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Salgado D, Kang J, Costa AF. Mimics of pancreatic neoplasms at cross-sectional imaging: Pearls for characterization and diagnostic work-up. Curr Probl Diagn Radiol 2025; 54:382-391. [PMID: 39701879 DOI: 10.1067/j.cpradiol.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 11/13/2024] [Accepted: 12/09/2024] [Indexed: 12/21/2024]
Abstract
Interpreting imaging examinations of the pancreas can be a challenge. Several different entities can mimic or mask pancreatic neoplasms, including normal anatomic variants, non-pancreatic lesions, and both acute and chronic pancreatitis. It is important to distinguish these entities from pancreatic neoplasms, as the management and prognosis of a pancreatic neoplasm, particularly adenocarcinoma, have considerable impact on patients. Normal pancreatic variants that mimic a focal lesion include focal fatty atrophy, annular pancreas, and ectopic pancreas. Extra-pancreatic lesions that can mimic a primary pancreatic neoplasm include vascular lesions, such as arteriovenous malformations and pseudoaneurysms, duodenal diverticula, and intra-pancreatic accessory spleen. Both acute and chronic pancreatitis can mimic or mask a pancreatic neoplasm and are also associated with pancreatic ductal adenocarcinoma. Awareness of these entities and their imaging features will enable the radiologist to narrow the differential diagnosis, provide recommendations that expedite diagnosis and avoid unnecessary work-up or delays in patient care.
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Affiliation(s)
- David Salgado
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9, Canada.
| | - Jessie Kang
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9, Canada.
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9, Canada.
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Qu H, Zhou L, Tang D, Zhang Q, Yang P, Yang B, Shi J. Relationship between liver fat, pancreatic fat, and new-onset type 2 diabetes mellitus in patients with metabolic dysfunction-associated fatty liver disease. Acta Diabetol 2025:10.1007/s00592-025-02501-7. [PMID: 40252104 DOI: 10.1007/s00592-025-02501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2024] [Accepted: 03/22/2025] [Indexed: 04/21/2025]
Abstract
PURPOSE Type 2 diabetes mellitus (T2DM) is associated with ectopic fat deposition, especially in the liver and pancreas. Therefore, this study aimed to evaluate the relationship between liver fat fraction (LFF), pancreatic fat fraction (PFF), and new-onset T2DM in metabolic dysfunction-associated fatty liver disease (MAFLD) by magnetic resonance imaging (MRI). METHODS This is a retrospective study of patients with MAFLD who underwent abdominal MRI between 2022 and July 2024. LFF and PFF were measured using an axial multi-echo Dixon-based sequence. All participants underwent routine medical history, anthropometric measurements, and laboratory tests. Multivariable stepwise selection models were constructed to predict PFF and T2DM status based on variables of clinical interest. RESULTS This study included 80 MAFLD patients with 40 untreated new-onset T2DM and 40 non-T2DM controls. LFF, PFF, and homeostasis model assessment of insulin resistance (HOMA-IR) index were higher in the T2DM group than in the control group. In the new-onset T2DM group, PFF was linearly positively correlated with LFF (rs = 0.321, P = 0.04) and HOMA-IR (rs = 0.350, P = 0.03). After adjustment for several metabolic variables, PFF remained an independent risk factor for incident T2DM in MAFLD patients (all P < 0.05). The area under the receiver operating characteristic curve for PFF and LFF to predict T2DM was 0.889 and 0.633 (P < 0.001 and P = 0.03), respectively. CONCLUSION In MAFLD patients, PFF, and LFF play a prominent role in new-onset T2DM with high predictive and diagnostic value.
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Affiliation(s)
- Huanjia Qu
- Department of Endocrinology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Lingling Zhou
- Department of Endocrinology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Dong Tang
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Qiuling Zhang
- Department of Endocrinology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Pu Yang
- Department of Endocrinology, Hangzhou Normal University, Hangzhou, 310000, China
| | - Boyi Yang
- Department of Endocrinology, Hangzhou Normal University, Hangzhou, 310000, China
| | - Junping Shi
- Department of Metabolic Disease Center, Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China.
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Ookura R, Usuki N, Miki Y. Correlation between Pancreatic Fat Deposition and Metabolic Syndrome: Relationships with Location in the Pancreas and Sex. Intern Med 2024; 63:2113-2123. [PMID: 38171856 PMCID: PMC11358728 DOI: 10.2169/internalmedicine.2450-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024] Open
Abstract
Objective To investigate the correlation between pancreatic fat deposition and metabolic syndrome (MetS) parameters, focusing on the locations of fat deposition in the pancreas and sex differences. Methods Degrees of fat deposition in the head, body, and tail of the pancreas were evaluated using computed tomography (CT). We examined the relationships between pancreatic fat deposition and the age, body mass index (BMI), visceral and subcutaneous fat, serum lipid profiles, hepatic steatosis, diabetes mellitus (DM), and hypertension (HTN). Results In this retrospective study, greater fat deposition was associated with a higher BMI, visceral and subcutaneous fat accumulation, and hepatic steatosis, with the pancreatic head showing the strongest correlation. Correlations of pancreatic fat deposition with the BMI and visceral and subcutaneous fat accumulation were stronger in females than in males, while correlations with hepatic steatosis were stronger in males than in females. In addition, a multivariate analysis did not suggest a direct causal relationship between pancreatic fat deposition and DM and HTN, but there was a significant correlation between pancreatic fat deposition in the pancreatic head and visceral fat area. Conclusion Pancreatic fat deposition, as evaluated by CT, especially in the part of the pancreatic head adjacent to the ampulla of Vater, is a sensitive indicator of MetS. The correlations between pancreatic fat deposition and MetS parameters tended to be stronger in females than in males. These results may help further elucidate the pathophysiology of MetS and provide opportunities for its diagnosis.
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Affiliation(s)
- Ryusuke Ookura
- Department of Diagnostic and Interventional Radiology, Japan Community Healthcare Organization Osaka Hospital, Japan
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Japan
| | - Noriaki Usuki
- Department of Diagnostic and Interventional Radiology, Japan Community Healthcare Organization Osaka Hospital, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Japan
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Huang C, Hecht EM, Soloff EV, Tiwari HA, Bhosale PR, Dasayam A, Galgano SJ, Kambadakone A, Kulkarni NM, Le O, Liau J, Luk L, Rosenthal MH, Sangster GP, Goenka AH. Imaging for Early Detection of Pancreatic Ductal Adenocarcinoma: Updates and Challenges in the Implementation of Screening and Surveillance Programs. AJR Am J Roentgenol 2024; 223:e2431151. [PMID: 38809122 DOI: 10.2214/ajr.24.31151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDA) is one of the most aggressive cancers. It has a poor 5-year survival rate of 12%, partly because most cases are diagnosed at advanced stages, precluding curative surgical resection. Early-stage PDA has significantly better prognoses due to increased potential for curative interventions, making early detection of PDA critically important to improved patient outcomes. We examine current and evolving early detection concepts, screening strategies, diagnostic yields among high-risk individuals, controversies, and limitations of standard-of-care imaging.
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Affiliation(s)
- Chenchan Huang
- Department of Radiology, NYU Langone Health, 660 First Ave, 3rd Fl, New York, NY 10016
| | | | - Erik V Soloff
- Department of Radiology, University of Washington, Seattle, WA
| | - Hina Arif Tiwari
- Department of Radiology, University of Arizona College of Medicine, Banner University Medicine, Tucson, AZ
| | - Priya R Bhosale
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Bellaire, TX
| | - Anil Dasayam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Naveen M Kulkarni
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Ott Le
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Bellaire, TX
| | - Joy Liau
- Department of Radiology, University of California at San Diego, San Diego, CA
| | - Lyndon Luk
- Department of Radiology, Columbia University Medical Center, New York, NY
| | - Michael H Rosenthal
- Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Sunouchi M, Inaishi J, Shimizu-Hirota R, Saisho Y, Hayashi K, Takaishi H, Itoh H. Longitudinal changes in pancreatic volume and pancreatic fat with weight gain in Japanese without diabetes: An analysis using health check-up data. Metabol Open 2023; 19:100250. [PMID: 37396402 PMCID: PMC10314282 DOI: 10.1016/j.metop.2023.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/04/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023] Open
Abstract
Aims/introduction There have been few reports about the longitudinal changes in pancreas volume (PV) or pancreatic steatosis (PS) in response to obesity. In this longitudinal analysis using health check-up data, we explored changes in PV, PS and glucose metabolic indices that occurred after weight gain in Japanese without diabetes. Materials/methods Clinical data on 37 Japanese subjects with a ≥1 kg/m2 increase in body mass index between two health check-ups and without diabetes were collected. PV, pancreas attenuation (PA) and splenic attenuation (SA) were evaluated using computed tomography (CT) images. The pancreas area was outlined by hand in multiple images with slice thickness of 2 mm, and the PV was computed by summing these areas. PS was defined as the difference between SA and PA (SA-PA). Medical records were collected, including findings on immunoreactive insulin (IRI), homeostasis model assessment of insulin resistance (HOMA-R) and beta cell function (HOMA-β). Paired t-test and Spearman's correlation coefficient were used in the analyses. Results The median follow-up period was 21.1 months and the mean BMI was increased from 25.5 ± 3.3 kg/m2 to 27.0 ± 3.3 kg/m2. PV (53.5 ± 15.9 cm3 vs. 56.2 ± 16.4 cm3) and SA-PA (8.7 ± 9.1 HU vs. 13.6 ± 10.9 HU) increased significantly after weight gain (both, P < 0.001). There were significant increases of IRI and HOMA-R with the weight gain (both, P < 0.05), whereas HOMA-β exhibited only a nonsignificant trend of increase (55.4％ (41.5-65.5) vs. 56.8％ (46.2-83.7), P = 0.07). Conclusions Both PV and PS were increased longitudinally with weight gain in Japanese without diabetes.
