
-2% das neoplasias pancreáticas
-Funcionais e não funcionais
-Até 90% dos não funcionais são malignos, grandes e tem melhor
resposta a quimio do que os adeno.
-INSULINOMAS
- 50% dos tumores endocrinos, sendo 10% malignos.
- 30-60 anos, 1H:1M
- Em 90% dos casos tem menos de 2cm,
- Tendem a ser muito vascularizados
-GASTRINOMAS
- 20% dos tu endócrinos, sendo 60% malignos
- Mais comum no sexo masculino – 5ª década de vida
- Síndrome de Zollinger Ellison e associação com NEM 1
19. TUMORES ENDÓCRINOS
-VIPOMAS
- Predileção pelo sexo feminino
- Diarréia, hipocalemia e hipocloridria.
-Glucagonomas e somatostinomas
-ACHADOS:
- Forte realce na fase arterial e na fase portal
- Podem ter aparência cística e calcificações discretas
- Os tu não funcionantes frequentemente são heterogêneos.
- Calcificação em 20% dos casos
- RM: hipo em T1 e hiper em T2
- MTS para fígado e lnf regionais
20. Insulinoma. Axial T2-weighted fat-suppressed image (A), axial arterial-phase T1-weighted fat-suppressed image (B), and axial portal venous—phase T1-weighted
fat-suppressed image (C) demonstrate a small, rounded, well-demarcated, hyperintense lesion in the tail of the pancreas (arrow). The lesion exhibits avid contrast
enhancement in the arterial phase of the dynamic image and retains contrast in the portal venous phase. D, Corresponding axial MDCT in the arterial phase of
enhancement displays the same finding (arrow).
21. Insulinoma. Axial T2-weighted fat-suppressed image (A), axial arterial-phase T1-weighted fat-suppressed image (B), and axial portal venous—phase T1-weighted
fat-suppressed image (C) demonstrate a small, rounded, well-demarcated, hyperintense lesion in the tail of the pancreas (arrow). The lesion exhibits avid contrast
enhancement in the arterial phase of the dynamic image and retains contrast in the portal venous phase. D, Corresponding axial MDCT in the arterial phase of
enhancement displays the same finding (arrow).
22. Gastrinoma. Coronal (A) and axial (B and C) contrast-enhanced MDCT images in the arterial phase display a rounded, well-circumscribed, homogeneously and intensely enhancing
lesion (arrow) close to the junction of the third and fourth portions of the duodenum and the mesenteric vessels. Diffuse thickening and enhancement of the gastric folds (arrowheads
in C) are seen in this patient with Zollinger-Ellison syndrome.
23. Gastrinoma. Coronal (A) and axial (B and C) contrast-enhanced MDCT images in the arterial phase display a rounded, well-circumscribed, homogeneously and
intensely enhancing lesion (arrow) close to the junction of the third and fourth portions of the duodenum and the mesenteric vessels. Diffuse thickening and
enhancement of the gastric folds (arrowheads in C) are seen in this patient with Zollinger-Ellison syndrome.
24. Nonfunctioning pancreatic endocrine tumor. Axial contrast-enhanced MDCT shows a large, well-defined, lobulated lesion in the tail of the pancreas. It appears inhomogeneous with enhancing solid areas (arrow) and has a
poorly enhancing, partially necrotic component (arrowheads).
25. LINFOMA
-0,5% das neoplasias pancreáticas
-Dor abdominal, perda de peso e icterícia
-Pode haver elevação do CA 19.9
-Média de idade: 55 anos
-Habitualmente ocorre na cabeça pancreática.
-Tendem a ser infiltrativos e geralmente tem hiposinal e T1 e T2
26. Pancreatic lymphoma. Axial T1-weighted opposed-phase (A), axial T2-weighted fat-suppressed (B), and axial arterial-phase T1-weighted fat-suppressed (C) MR images display
enlargement and rounding of the pancreatic head, with a well-demarcated area of low signal intensity within, corresponding to lymphoma (arrows). The low-signal-intensity area does
not significantly enhance compared with the highly enhancing normal pancreatic parenchyma.
27. Pancreatic lymphoma. Axial T1-weighted opposed-phase (A), axial T2-weighted fat-suppressed (B), and axial arterial-phase T1-weighted fat-suppressed (C) MR images display
enlargement and rounding of the pancreatic head, with a well-demarcated area of low signal intensity within, corresponding to lymphoma (arrows). The low-signal-intensity area does
not significantly enhance compared with the highly enhancing normal pancreatic parenchyma.
28. Pancreatic lymphoma. Axial contrast-enhanced MDCT shows a well-demarcated hypodense area in the head of the pancreas (arrow). The pancreatic duct is not dilated (arrowhead).