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Affiliation(s)
- Maria Sunouchi
- Keio University School of Medicine, Department of Endocrinology, Metabolism and Nephrology, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Jun Inaishi
- Keio University School of Medicine, Department of Endocrinology, Metabolism and Nephrology, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Keio University School of Medicine, Center for Preventive Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryoko Shimizu-Hirota
- Keio University School of Medicine, Department of Endocrinology, Metabolism and Nephrology, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Keio University School of Medicine, Center for Preventive Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoshifumi Saisho
- Keio University School of Medicine, Department of Endocrinology, Metabolism and Nephrology, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Saisho Diabetes Clinic, 5-67-5 Nakano, Nakano-ku, Tokyo, 164-0001, Japan
| | - Kaori Hayashi
- Keio University School of Medicine, Department of Endocrinology, Metabolism and Nephrology, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiromasa Takaishi
- Keio University School of Medicine, Center for Preventive Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Itoh
- Keio University School of Medicine, Department of Endocrinology, Metabolism and Nephrology, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Keio University School of Medicine, Center for Preventive Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Zhang CL, Wang JJ, Li JN, Yang Y. Nonalcoholic fatty pancreas disease: An emerging clinical challenge. World J Clin Cases 2021; 9:6624-6638. [PMID: 34447810 PMCID: PMC8362510 DOI: 10.12998/wjcc.v9.i23.6624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty pancreas disease (NAFPD) is an emerging disease that has gained an increasing amount of attention in recent years. It describes fat accumulation in the pancreas with insignificant alcohol consumption, but the pathogenesis is largely unknown. A wide range of terms have been used to describe the phenomenon of pancreatic fat accumulation, but NAFPD remains an under-recognized and non-independent disorder. Obesity, age, sex, race, and unhealthy lifestyle are established independent risk factors for NAFPD, which is strongly associated with metabolic syndrome, type 2 diabetes, pancreatitis, pancreatic fistula, pancreatic cancer, and nonalcoholic fatty liver disease. At present, imaging techniques are common diagnostic aids, but uniform criteria and consensus are lacking. Therapeutically, healthy diet, weight loss, and exercise are the mainstays to reduce pancreatic fat accumulation. It can be seen that there is a limited understanding of NAFPD at this stage and further exploration is needed. Previous studies have revealed that NAFPD may directly affect diagnosis and clinical decision-making. Therefore, exploring the pathophysiological mechanism and clinical associations of NAFPD is a major challenge for researchers and clinicians.
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Affiliation(s)
- Cheng-Lei Zhang
- Department of Clinical Laboratory, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
- The Institute of Endocrinology, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
| | - Jing-Jiao Wang
- Department of Stomatology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
| | - Jian-Ning Li
- The Institute of Endocrinology, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
- School of Basic Medical Sciences, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
| | - Yi Yang
- The Institute of Endocrinology, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
- School of Basic Medical Sciences, Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
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Desai V, Patel K, Sheth R, Barlass U, Chan YM, Sclamberg J, Bishehsari F. Pancreatic Fat Infiltration Is Associated with a Higher Risk of Pancreatic Ductal Adenocarcinoma. Visc Med 2020; 36:220-226. [PMID: 32775353 DOI: 10.1159/000507457] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) has a poor survival rate, partly due to delayed diagnosis. Identifying high-risk individuals could lead to early detection and improve survival. A number of risk factors such as alcohol consumption and metabolic syndrome are associated with fatty infiltration of the pancreas. Experimental models show that a fatty pancreas promotes tissue inflammation and fibrosis, which could promote PDAC. Methods We conducted a case-control study in a single-university tertiary hospital. Sixty-eight PDAC cases with recent non-contrast computed tomography (CT) and 235 controls were studied. The controls had no history of malignancy and underwent CT colonography for cancer screening in the same period. Pancreatic fat was estimated by calculating pancreatic (P) attenuation, corrected to splenic (S) attenuation, measured in three 1.0-cm2 regions of the pancreas. The P.S100 value calculated was used to estimate fatty infiltration of the pancreas (FIP), with a lower P.S100 representing a higher FIP. Results The PDAC patients had a lower BMI and a higher rate of type 2 diabetes mellitus. The P.S100 was lower in cases than in controls (86.452 vs. 92.414, p = 4.016e-06), suggesting that FIP is higher with PDAC. The risk of developing PDAC steadily increased significantly for the quartiles with a higher FIP compared to the low FIP quartile. No correlation between BMI and FIP (r = -0.1031179; 95% confidence interval [CI] -0.22267106 to 0.01949092) was found. Adjusting for confounders (age, sex, BMI, and DM), the risk of developing PDAC according to the FIP was estimated to be 3.75 (95% CI 1.9234408-7.993337; p = 0.000171). FIP was stable before and after the diagnosis of PDAC in 9 cases with prior CT scans when no pancreatic tumor was identifiable. Conclusion Fatty pancreas is associated with an increased risk of pancreatic cancer. Once confirmed in larger-scale studies, these findings could help to identify at-risk individuals, particularly in high-risk groups such as chronic alcohol consumers.
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Affiliation(s)
- Vishal Desai
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kevin Patel
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ravi Sheth
- Department of Radiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Usman Barlass
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Yuet-Ming Chan
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Joy Sclamberg
- Department of Radiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Faraz Bishehsari
- Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
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Elbanna KY, Jang HJ, Kim TK. Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review. Insights Imaging 2020; 11:58. [PMID: 32335790 PMCID: PMC7183518 DOI: 10.1186/s13244-020-00861-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has continued to have a poor prognosis for the last few decades in spite of recent advances in different imaging modalities mainly due to difficulty in early diagnosis and aggressive biological behavior. Early PDAC can be missed on CT due to similar attenuation relative to the normal pancreas, small size, or hidden location in the uncinate process. Tumor resectability and its contingency on the vascular invasion most commonly assessed with multi-phasic thin-slice CT is a continuously changing concept, particularly in the era of frequent neoadjuvant therapy. Coexistent celiac artery stenosis may affect the surgical plan in patients undergoing pancreaticoduodenectomy. In this review, we discuss the challenges related to the imaging of PDAC. These include radiological and clinical subtleties of the tumor, evolving imaging criteria for tumor resectability, preoperative diagnosis of accompanying celiac artery stenosis, and post-neoadjuvant therapy imaging. For each category, the key imaging features and potential pitfalls on cross-sectional imaging will be discussed. Also, we will describe the imaging discriminators of potential mimickers of PDAC.
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Affiliation(s)
- Khaled Y Elbanna
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
| | - Hyun-Jung Jang
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tae Kyoung Kim
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Tremmel DM, Feeney AK, Mitchell SA, Chlebeck PJ, Raglin S, Fernandez LA, Odorico JS, Sackett SD. Hypertension, but not body mass index, is predictive of increased pancreatic lipid content and islet dysfunction. Am J Transplant 2020; 20:1105-1115. [PMID: 31715064 PMCID: PMC7103563 DOI: 10.1111/ajt.15698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/15/2019] [Accepted: 11/04/2019] [Indexed: 01/25/2023]
Abstract
Pancreatic steatosis is thought to be a negative risk factor for pancreas transplant outcomes. Despite considering donor body mass index (BMI) and the visualization of intercalated fat as indicators of donor pancreas lipid content, transplant surgeons do not use a quantitative method to directly measure steatosis when deciding to transplant a pancreas. In this study, we used nondiabetic human pancreata donated for research to measure the pancreatic and islet-specific lipid content to determine which clinical markers correlate best with lipid content. Interestingly, we found that BMI and age correlate with increased pancreatic lipid content (Panc-LC) in men, but not women. Our findings further suggest that total Panc-LC correlates with an increase in islet lipid content for both men and women. We noted that pancreata donated from individuals with a history of hypertension have increased Panc-LC independent of donor BMI or sex. Moreover, we identify hypertension as a risk factor for reduced islet function after islet isolation. Together, our findings emphasize differences in pancreas graft quality related to pancreatic and islet lipid content, which may not be predicted by assessing BMI alone but may be influenced by a donor history of hypertension.
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Affiliation(s)
- Daniel M. Tremmel
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, 53705, USA.,Co-first authors
| | - Austin K. Feeney
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, 53705, USA.,Co-first authors
| | - Samantha A. Mitchell
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, 53705, USA
| | - Peter J. Chlebeck
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, 53705, USA
| | - Sierra Raglin
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, 53705, USA
| | - Luis A. Fernandez
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, 53705, USA
| | - Jon S. Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, 53705, USA
| | - Sara D. Sackett
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, 53705, USA
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10
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Haj-Mirzaian A, Kawamoto S, Zaheer A, Hruban RH, Fishman EK, Chu LC. Pitfalls in the MDCT of pancreatic cancer: strategies for minimizing errors. Abdom Radiol (NY) 2020; 45:457-478. [PMID: 31897686 DOI: 10.1007/s00261-019-02390-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multidetector computed tomography (MDCT) is a widely used cross-sectional imaging modality for initial evaluation of patients with suspected pancreatic ductal adenocarcinoma (PDAC). However, diagnosis of PDAC can be challenging due to numerous pitfalls associated with image acquisition and interpretation, including technical factors, imaging features, and cognitive errors. Accurate diagnosis requires familiarity with these pitfalls, as these can be minimized using systematic strategies. Suboptimal acquisition protocols and other technical errors such as motion artifacts and incomplete anatomical coverage increase the risk of misdiagnosis. Interpretation of images can be challenging due to intrinsic tumor features (including small and isoenhancing masses, exophytic masses, subtle pancreatic duct irregularities, and diffuse tumor infiltration), presence of coexisting pathology (including chronic pancreatitis and intraductal papillary mucinous neoplasm), mimickers of PDAC (including focal fatty infiltration and focal pancreatitis), distracting findings, and satisfaction of search. Awareness of pitfalls associated with the diagnosis of PDAC along with the strategies to avoid them will help radiologists to minimize technical and interpretation errors. Cognizance and mitigation of these errors can lead to earlier PDAC diagnosis and ultimately improve patient prognosis.
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Affiliation(s)
- Arya Haj-Mirzaian
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Satomi Kawamoto
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Atif Zaheer
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph H Hruban
- Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda C Chu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Abstract
Pancreatic steatosis is an emerging clinical entity whose pathophysiology, natural history, and long-term complications are poorly characterized in the current literature. Epidemiological and prospective studies have described prevalence rates between 16% and 35%. Although the natural history is not well known, there are strong associations with obesity, metabolic syndrome, type 2 diabetes mellitus, and nonalcoholic fatty liver disease. Ectopic fat accumulation of the pancreas can cause chronic, low-grade inflammation from adipocytokine imbalances that involve beta cells and acinar cells. This mechanism can lead to pancreatic endocrine and exocrine dysfunction and initiate carcinogenesis. Although it is associated with morbid conditions, pancreatic steatosis may be amendable to treatment with a healthy diet, less meat consumption, exercise, and smoking cessation. Pancreatic steatosis should factor into clinical decision-making and prognostication of patients with pancreatic and systemic disease. This review seeks to describe the pathophysiology, natural history, diagnosis, and complications of this emerging clinically relevant entity.
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Abstract
PURPOSE OF REVIEW Pancreatic steatosis is a clinical entity with emerging significance and impacts patient health in a multitude of ways. It has a high prevalence in the global population with predilections for different demographics by age, sex and ethnicity. Understanding the pathophysiology, clinical features and complications of this entity may be important to understanding the consequences of the ongoing obesity global epidemic. RECENT FINDINGS Obesity and metabolic syndrome contribute to metabolic derangements that result in lipid mishandling by adipocytes. Adipocytokine imbalances in circulation and in the pancreatic microenvironment cause chronic, low-grade inflammation. The resulting beta cell and acinar cell apoptosis leads to pancreatic endocrine and exocrine dysfunction. Furthermore, these adipocytokines regulate cell growth, differentiation, as well as angiogenesis and lymphatic spread. These consequences of adipocyte infiltration are thought to initiate carcinogenesis, leading to pancreatic intraepithelial neoplasia and pancreatic ductal adenocarcinoma. SUMMARY Obesity will lead to millions of deaths each year and pancreatic steatosis may be the key intermediate entity that leads to obesity-related complications. Enhancing our understanding may reveal strategies for preventing mortality and morbidity related to the global epidemic of obesity. Further research is needed to determine the pathophysiology, long-term complications and effective treatment strategies for this condition.
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Żendzian-Piotrowska M, Łukaszuk B, Maciejczyk M, Ostrowska L, Zalewska A, Chabowski A, Kurek K. High-fat, high-protein, and high-carbohydrate diets affect sphingolipid profile in pancreatic steatosis in Wistar rats. Nutrition 2019; 60:197-205. [DOI: 10.1016/j.nut.2018.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/23/2018] [Accepted: 10/07/2018] [Indexed: 01/22/2023]
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14
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Zhang L, Sanagapalli S, Stoita A. Challenges in diagnosis of pancreatic cancer. World J Gastroenterol 2018; 24:2047-2060. [PMID: 29785074 PMCID: PMC5960811 DOI: 10.3748/wjg.v24.i19.2047] [Citation(s) in RCA: 347] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/28/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is a growing source of cancer related death, yet has poor survival rates which have not improved in the last few decades. Its high mortality rate is attributed to pancreatic cancer biology, difficulty in early diagnosis and the lack of standardised international guidelines in assessing suspicious pancreatic masses. This review aims to provide an update in the current state of play in pancreatic cancer diagnosis and to evaluate the benefits and limitations of available diagnostic technology. The main modalities discussed are imaging with computed tomography, magnetic resonance imaging, endoscopic ultrasound and positron emission tomography and tissue acquisition with fine needle aspiration. We also review the improvements in the techniques used for tissue acquisition and the opportunity for personalised cancer medicine. Screening of high risk individuals, promising biomarkers and common mimickers of pancreatic cancer are also explored, as well as suggestions for future research directions to allow for earlier detection of pancreatic cancer. Timely and accurate diagnosis of pancreatic cancer can lead to improvements in the current poor outcome of this disease.
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Affiliation(s)
- Lulu Zhang
- Department of Gastroenterology, St. Vincent’s Hospital Sydney, Darlinghurst 2010, NSW, Australia
| | - Santosh Sanagapalli
- Department of Gastroenterology, St. Vincent’s Hospital Sydney, Darlinghurst 2010, NSW, Australia
| | - Alina Stoita
- Department of Gastroenterology, St. Vincent’s Hospital Sydney, Darlinghurst 2010, NSW, Australia
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15
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Torres US, Matsumoto C, de Macedo Neto AC, Caldana RP, Motoyama Caiado ÂH, Tiferes DA, Warmbrand G, de Godoy LL, D’Ippolito G. Common and Uncommon Benign Pancreatic Lesions Mimicking Malignancy: Imaging Update and Review. Semin Ultrasound CT MR 2018; 39:206-219. [DOI: 10.1053/j.sult.2017.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Abstract
Pancreatic ductal adenocarcinoma is the most common primary malignancy of the pancreas. The classic imaging features are a hypovascular mass with proximal ductal dilatation. Different pancreatic pathologies can mimic the imaging appearance of carcinoma including other tumors involving the pancreas (pancreatic neuroendocrine tumors, lymphoma, metastasis, and rare tumors like pancreatic acinar cell carcinoma and solid pseudopapillary tumors), inflammatory processes (chronic pancreatitis and autoimmune pancreatitis), and anatomic variants (annular pancreas). Differentiation between these entities can sometimes be challenging due to overlap of imaging features. The purpose of this article is to describe the common entities that can mimic pancreatic cancer on imaging with illustrative examples and to suggest features that can help in differentiation of these entities.
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17
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Khoury T, Asombang AW, Berzin TM, Cohen J, Pleskow DK, Mizrahi M. The Clinical Implications of Fatty Pancreas: A Concise Review. Dig Dis Sci 2017; 62:2658-2667. [PMID: 28791556 DOI: 10.1007/s10620-017-4700-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 07/27/2017] [Indexed: 12/19/2022]
Abstract
Fatty pancreas is a newly recognized condition which is poorly investigated until today as compared to nonalcoholic fatty liver disease. It is characterized by pancreatic fat accumulation and subsequent development of pancreatic and metabolic complications. Association of fatty pancreas have been described with type 2 diabetes mellitus, acute and chronic pancreatitis and even pancreatic carcinoma. In this review article, we provide an update on clinical implications, pathogenesis, diagnosis, treatment and outcomes.