29. Pancreatic lymphoma. Axial T1-weighted opposed-phase (A), axial contrast-enhanced T1-weighted fat-suppressed (B), and axial T2-weighted fat-suppressed (C) images show
enlargement and rounding of the head of the pancreas. An area of low signal intensity (arrow) is best seen on the contrast-enhanced image in the dorsal aspect (B). MRCP (D)
displays smooth tapering of the distal common bile duct (large arrow) and of the duct of Wirsung (arrows), main pancreatic duct prominence (large arrowheads), and widening of the
duodenal loop (small arrowheads).
30. Fi Pancreatic lymphoma. Axial T1-weighted opposed-phase (A), axial contrast-enhanced T1-weighted fat-suppressed (B), and axial T2-weighted fat-suppressed (C) images show
enlargement and rounding of the head of the pancreas. An area of low signal intensity (arrow) is best seen on the contrast-enhanced image in the dorsal aspect (B). MRCP (D)
displays smooth tapering of the distal common bile duct (large arrow) and of the duct of Wirsung (arrows), main pancreatic duct prominence (large arrowheads), and widening of the
duodenal loop (small arrowheads).
31. METÁSTASE INTRAPANCREÁTICA
-Raras: 2% dos tumores pancreáticos
-Rim – pulmão – mama – colorretal – melanoma.
-As caracteristicas de imagem tendem a repetir as características do tu
primário.
32. Intrapancreatic metastases from renal cancer. Axial contrast-enhanced MDCT in the arterial phase shows a rounded, relatively homogeneous, well-circumscribed area of enhancement in the uncinate
process (arrow). This patient had undergone left nephrectomy for renal cancer.
33. Intrapancreatic metastases from renal cancer. Coronal portal venous—phase (A) and axial arterial-phase (B) MDCT images demonstrate a rounded, well-demarcated lesion in the tail
of the pancreas (arrow). It exhibits heterogeneous contrast enhancement.
34. LESOES CISTICAS
-A existência de lesões pancreáticas císticas benignas e malignas , justifica a
importância diagnóstico.
-Cistoadenomas serosos, cistoadenoma mucinoso e NMIP
-TCMD e RM – colagio RM
-Assintomatico ou dor abdominal, icterícia e pancreatite recorrente.
CISTOADENOMA SEROSO
-Corresponde a 30% das neoplasias císticas e são mais comuns nas
mulheres.
-Evidenciam-se com padrão policístico ou microcístico (1mm até 2cm)
-Pode parecer sólida
-Cicatriz central fibrosa
-Os septos podem realçar
-Crescimento de 4 mm por ano.
35. A, Axial contrast-enhanced MDCT reveals a finely lobulated lesion (arrow) with a microcystic appearance in the proximal body of the pancreas. B, Corresponding coronal T2-weighted
MR image demonstrates the same findings (arrow) and also reveals a central scar (arrowhead) that is virtually pathognomonic for serous cystadenoma.
36. Axial contrast-enhanced MDCT reveals a lobulated lesion with internal septations and a calcified central scar (arrow), a characteristic finding in serous cystadenoma.
37. CISTOADENOMA MUCINOSO
-Contituem 44-49% das lesões císticas
-Predomina em mulheres, com média de idade de 47 anos
-A maioria das lesões são solitárias e multiloculadas, com compartimentos
grandes (2-6cm)
-Maioria tem contorno regular
-Não se comunicão com o ducto pancreátco, mas podem causar
obstrução do mesmo.
-Septos e nódulos murais são melhor apreciado pela RM e USE
-Calcificações periféricas ou septais são fortemente sugestiva de C.
mucinoso.
38. Axial contrast-enhanced MDCT reveals a macrocystic or oligocystic variety of serous cystadenoma with fewer large (>2 cm) internal cysts (arrow). This variant may be difficult to differentiate from a
mucinous cystic lesion.
39. Mucinous cystic neoplasm. Axial contrast-enhanced MDCT shows a large, smooth cystic lesion with internal septations (arrow) and peripheral and septal calcification
(arrowheads).
40. Mucinous cystic neoplasm. A, Axial contrast-enhanced MDCT reveals a cystic lesion with an eccentric mural nodule (arrow). B, Corresponding coronal reformatted MDCT reveals the
same findings (arrow). The presence of a mural nodule increases the likelihood of malignancy; however, it is sometimes difficult to distinguish a mural nodule from debris or
inspissated mucin.
41. Mucinous lesion. A, Axial contrast-enhanced MDCT image reveals a macrocystic lesion in the uncinate process (horizontal arrow in A and B). B, Corresponding axial T2-weighted fat-
saturated MR image reveals a mural nodule (long arrow), which was not evident on CT, as an area of low signal intensity.
42. NEOPLASIAS MUCINOSAS INTRADUCTAIS PAPILARES
-Desenvolve-se a partir do revestimento epitelial do ducto pancreático
principal ou de seus ramos laterais.
-Tem prognóstico melhor do que as outras neoplasia pancreáticas.
-21-33% das neoplasias císticas, leve predominância no sexo masc.
-A secreção excessiva de mucina pode causar protrusão das papilas
maiores na luz duodenal (cpre)
-Superfície interna do ducto principal frequentemente tem nódulos murais.
-NMIP dos ramos laterais manifesta-se por lesões císticas uniloculadas ou
multiloculadas e a não visualização da comunicação com o ducto
pancreático principal não afasta o diagnóstico.
-A presença de nodulos murais, septos espessos, calcificações e ducto
principal > 10mm sugere malignidade.
-Sobrevida em 5 anos é de 50 - 75% nos tumores malignos.
43. Main-duct intraductal papillary mucinous neoplasm A, Coronal reformatted MDCT shows diffuse dilation of the main pancreatic duct (arrows), which is filled with mucin. The ductal
dilation is disproportionate to the degree of parenchymal atrophy. B, ERCP reveals the diffuse ductal dilation (arrows) without any evidence of side-branch irregularity.
44. Main-duct intraductal papillary mucinous neoplasm A, Coronal reformatted MDCT shows diffuse dilation of the main pancreatic duct (arrows), which is filled with mucin. The ductal dilation is
disproportionate to the degree of parenchymal atrophy. B, ERCP reveals the diffuse ductal dilation (arrows) without any evidence of side-branch irregularity.
45. Main-duct intraductal papillary mucinous neoplasm. Axial contrast-enhanced (A) and coronal reformatted (B) MDCT images show the major papilla bulging into the duodenal lumen
(arrow), which is considered a pathognomonic sign.
46. Main-duct intraductal papillary mucinous neoplasm. Coronal reformatted MDCT (A) and coronal MRCP (B) reveal diffuse dilation of the main pancreatic duct due to excessive mucin secretin (arrows in A).
The distal duct (arrow in B) is not seen on the MRCP image, possibly owing to inspissated mucin.
47. Side-branch intraductal papillary mucinous neoplasm. A, Axial contrast-enhanced MDCT reveals a small cystic lesion (arrow) in the inferior body of the pancreas. B,
Coronal reformatted image demonstrates the communication (arrow) of the lesion with the pancreatic duct. C and D, Two-dimensional (C) and three-dimensional (D)
MR pancreatograms demonstrate the lobulated cystic lesion and its communication (arrow) with the main pancreatic duct.
48. Side-branch intraductal papillary mucinous neoplasm. A, Axial contrast-enhanced MDCT reveals a small cystic lesion (arrow) in the inferior body of the pancreas. B, Coronal
reformatted image demonstrates the communication (arrow) of the lesion with the pancreatic duct. C and D, Two-dimensional (C) and three-dimensional (D) MR pancreatograms
demonstrate the lobulated cystic lesion and its communication (arrow) with the main pancreatic duct.
49. Side-branch intraductal papillary mucinous neoplasm. A, Axial contrast-enhanced MDCT reveals a well-defined cystic lesion in the neck of the pancreas and its narrow communication
(arrow) with the pancreatic duct. B, The cystic lesion and communication (arrow) are well demonstrated on a two-dimensional MR pancreatogram acquired in the coronal oblique
plane.
50. Axial curved reformatted MDCT reveals multiple communicating side-branch intraductal papillary mucinous neoplasms (arrows) along the main pancreatic duct.
51. Combined or mixed intraductal papillary mucinous neoplasm. Axial curved reformatted MDCT reveals a loculated cystic lesion in the head, neck, and uncinate
process of the pancreas (arrows), with diffuse dilation of the main pancreatic duct (arrowheads). Histopathology revealed a mixed intraductal papillary mucinous
neoplasm with papillary growth and mucin extending from the cystic lesion in the main pancreatic duct.
52. Main-duct intraductal papillary mucinous neoplasm. A, Axial contrast-enhanced MDCT reveals an isoattenuating lesion (arrow) in the terminal main pancreatic duct. B, 18FDG PET
shows a hot spot (arrow) in the same location. C, Findings are confirmed on a fused PET CT image (arrow). Histopathology revealed a high-grade malignancy.
53. Main-duct intraductal papillary mucinous neoplasm. A, Axial contrast-enhanced MDCT reveals an isoattenuating lesion (arrow) in the terminal main pancreatic duct. B, 18FDG PET
shows a hot spot (arrow) in the same location. C, Findings are confirmed on a fused PET CT image (arrow). Histopathology revealed a high-grade malignancy.