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Affiliation(s)
- Tawfik Khoury
- Department of Internal Medicine, Department of Gastroenterology and Liver Unit, Hadassah Hebrew University Medical Center, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel.
| | - Akwi W Asombang
- Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
| | - Tyler M Berzin
- Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
| | - Jonah Cohen
- Center of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Dana 501, Boston, MA, 02215, USA
| | - Douglas K Pleskow
- Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
| | - Meir Mizrahi
- Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, USA
- Division of Gastroenterology, Center for Advanced Endoscopy, University of South Alabama, Mobile, AL, USA
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18
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Significance of steatosis in pancreatic transplantation. Transplant Rev (Orlando) 2017; 31:225-231. [PMID: 28855081 DOI: 10.1016/j.trre.2017.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 02/08/2023]
Abstract
The on-going success of whole organ pancreatic transplantation is dependent on overcoming the imbalance between demand and supply of optimal organs as well as tackling the vast comorbidity associated with the procedure. Pancreas steatosis is a common contributing factor to the problem and with obesity pandemics affecting the global population; the size and type of organs received from donors will only make steatosis more of an issue. The aim of this review is to highlight what is known about steatosis in the context of pancreas transplantation identifying potential methods to help its evaluation. Narrative review of literature from inception to June 2017, using OVID interface searching EMBASE and MEDLINE databases as well recent transplant conference data. All studies related to pancreas steatosis examined for clinical relevance with no exclusion criteria. Key ideas extracted and referenced. Pancreatic steatosis is not innocuous and is precariously regarded by transplant surgeons, however its associations with obesity, metabolic syndrome and long list of associated complications clearly show it needs more careful consideration. Radiologic and surgical advances now allow assessment of the fat content of organs, which could be used to quantify organs allowing better optimisation, but there is still much work to be done to refine the optimal method to achieve this.
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19
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Al-Mrabeh A, Hollingsworth KG, Steven S, Tiniakos D, Taylor R. Quantification of intrapancreatic fat in type 2 diabetes by MRI. PLoS One 2017; 12:e0174660. [PMID: 28369092 PMCID: PMC5378354 DOI: 10.1371/journal.pone.0174660] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/13/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Accumulation of intrapancreatic fat may be important in type 2 diabetes, but widely varying data have been reported. The standard quantification by MRI in vivo is time consuming and dependent upon a high level of experience. We aimed to develop a new method which would minimise inter-observer variation and to compare this against previously published datasets. METHODS A technique of 'biopsying' the image to minimise inclusion of non-parenchymal tissues was developed. Additionally, thresholding was applied to exclude both pancreatic ducts and intrusions of visceral fat, with pixels of fat values of <1% or >20% being excluded. The new MR image 'biopsy' (MR-opsy) was compared to the standard method by 6 independent observers with wide experience of image analysis but no experience of pancreas imaging. The effect of the new method was examined on datasets from two studies of weight loss in type 2 diabetes. RESULTS At low levels of intrapancreatic fat neither the result nor the inter-observer CV was changed by MR-opsy, thresholding or a combination of the methods. However, at higher levels the conventional method exhibited poor inter-observer agreement (coefficient of variation 26.9%) and the new combined method improved the CV to 4.3% (p<0.03). Using either MR-opsy alone or with thresholding, the new methods indicated a closer relationship between decrease in intrapancreatic fat and fall in blood glucose. CONCLUSION The inter-observer variation for quantifying intrapancreatic fat was substantially improved by the new method when pancreas fat levels were moderately high. The method will improve comparability of pancreas fat measurement between research groups.
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Affiliation(s)
- Ahmad Al-Mrabeh
- Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kieren G. Hollingsworth
- Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah Steven
- Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Dina Tiniakos
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Roy Taylor
- Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
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20
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Shaaban AM, Rezvani M, Tubay M, Elsayes KM, Woodward PJ, Menias CO. Fat-containing Retroperitoneal Lesions: Imaging Characteristics, Localization, and Differential Diagnosis. Radiographics 2017; 36:710-34. [PMID: 27163589 DOI: 10.1148/rg.2016150149] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The complex anatomy of the retroperitoneum is reflected in the spectrum of neoplastic and nonneoplastic conditions that can occur in the retroperitoneum and appear as soft-tissue masses. The presence of fat within a retroperitoneal lesion is helpful in refining the differential diagnosis. Fat is easily recognized because of its characteristic imaging appearance. It typically is hyperechoic at ultrasonography and demonstrates low attenuation at computed tomography (-10 to -100 HU). Magnetic resonance imaging is a more ideal imaging modality because it has better soft-tissue image contrast and higher sensitivity for depicting (a) microscopic fat by using chemical shift imaging and (b) macroscopic fat by using fat-suppression techniques. Whether a lesion arises from a retroperitoneal organ or from the soft tissues of the retroperitoneal space (primary lesion) is determined by examining the relationship between the lesion and its surrounding structures. Multiple imaging signs help to determine the organ of origin, including the "beak sign," the "embedded organ sign," the "phantom (invisible) organ sign," and the "prominent feeding artery sign." Adrenal adenoma is the most common adrenal mass that contains microscopic fat, while myelolipoma is the most common adrenal mass that contains macroscopic fat. Other adrenal masses, such as pheochromocytoma and adrenocortical carcinoma, rarely contain fat. Renal angiomyolipoma is the most common fat-containing renal mass. Other fat-containing renal lesions, such as lipoma and liposarcoma, are rare. Fatty replacement of the pancreas and pancreatic lipomas are relatively common, whereas pancreatic teratomas are rare. Of the primary retroperitoneal fat-containing lesions, lipoma and liposarcoma are common, while other lesions are relatively rare. (©)RSNA, 2016.
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Affiliation(s)
- Akram M Shaaban
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Maryam Rezvani
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Marc Tubay
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Khaled M Elsayes
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Paula J Woodward
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
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21
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Ünal E, Karaosmanoğlu AD, Akata D, Özmen MN, Karçaaltıncaba M. Invisible fat on CT: making it visible by MRI. Diagn Interv Radiol 2017; 22:133-40. [PMID: 26782156 DOI: 10.5152/dir.2015.15286] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Presence of fat in a lesion significantly narrows the differential diagnosis. Small quantities of macroscopic fat and intracellular fat are invisible on computed tomography (CT) and ultrasonography. Magnetic resonance imaging (MRI) can reveal any fatty change in a lesion and can also differentiate macroscopic fat from intracellular and intravoxel fat. Hypodensity on CT may be a sign of invisible fat and MRI can help to diagnose even minute amounts of fat in liver, pancreas, adrenal, musculoskeletal, and omental pseudolesions and lesions. This article will review the superiority of MRI over CT in demonstrating fat in abdominal lesions.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, Hacettepe University School of Medicine Ankara, Turkey; Department of Radiology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
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22
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Nema D, Arora S, Mishra A. Lipomatous pseudohypertrophy of pancreas with coexisting chronic calcific pancreatitis leading to malabsorption due to exocrine pancreatic insufficiency. Med J Armed Forces India 2016; 72:S213-S216. [PMID: 28050116 DOI: 10.1016/j.mjafi.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Devendra Nema
- Graded Specialist (Radiodiagnosis), Military Hospital, Shillong, C/O 99 APO, India
| | - Sumeet Arora
- Senior Advisor (Radiodiagnosis), 158 Base Hospital, C/O 99 APO, India
| | - Ashutosh Mishra
- Graded Specialist (Medicine), 158 Base Hospital, C/O 99 APO, India
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23
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Catanzaro R, Cuffari B, Italia A, Marotta F. Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease. World J Gastroenterol 2016; 22:7660-7675. [PMID: 27678349 PMCID: PMC5016366 DOI: 10.3748/wjg.v22.i34.7660] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/25/2016] [Accepted: 08/10/2016] [Indexed: 02/06/2023] Open
Abstract
After the first description of fatty pancreas in 1933, the effects of pancreatic steatosis have been poorly investigated, compared with that of the liver. However, the interest of research is increasing. Fat accumulation, associated with obesity and the metabolic syndrome (MetS), has been defined as "fatty infiltration" or "nonalcoholic fatty pancreas disease" (NAFPD). The term "fatty replacement" describes a distinct phenomenon characterized by death of acinar cells and replacement by adipose tissue. Risk factors for developing NAFPD include obesity, increasing age, male sex, hypertension, dyslipidemia, alcohol and hyperferritinemia. Increasing evidence support the role of pancreatic fat in the development of type 2 diabetes mellitus, MetS, atherosclerosis, severe acute pancreatitis and even pancreatic cancer. Evidence exists that fatty pancreas could be used as the initial indicator of "ectopic fat deposition", which is a key element of nonalcoholic fatty liver disease and/or MetS. Moreover, in patients with fatty pancreas, pancreaticoduodenectomy is associated with an increased risk of intraoperative blood loss and post-operative pancreatic fistula.
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24
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Abstract
Pancreatic lipomatosis – also commonly called fat replacement – represents the most frequent benign pathologic condition of the adult pancreas. Most cases remain asymptomatic, and only some rare extreme degrees of lipomatosis or fat replacement may lead to exocrine pancreatic insufficiency. The precise etiology of the entity remains unclear, and the condition has been found associated with several diseases comprising diabetes mellitus, metabolic syndrome, acquired or hereditary pancreatitis, alcoholic hepatitis, cystic fibrosis and condition comprising increasing age, body mass index, or more precisely visceral fat index, and use of steroid therapy. Numerous cases are also associated with condition compromising the permeability of the pancreas ductal system, such as intraductal calculus, pancreatic tumors, and congenital or experimental stenosis. Uneven lipomatosis and fat replacement are also common presentations and responsible for the great diversity of imaging features. The reasons for uneven presentations are controversial and probably interweave embryologic or ductal hypotheses. Lipomatous pseudohypertrophy of the pancreas represents the most extreme situation of pancreatic lipomatosis and is considered, probably in a contestable way, as a rare, specific, and distinct entity. We hereby present an extensive pictorial review of the broad spectrum of imaging features of this entity. The images are extracted from a compilation of cases collected in our department over more than a decade. We review and discuss the embryologic and ductal hypothesis, the differential diagnosis. Finally, we illustrate some unusual presentations and evolutions.
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25
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Chai J, Liu P, Jin E, Su T, Zhang J, Shi K, Hong XU, Yin J, Yu H. MRI chemical shift imaging of the fat content of the pancreas and liver of patients with type 2 diabetes mellitus. Exp Ther Med 2015; 11:476-480. [PMID: 26893633 PMCID: PMC4734085 DOI: 10.3892/etm.2015.2925] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/25/2015] [Indexed: 01/01/2023] Open
Abstract
The present study aimed to investigate the association between the content and distribution of fat in the pancreas and liver in patients with type 2 diabetes mellitus (T2DM). A total of 70 patients newly diagnosed with T2DM (T2DM group) and 30 healthy volunteers (normal control group) were enrolled in the present study. Dual-echo magnetic resonance (MR) chemical shift imaging was used to measure the fat content of the liver and the head, body and tail regions of the pancreas. In addition, the distribution of fat in the various regions of the pancreas, as well as the average fat content of the pancreas versus the liver, were compared. The fat content of the pancreatic head, body and tail regions of the T2DM group were 5.59±4.70, 4.80±3.75 and 4.89±3.86%, respectively. The fat content of these regions in the normal control group were 3.89±2.47, 3.30±2.11 and 3.23±2.23%, respectively. The average fat content of the pancreas was 5.19±3.75% for the T2DM group and 3.47±2.00% for the normal control group. The average fat content of the liver was 9.87±3.19% for the T2DM group and 7.24±2.38% for the normal control group. Therefore, the results from MR chemical shift imaging suggested that there were no significant differences in the distribution of fat between the pancreas of patients newly diagnosed with T2DM and that from the healthy population; however, the average fat content in the pancreas of the T2DM group was significantly higher (F=3.597; P<0.05), as compared with the normal control group. In addition, there was no correlation between the fat contents in the pancreas and liver in patients newly diagnosed with T2DM and the healthy population.
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Affiliation(s)
- Jun Chai
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Peng Liu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Erhu Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Tianhao Su
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jie Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Kaining Shi
- GE Healthcare China, General Electric Company, Beijing 100176, P.R. China
| | - X U Hong
- Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jie Yin
- Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Hengchi Yu
- Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
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26
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Al Ansari N, Ramalho M, Semelka RC, Buonocore V, Gigli S, Maccioni F. Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: An update. World J Radiol 2015; 7:361-374. [PMID: 26644822 PMCID: PMC4663375 DOI: 10.4329/wjr.v7.i11.361] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/27/2015] [Accepted: 10/08/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic ductal adenocarcinoma is the most common malignant tumor of the pancreas. The remaining pancreatic tumors are a diverse group of pancreatic neoplasms that comprises cystic pancreatic neoplasms, endocrine tumors and other uncommon pancreatic tumors. Due to the excellent soft tissue contrast resolution, magnetic resonance imaging (MRI) is frequently able to readily separate cystic from noncystic tumors. Cystic tumors are often easy to diagnose with MRI; however, noncystic non-adenocarcinoma tumors may show a wide spectrum of imaging features, which can potentially mimic ductal adenocarcinoma. MRI is a reliable technique for the characterization of pancreatic lesions. The implementation of novel motion-resistant pulse sequences and respiratory gating techniques, as well as the recognized benefits of MR cholangiopancreatography, make MRI a very accurate examination for the evaluation of pancreatic masses. MRI has the distinctive ability of non-invasive assessment of the pancreatic ducts, pancreatic parenchyma, neighbouring soft tissues, and vascular network in one examination. MRI can identify different characteristics of various solid pancreatic lesions, potentially allowing the differentiation of adenocarcinoma from other benign and malignant entities. In this review we describe the MRI protocols and MRI characteristics of various solid pancreatic lesions. Recognition of these characteristics may establish the right diagnosis or at least narrow the differential diagnosis, thus avoiding unnecessary tests or procedures and permitting better management.
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27
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Kaza RK, Al-Hawary MM, Sokhandon F, Shirkhoda A, Francis IR. Pitfalls in pancreatic imaging. Semin Roentgenol 2015; 50:320-7. [PMID: 26542432 DOI: 10.1053/j.ro.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Ravi K Kaza
- Department of Radiology, University of Michigan Hospitals, Ann Arbor, MI.
| | | | - Farnoosh Sokhandon
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Ali Shirkhoda
- Department of Radiology, University of California School of Medicine, Irvine, CA
| | - Isaac R Francis
- Department of Radiology, University of Michigan Hospitals, Ann Arbor, MI
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28
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Ozbulbul NI, Yurdakul M, Tola M. Does the visceral fat tissue show better correlation with the fatty replacement of the pancreas than with BMI? Eurasian J Med 2015; 42:24-7. [PMID: 25610114 DOI: 10.5152/eajm.2010.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 03/24/2010] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Obesity is a risk factor of fatty replacement of the pancreas. We aimed to investigate whether there is a better correlation between the visceral fat tissue and the fatty infiltration of the pancreas than with the BMI. MATERIALS AND METHODS One hundred-eighteen patients were visually divided into three groups according to the pattern of the fatty infiltration of the pancreas. Group 0 (n=70) has no fatty infiltration, Group 1 (n=23) has fatty infiltration on the head only, and Group 2 (n=25) has fatty infiltration on the entire pancreas. Additionally, the attenuation numbers (HU) were measured separately at the head, body and tail of the pancreas on contrast-enhanced Computed Tomography CT. The sum of the attenuation number of each part of the pancreas was calculated as the attenuation number of the pancreas. A CT-scan was used to calculate the visceral fat area (cm(2)). Correlation coefficients were determined between the visceral fat area and fatty infiltration of the pancreas and the BMI. RESULTS The visceral fat area showed a stronger correlation with the attenuation number of the pancreas than the BMI (r=-0.552, r=-0.345 and p=0.0001, p=0.0001, respectively). The difference existed between the Groups 0 and 1 (p=0.0001) or Groups 0 and 2 (p=0.0001) in terms of visceral fat area. The difference existed only between Group 0 and Group 2 in terms of BMI (p=0.006). CONCLUSIONS The visceral fat tissue area has a stronger correlation than the BMI in the fatty infiltration of the pancreas.
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Affiliation(s)
| | - Mehmet Yurdakul
- Turkiye Yuksek Ihtisas Hospital, Department of Radiology, Ankara, Turkey
| | - Muharrem Tola
- Turkiye Yuksek Ihtisas Hospital, Department of Radiology, Ankara, Turkey
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29
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Mimickers of neoplasm on abdominal and pelvic CT. ACTA ACUST UNITED AC 2014; 40:400-10. [PMID: 25123077 DOI: 10.1007/s00261-014-0216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The radiologist can encounter benign significant imaging findings on computed tomography that can be incorrectly interpreted as neoplasm. The authors review several benign findings and demonstrate several methods to differentiate these findings from more sinister pathology. CONCLUSION It is imperative for the radiologist to be cognizant of and how to correctly identify mimickers of pathology so that unnecessary interventions and surgeries are avoided.
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Kim SY, Kim H, Cho JY, Lim S, Cha K, Lee KH, Kim YH, Kim JH, Yoon YS, Han HS, Kang HS. Quantitative assessment of pancreatic fat by using unenhanced CT: pathologic correlation and clinical implications. Radiology 2014; 271:104-12. [PMID: 24475851 DOI: 10.1148/radiol.13122883] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the relationship between computed tomographic (CT) indexes and histologically measured pancreatic fat in surgical specimens and to evaluate patients with impaired glucose metabolism in a clinical setting. MATERIALS AND METHODS This retrospective study was institutional review board approved and informed consent was waived. The hospital database was searched for records from November 2008 to April 2009, and 62 patients (42 men and 20 women; mean age, 61.4 years; age range, 21-81 years) who underwent CT within 1 month before pancreatectomy were identified. The histologic pancreatic fat fraction (area ratio of fat to total tissue times 100%) was measured in nontumorous pancreatic tissue. Attenuation was measured in three regions of interest in the pancreas and the spleen on nonenhanced CT images. The difference between pancreatic and splenic attenuation and the pancreas-to-spleen attenuation ratio were calculated. Visceral fat area at the level of the umbilicus was measured on the CT images. Spearman correlation coefficients (ρ) were calculated to examine the correlation between the CT indexes or visceral fat area and the histologic pancreatic fat fraction. A multivariate logistic regression model was used to determine whether CT attenuation indexes and patient age, sex, and visceral fat correlated with impaired glucose metabolism (ie, impaired glucose tolerance, impaired fasting glucose, or presence of diabetes). RESULTS The histologic pancreatic fat fraction ranged from 0% to 65.3% and was significantly correlated with the difference between pancreatic and splenic attenuation (ρ = -0.622, P < .01) and the pancreas-to-spleen attenuation ratio (ρ = -0.616, P < .01). The visceral fat area was not correlated with the histologic pancreatic fat fraction (ρ = 0.09, P = .50). The CT attenuation indexes were significant and independent variables predictive of impaired glucose metabolism after adjusting for age, sex, and visceral fat. CONCLUSION Pancreatic fat can be quantified by using CT, and CT attenuation indexes that are applied to the quantification of pancreatic fat are significantly associated with clinical assessment of impaired glucose metabolism.
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Affiliation(s)
- So Yeon Kim
- From the Departments of Radiology (S.Y.K., K.H.L., Y.H.K., H.S.K.), Pathology (H.K.), Surgery (J.Y.C., J.H.K., Y.S.Y., H.S.H.), and Internal Medicine (S.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea; and Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pa (K.C.)
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Pokharel SS, Macura KJ, Kamel IR, Zaheer A. Current MR imaging lipid detection techniques for diagnosis of lesions in the abdomen and pelvis. Radiographics 2014; 33:681-702. [PMID: 23674769 DOI: 10.1148/rg.333125068] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
One application of the unique capability of magnetic resonance (MR) imaging for characterizing soft tissues is in the specific detection of lipid. Adipose tissue may be abundant in the body, but its presence in a lesion can greatly limit differential diagnostic considerations. This article reviews MR imaging fat detection techniques and discusses lesions in the abdomen and pelvis that can be readily diagnosed by using these techniques. Traditional fat detection methods include inversion-recovery and chemically selective fat-suppression pulse sequences, with the former being less sensitive to field heterogeneity and less tissue specific than the latter. Chemical shift-based sequences, which exploit the inherent resonance frequency difference between lipid and water to depict intracytoplasmic fat, have great utility for evaluating hepatic steatosis and lesions such as adrenal and hepatic adenomas, hepatocellular carcinoma, focal lipomatosis of the pancreas, and adrenal cortical carcinoma. The signal from large amounts of fat can be suppressed by using a narrow radiofrequency pulse for selective excitation of fat protons (ie, fat saturation imaging), a technique that increases image contrast resolution and highlights lesions such as contrast-enhancing tissue, edema, and blood products. This technique is especially useful for evaluating renal angiomyolipomas, adrenal myelolipomas, ovarian teratomas, and liposarcomas. MR spectroscopy is a promising method for quantifying absolute liver fat concentration and changes in hepatic triglyceride content during treatment. New and evolving techniques include magnetization transfer and modified Dixon sequences. A solid understanding of these techniques will help improve the interpretation of abdominal and pelvic imaging studies.
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Affiliation(s)
- Sajal S Pokharel
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD 21287, USA
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Ishikawa D, Shimada M, Utsunomiya T, Morine Y, Imura S, Ikemoto T, Mori H, Arakawa Y, Kanamoto M, Iwahashi S, Yamada S, Asanoma M. Atypically large well-differentiated hepatocellular carcinoma with extensive fatty metamorphosis: report of a case. THE JOURNAL OF MEDICAL INVESTIGATION 2013; 60:267-71. [PMID: 24190046 DOI: 10.2152/jmi.60.267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A large well-differentiated hepatocellular carcinoma (HCC) with fatty change is rare, and to date only a few cases have been reported. Herein, we present a 68-year-old man who developed a well-differentiated HCC with extensive fatty metamorphosis. The patient was referred to our institute because of a rapidly growing tumor in the left lobe of the liver. Ultrasonography showed a hyperechoic lesion with a peripheral hypoechoic area. Dynamic contrast-enhanced computed tomography (CT) scan in all three phases revealed the tumor which showed diffuse low attenuation with internal irregular enhancement. He underwent left lateral segmentectomy at the liver. Histological diagnosis confirmed well-differentiated HCC and the surrounding non-cancerous area was diagnosed as non-alcoholic steatohepatitis. The patient is still alive without recurrence after 17 months of follow-up.
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Patel NS, Peterson MR, Brenner DA, Heba E, Sirlin C, Loomba R. Association between novel MRI-estimated pancreatic fat and liver histology-determined steatosis and fibrosis in non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2013; 37:630-9. [PMID: 23383649 PMCID: PMC4136524 DOI: 10.1111/apt.12237] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 11/17/2012] [Accepted: 01/18/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ectopic fat deposition in the pancreas and its association with hepatic steatosis have not previously been examined in patients with biopsy-proven non-alcoholic fatty liver disease (NAFLD). AIM To quantify pancreatic fat using a novel magnetic resonance imaging (MRI) technique and determine whether it is associated with hepatic steatosis and/or fibrosis in patients with NAFLD. METHODS This is a cross-sectional study including 43 adult patients with biopsy-proven NAFLD who underwent clinical evaluation, biochemical testing and MRI. The liver biopsy assessment was performed using the NASH-CRN histological scoring system, and liver and pancreas fat quantification was performed using a novel, validated MRI biomarker; the proton density fat fraction. RESULTS The average MRI-determined pancreatic fat in patients with NAFLD was 8.5% and did not vary significantly between head, body, and tail of the pancreas. MRI-determined pancreatic fat content increased significantly with increasing histology-determined hepatic steatosis grade; 4.6% in grade 1; 7.7% in grade 2; 13.0% in grade 3 (P = 0.004) respectively. Pancreatic fat content was lower in patients with histology-determined liver fibrosis than in those without fibrosis (11.2% in stage 0 fibrosis vs. 5.8% in stage 1-2 fibrosis, and 6.9% in stage 3-4 fibrosis, P = 0.013). Pancreatic fat did not correlate with age, body mass index or diabetes status. CONCLUSIONS In patients with NAFLD, increased pancreatic fat is associated with hepatic steatosis. However, liver fibrosis is inversely associated with pancreatic fat content. Further studies are needed to determine underlying mechanisms to understand if pancreatic steatosis affects progression of NAFLD.
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Affiliation(s)
- N S Patel
- Division of Internal Medicine, Department of Medicine, University of California, San Diego, CA, USA
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34
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Holalkere NS, Soto J. Imaging of miscellaneous pancreatic pathology (trauma, transplant, infections, and deposition). Radiol Clin North Am 2012; 50:515-28. [PMID: 22560695 DOI: 10.1016/j.rcl.2012.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this article's coverage of miscellaneous pancreatic topics, a brief review of pancreatic trauma; pancreatic transplantation; rare infections, such as tuberculosis; deposition disorders, including fatty replacement and hemochromatosis; cystic fibrosis; and others are discussed with pertinent case examples.
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Affiliation(s)
- Nagaraj-Setty Holalkere
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA.
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35
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Low G, Panu A, Millo N, Leen E. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics 2012; 31:993-1015. [PMID: 21768235 DOI: 10.1148/rg.314105731] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Solid lesions of the pancreas represent a heterogeneous group of entities that can be broadly classified as either neoplastic or nonneoplastic. Neoplastic lesions include pancreatic adenocarcinoma, pancreatic neuroendocrine tumor, solid pseudopapillary tumor, pancreatoblastoma, pancreatic lymphoma, metastases to the pancreas, and rare miscellaneous neoplasms. Nonneoplastic lesions include focal pancreatitis, fatty infiltration-replacement, intrapancreatic accessory spleen, congenital anomalies such as prominent pancreatic lobulation and bifid pancreatic tail (pancreatic bifidum), and rare miscellaneous lesions (eg, pancreatic sarcoidosis, Castleman disease of the pancreas). A variety of imaging modalities are available for assessing these solid lesions, including ultrasonography (US), computed tomography (CT), magnetic resonance imaging, endoscopic US, and hybrid nuclear imaging techniques such as single photon emission computed tomography-CT and positron emission tomography-CT, each of which has its own strengths and limitations. Accurate diagnosis can be challenging, and use of a multimodality imaging approach is often helpful in equivocal or complex cases. Knowledge of relevant clinical information and key radiologic features is essential for confident lesion characterization and differentiation.
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Affiliation(s)
- Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB, Canada.
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Abstract
Understanding pancreatic development and the congenital anomalies and variants that result from alterations in normal development allows for better recognition of these anomalies at diagnostic imaging. This article reviews normal pancreatic embryology and anatomy, and the appearance of the more common developmental anomalies and ductal variants, with emphasis on computed tomography and magnetic resonance imaging. Common mimics of masses are also covered.
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Affiliation(s)
- Lauren F Alexander
- Department of Radiology, University of Alabama - Birmingham, 619 19th Street South, JTN355B, Birmingham, AL 35249-6830, USA.
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Rossi AP, Fantin F, Zamboni GA, Mazzali G, Zoico E, Bambace C, Antonioli A, Pozzi Mucelli R, Zamboni M. Effect of moderate weight loss on hepatic, pancreatic and visceral lipids in obese subjects. Nutr Diabetes 2012; 2:e32. [PMID: 23449531 PMCID: PMC3341708 DOI: 10.1038/nutd.2012.5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To compare the effects of weight loss on visceral and subcutaneous abdominal fat, liver and pancreas lipid content and to test the effects of these changes on metabolic improvement observed after weight loss. DESIGN Weight-loss program designed to achieve a loss of 7-10% of the initial weight. SUBJECTS 24 obese subjects (13 males and 11 females) with age ranging from 26 to 69 years and body mass index (BMI) 30.2-50.5 kg m(-2). MEASUREMENTS weight, BMI, waist circumference, body composition as assessed by dual-energy X-ray absorptiometry, metabolic variables, leptin, adiponectin, visceral and subcutaneous abdominal fat, liver and pancreas lipid content as assessed by magnetic resonance were evaluated before and after weight loss achieved by hypocaloric diet. RESULTS After a mean body weight decrease of 8.9%, BMI, waist circumference, fat mass, all metabolic variables, homeostasis model assessment of insulin resistance (HOMA), alanine amino transferase, gamma glutamyl transpeptidase, high-sensitivity C-reactive protein (hs-CRP) and leptin, but not adiponectin and high-density lipoprotein-cholesterol, significantly decreased (all P<0.01). Visceral and subcutaneos abdominal fat, liver and pancreas lipid content significantly decreased (all P<0.01). Percent changes in liver lipid content were greater (84.1±3%) than those in lipid pancreas content (42.3±29%) and visceral abdominal fat (31.9±15.6%). After weight loss, percentage of subjects with liver steatosis decreased from 75 to 12.5%. Insulin resistance improvement was predicted by changes in liver lipid content independently of changes in visceral fat, pancreas lipid content, systemic inflammation, leptin and gender. CONCLUSION Moderate weight loss determines significant decline in visceral abdominal fat, lipid content in liver and pancreas. Reduction of liver lipid content was greater than that of pancreas lipid content and visceral fat loss. Liver lipid content is the strongest predictor of insulin resistance improvement after weight loss.
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Affiliation(s)
- A P Rossi
- Department of Medicine, Division of Geriatrics, University of Verona, Verona, Italy
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Kani KK, Moshiri M, Bhargava P, Kolokythas O. Extrahepatic, Nonneoplastic, Fat-Containing Lesions of the Abdominopelvic Cavity: Spectrum of Lesions, Significance, and Typical Appearance on Multidetector Computed Tomography. Curr Probl Diagn Radiol 2012; 41:56-72. [DOI: 10.1067/j.cpradiol.2011.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Balthazar EJ. CT contrast enhancement of the pancreas: patterns of enhancement, pitfalls and clinical implications. Pancreatology 2012; 11:585-7. [PMID: 22237258 DOI: 10.1159/000335130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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40
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Rossi AP, Fantin F, Zamboni GA, Mazzali G, Rinaldi CA, Del Giglio M, Di Francesco V, Barillari M, Pozzi Mucelli R, Zamboni M. Predictors of ectopic fat accumulation in liver and pancreas in obese men and women. Obesity (Silver Spring) 2011; 19:1747-54. [PMID: 21593811 DOI: 10.1038/oby.2011.114] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
UNLABELLED The aim of the present study was to determine the relationship between body fat distribution, adipocytokines, inflammatory markers, fat intake and ectopic fat content of liver and pancreas in obese men and women. A total of 12 lean subjects (mean age 47.25 ± 14.88 years and mean BMI 22.85 ± 2), 38 obese subjects (18 men and 20 women) with mean age 49.1 ± 13.0 years and mean BMI 34.96 ± 4.21 kg/m2 were studied. MEASUREMENTS weight, height, BMI, waist circumference, as well as glucose, insulin, HOMA (homeostasis model assessment of insulin resistance), cholesterol, triglycerides, high-density lipoprotein cholesterol, high sensitivity C-reactive protein, daily energy intake, leptin, and adiponectin. Magnetic resonance was used to evaluate visceral, subcutaneous adipose tissue (SCAT) as well as liver and pancreas lipid content using in-phase and out-of-phase magnetic resonance imaging (MRI) sequence. Obese subjects had significantly higher weight, waist circumference, SCAT, deep SCAT, visceral adipose tissue (VAT), liver and pancreatic lipid content than lean subjects. Obese women had significantly lower VAT, liver and pancreas lipid content regardless of same BMI. In multiple regression analyses, the variance of liver lipid content explained by gender and VAT was 46%. When HOMA was added into a multiple regression, a small increase in the proportion of variance explained was observed. A 59.2% of the variance of pancreas lipid content was explained by gender and VAT. In conclusion, obese men show higher VAT and ectopic fat deposition in liver and pancreas than obese women despite same BMI. Independent of overall adiposity, insulin resistance, adiponectin and fat intake, VAT, measured with MRI, is the main predictor of ectopic fat deposition in both liver and pancreas.
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Affiliation(s)
- Andrea P Rossi
- Department of Biomedical and Surgical Science, Division of Geriatric Medicine, University of Verona, Verona, Italy.
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41
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Part 2: CT characterisation of pancreatic neoplasm: tumour mimics. Insights Imaging 2011; 2:389-397. [PMID: 22347960 PMCID: PMC3259386 DOI: 10.1007/s13244-011-0103-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 02/28/2011] [Accepted: 05/04/2011] [Indexed: 12/18/2022] Open
Abstract
There are numerous pancreatic and peripancreatic conditions that can mimic pancreatic neoplasms. Many of these can be confidently diagnosed on computed tomography (CT), while others will require further imaging. Knowledge of these tumour mimics is important to avoid misclassification of benign conditions as malignant and to avoid unnecessary surgery. Mimics can be grouped as parenchymal, vascular, biliary and peripancreatic. These are discussed and illustrated in this review.
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Diagnostic performance and accuracy of 3-D spoiled gradient-dual-echo MRI with water- and fat-signal separation in liver-fat quantification: comparison to liver biopsy. Invest Radiol 2011; 45:465-70. [PMID: 20479652 DOI: 10.1097/rli.0b013e3181da1343] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To prospectively evaluate a 3-dimensional spoiled gradient-dual-echo (3D SPGR-DE) magnetic resonance imaging (MRI) sequence for the qualitative and quantitative analysis of liver fat content (LFC) in patients with the suspicion of fatty liver disease using histopathology as the standard of reference. MATERIALS AND METHODS Thirty-four adult patients (15 women; mean age, 67 +/- 13 years) underwent hepatic 1.5-Tesla 3D SPGR-DE MRI including in-/out-of-phase (IP/OP) and fat-only sequences prior to hepatic surgery with biopsy. Histopathological analyses of total and macrovesicular LFC could be made from biopsies of 39 segments in 23 patients. Two radiologists independently classified steatosis visually using a 4-point scale for IP/OP and fat-only images. Additionally, fat signal fractions (FSF) were calculated from signal intensities on IP/OP (FSF(ip/op)) and fat-only images (FSF(fat-only)). Pearson correlation analysis and Student t test were used to study the relationship between the FSF and LFC as determined by histopathology. The accuracy of MRI in detecting pathologically elevated LFC was assessed by receiver operating characteristic analysis. RESULTS Histopathology revealed steatosis in 29/39 (74%) segments in 15/23 patients (65%), with a total LFC ranging from <5% to 90%. Inter-reader agreement for visual steatosis grading was moderate (k = 0.53) for IP/OP images and good (k = 0.68) for fat-only images. FSF calculated from IP/OP and fat-only images significantly correlated with LFC from histopathology (both, P < 0.0001). Mean FSF(fat-only) and FSF(ip/op) values significantly differed from total LFC (both, P < 0.0001), whereas mean FSF(fat-only) showed no significant differences to macrovesicular LFC (P = 0.46). Both FSF(fat-only) and FSF(ip/op) performed accurately in discriminating between normal LFC and elevated LFC according to histopathology with good diagnostic accuracy (AUC: 0.85; 95% CI: 0.73-0.89 vs. AUC 0.90, 95% CI: 0.7-1.00). CONCLUSIONS FSF(fat-only) and FSF(ip/op) derived from 3D SPGR-DE MRI mostly reflect the macrovesicular as opposed to the total LFC from histopathology, whereas both discriminate healthy and fatty liver. Analysis of fat-only images improves interreader-agreement for visual liver steatosis grading.
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Li J, Xie Y, Yuan F, Song B, Tang C. Noninvasive quantification of pancreatic fat in healthy male population using chemical shift magnetic resonance imaging: effect of aging on pancreatic fat content. Pancreas 2011; 40:295-299. [PMID: 21178651 DOI: 10.1097/mpa.0b013e318201669f] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study was aimed to establish a database of pancreatic fat fractions for healthy men aged 20 to 70 years using double-echo chemical shift gradient-echo magnetic resonance imaging. METHODS The double-echo chemical shift gradient-echo magnetic resonance imaging technique was used in this study. A phantom of fat-water mixtures was established to test the accuracy of the sequence. In addition, 126 healthy male volunteers (20-70 years, body mass index ≤ 25) were enrolled. Fat content of the pancreas (head, body, and tail) was examined. RESULTS On the phantom, a significant positive linear correlation and linear regression was found between the calculated and actual fat fractions of fat emulsions. For volunteers, there was no significant difference regarding fat fractions among the 3 regions of pancreata in each age group (P > 0.05). Pancreatic fat fraction (6.32% ± 1.18%) of healthy men aged 50 to 70 years was approximately 1-fold higher than that (2.8% ± 0.66%) of those aged 20 to 50 years (P < 0.01). CONCLUSIONS Double-echo chemical shift gradient-echo magnetic resonance imaging is useful for quantifying pancreatic fat fraction. This noninvasive technique has revealed (1) an even distribution of pancreatic fat in healthy men, (2) aging as an independent risk factor for pancreatic steatosis, and (3) the increase in pancreatic fat fraction beginning in the fifth decade.
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Affiliation(s)
- Jing Li
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Abstract
More research is now focused on pancreatic steatosis. Multiple definitions, clinical associations and synonyms for pancreatic steatosis are described in the literature and can be confusing. The integration and comparison of several studies concerning this topic is therefore challenging. In the past, pancreatic steatosis was considered an innocuous condition, a bystander of many underlying diseases (such as congenital syndromes, hemochromatosis and viral infection). However, evidence that pancreatic steatosis (strongly associated with obesity and the metabolic syndrome) has a role in type 2 diabetes mellitus, pancreatic exocrine dysfunction, acute pancreatitis, pancreatic cancer and the formation of pancreatic fistula after pancreatic surgery is emerging. This Review focuses on the different etiological factors and the clinical consequences of pancreatic steatosis.
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Affiliation(s)
- Mark M Smits
- Department of Gastroenterology & Hepatology, Vrije Universiteit University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
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Abstract
Total fat replacement of the pancreas is rare. Focal fatty replacement is the most common degenerative lesion of pancreas. Focal fatty deposits have no major clinical significance; however, extreme fat replacement is of pathologic significance, as it is associated with marked reduction in exocrine function of pancreas, resulting in malabsorption due to pancreatic enzyme insufficiency.
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Affiliation(s)
- Rama Anand
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi-110 001, India
| | - Mahender K. Narula
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi-110 001, India
| | - Vikas Chaudhary
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi-110 001, India
- ESIC Model Hospital, Gurgaon-122 001, Haryana, India
| | - Rohini Agrawal
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi-110 001, India
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Metabolic syndrome and ectopic fat deposition: what can CT and MR provide? Acad Radiol 2010; 17:1302-12. [PMID: 20605492 DOI: 10.1016/j.acra.2010.03.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 03/26/2010] [Accepted: 03/29/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Metabolic syndrome affects 20-30% of adults and is increasing in prevalence, making it a leading public health issue. Radiologists often encounter images of obese patients during routine studies and are in a unique position to address the importance of excess fat and need to be aware of the spectrum of pathologic consequences in different organ systems. In this review, the role of CT and MR imaging in assessment of patients with metabolic syndrome will be reviewed and the constellation of structural and functional changes in the major affected organ systems due to ectopic fatty deposition will be discussed. METHODS We specifically discuss the pathophysiology of metabolic syndrome, visceral versus subcutaneous obesity, cardiac lipomatosis, nonalcoholic fatty liver disease, nonalcoholic fatty pancreas disease, and fat deposition in other organs. CONCLUSION Many of the multisystem manifestations of metabolic syndrome can be visualized on routine CT and MR images and radiologists can provide clinicians with important data regarding anatomic and pathologic distribution of fat in different organs. Perhaps the visualization of the fatty changes will provide tangible evidence to motivate patients to begin lifestyle modification.
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Temizoz O, Genchellac H, Unlu E, Kantarci F, Umit H, Demir MK. Incidental pancreatic lipomas: computed tomography imaging findings with emphasis on diagnostic challenges. Can Assoc Radiol J 2010; 61:156-61. [PMID: 20350800 DOI: 10.1016/j.carj.2010.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 01/08/2010] [Accepted: 01/12/2010] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of this study was to describe the computed tomography (CT) findings of pancreatic lipomas of 9 cases, with emphasis to diagnostic challenges. METHODS Between March 2006 and April 2008, 9 patients with pancreatic lipomas that were diagnosed by CT were reviewed in the present study. Clinical data and CT features of these 9 cases were retrospectively analysed. The patient population included 5 men and 4 women, aged 42-81 years (mean age, 65.8 years). The patients were followed up for at least 2 years with control CTs. RESULTS In all 9 cases, a well-bordered nodular fat density lesion was incidentally detected in the pancreas. Four of the lesions had a lobulated contour, and 2 of them had septations. Two of the lipomas were located in the head, 3 in the neck, 3 in the corpus, and 1 in the tail. The CT densitometric values were between -90 and -120 HU, with a mean value of -106 HU. No pancreatic or biliary dilatation or compression to the adjacent structures was seen. All the cases had control CTs, and the lipomas remained unchanged during the follow-up period. Histopathologic confirmation of the diagnosis was not planned for the cases. CONCLUSION Lipomas are rarely encountered in the pancreas. They often are diagnosed coincidentally as small, well-circumscribed, encapsulated, homogeneous, mature adipose masses on imaging studies. Imaging follow-up strategy or histopathologic confirmation is not necessary in asymptomatic patients.
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Affiliation(s)
- Osman Temizoz
- Department of Radiology, Trakya University Faculty of Medicine, Edirne, Turkey.
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Cha SW, Kim SH, Lee HI, Lee YJ, Yang HW, Jung SH, Kim A, Lee MK, Han HY, Kang DW. Pancreatic pseudocyst filled with semisolid lipids mimicking solid mass on endoscopic ultrasound. World J Gastroenterol 2010; 16:1034-8. [PMID: 20180247 PMCID: PMC2828592 DOI: 10.3748/wjg.v16.i8.1034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pancreatic pseudocysts, which account for 70%-90% of pancreatic cystic lesions, characteristically are non-epithelially lined cystic cavities that are contiguous with the pancreas. Pancreatic pseudocysts can be caused by acute, chronic or traumatic pancreatitis and should be differentiated from other pancreatic diseases with cystic appearances, especially cystic neoplasms. We report a unique case of a pancreatic pseudocyst filled with semisolid lipids, which appeared by endoscopic ultrasound as a solid mass, and was therefore resected.
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Makay O, Kazimi M, Aydin U, Nart D, Yilmaz F, Zeytunlu M, Goker E, Coker A. Fat replacement of the malignant pancreatic tissue after neoadjuvant therapy. Int J Clin Oncol 2010; 15:88-92. [PMID: 20091080 DOI: 10.1007/s10147-009-0001-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 04/01/2009] [Indexed: 01/09/2023]
Abstract
Pancreatic lipomatosis is characterized as massive lipid infiltration of the pancreatic tissue. Although its etiology is ill defined; obesity, diabetes mellitus, chronic pancreatitis, hereditary pancreatitis, and conditions that cause pancreatic ductal obstruction, for example tumors and stones, are related to its pathogenesis. Recently, with the increased use of computerized tomography and magnetic resonance imaging, it has become possible to observe the fat replacement of the pancreas. Herein, we report a 60-year-old man complaining of abdominal pain and weight loss. Preoperative work-up revealed a locally advanced (Stage III) pancreatic adenocarcinoma. Multimodal treatment was carried out and a 100% complete response was detected after neoadjuvant therapy. The patient underwent a standard pancreaticoduodenectomy, without complications. The tissue pathology revealed lipomatosis of the pancreas. He was disease-free and symptom-free at 1 year follow-up. To our knowledge, this is the first report in the literature of pancreatic head carcinoma with total fat replacement of the pancreas after neoadjuvant chemoradiotherapy.
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Affiliation(s)
- Ozer Makay
- Department of General Surgery, Ege University School of Medicine, Izmir, Turkey.
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Yang DM, Kim HC, Ryu JK, Joo KR, Ahn KJ. Sonographic appearance of focal fatty infiltration of the pancreas. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:45-47. [PMID: 19790258 DOI: 10.1002/jcu.20632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report the sonographic, CT, and MRI findings in a case of focal fatty infiltration of the pancreas. Sonography revealed an echogenic mass in pancreas head. On CT, the mass was hypodense. The mass showed same signal intensity to the surrounding normal pancreas on in-phase T1-weighted MR images and a loss of signal intensity on opposed-phase MR images.
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Affiliation(s)
- Dal Mo Yang
- Department of Radiology and Internal Medicine, Kyung Hee University East-West Neo Medical Center, Gangdong-Gu, Seoul, South Korea
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