Anatomical and computed tomographic studies of the pancreatic tail

The location of the pancreatic tail in the lienorenal ligament and its relationship to the splenic hilus were studied in 32 computed tomography (CT) scannings and in 37 autopsy specimens. We found several anatomical variations in both study groups: the pancreatic tail did not penetrate the lienorenal ligament in 24% of the autopsy specimens and in 37.5% of the CT group. The tail was adjacent to the splenic hilus in 29.7% of the autopsies and in 25% of the CT group. We classified the anatomical variations into 4 categories, three of which could be well demonstrated on CT with satisfactory correlation to the anatomical findings of the autopsy specimens.     

低剂量灌注CT成像诊断胰腺癌的研究进展

随着MSCT的不断发展以及检查技术的不断完善,胰腺疾病的诊断率也不断进步。CT可以对胰腺进行普通平扫、多期增强扫描及CT灌注扫描(CTPI)。其中,普通平扫及增强扫描对小的胰腺癌病灶诊断率较低;普通灌注扫描可以通过监测胰腺组织血流动力学评价胰腺功能,对于早期胰腺癌的诊断率较高,但辐射剂量也较高,因此对患者的远期影响较大。因此,在满足对胰腺癌疾病诊断条件的前提下,减少CT扫描对患者的辐射剂量是目前临床研究的热点。灌注扫描通过监测患者血流量(BF)、血容量(BV)对正常胰腺及胰腺癌病灶进行观察,能够在减少辐射剂量的同时获得灌注数据,从而提供更多的诊断信息,进而满足临床诊断的要求。     

Prospective comparison of three non-invasive tests for pancreatic disease.

Ultrasonography, computed tomography (CT), and an oral pancreatic function test were evaluated prospectively in 107 consecutive patients suspected of having pancreatic disease, the final diagnosis being made independently of these tests. Seventeen patients proved to have either chronic pancreatitis or a pancreatic neoplasm. Five had an unfused ventral pancreas and 10 had "minimal change" pancreatograms. Seventy five patients did not have pancreatic disease. Among the 17 patients with pancreatic disease the sensitivities of ultrasound, CT, and the pancreatic function test were 70%, 71%, and 76% respectively; among those without disease values of specificity of the three tests were 75%, 87%, and 72%. All three tests failed to detect most of the patients with unfused ventral pancreases or minimal change pancreatograms. The predictive values of a positive result for the three tests were 43%, 67%, and 34%. The predictive value of a negative result was greater than 90% for all the tests. Results improved when CT was combined with either of the two other tests. These findings show that CT is the most accurate of the three tests in diagnosing pancreatic disease but that a combination of ultrasound and the oral pancreatic function test offers a more widely applicable and almost as accurate alternative.     

多层螺旋CT在胰腺癌中的诊断价值

目的:探讨多层螺旋CT在胰腺癌中的诊断价值。方法:回顾性分析2017年2月至2019年2月我院接诊的72例经过手术病理证实的胰腺癌患者。比较多排螺旋CT平扫、动脉期、胰腺期、门脉期的检出率、神经、血管浸润情况、及选择55例正常胰腺组织比较两者多层螺旋CT扫描密度值的差异。结果:多层螺旋CT扫描,平扫、动脉期、胰腺期、门脉期检出率分别为63.89%、77.78%、95.83%、90.28%,胰腺期、门脉期检出率均显著高于平扫、动脉期(P<0.05);多层螺旋CT增强扫描诊断胰腺癌神经浸润的准确性为80.56%(58/72),敏感性为91.07%(51/56),特异性为43.75%(7/16),阳性预测值85.00%(51/60),阴性预测值58.33%(7/12);多层螺旋CT增强扫描诊断胰腺癌血管浸润的准确性为95.83%(69/72),敏感性为80.00%(8/10),特异性为98.39%(61/62),阳性预测值88.89%(8/9),阴性预测值96.83%(61/63);胰腺癌组织多层螺旋CT扫描密度值均显著高于正常胰腺组织密度值,(P<0.05)。结论:多排螺旋CT在胰腺癌中诊断价值高,可帮助临床提供正确诊断,以选择合适的治疗方案。     

非典型局限性胰腺脂肪沉积的CT诊断

目的:研究探讨CT扫描检查对非典型局限性胰腺脂肪沉积的应用价值。方法:选择2013年1月~2016年12月期间我院消化内科收治的非典型局限性胰腺脂肪沉积患者42例为观察组,同时期在本院进行健康体检的50例正常人群为对照组。比较两组受试者的CT扫描检查结果。结果:观察组患者在普通CT结果显示胰腺形态和大小未改变,胆总管无扩张现象,增强CT扫描显示胰腺内有均匀的低密度影出现。观察组增强CT的动脉、静脉、延时期的扫描值分别为(68.19±2.01)、(44.34±3.52)、(36.28±4.96),对照组分别为(90.39±4.67)、(83.37±6.02)、(66.08±5.91),组间比较有显著差异性(P0.05)。结论:采用普通CT结合增强CT扫描检查可以准确诊断非典型局限性胰腺脂肪沉积的发病,能够较好的对该病作出诊断与鉴别诊断,但应注意与其他胰腺疾病进行鉴别区分。     

Management of necrotizing pancreatitis.

A comprehensive management plan is presented for patients with severe acute pancreatitis. These patients may have pancreatic or peripancreatic necrosis or pancreatic fluid collections. Multiple organ failure often develops in patients with severe pancreatitis. We therefore recommend that all patients with acute pancreatitis be evaluated for pancreatic anatomy and function. If a patient is seriously ill, a computed tomographic (CT) scan with vascular enhancement should be done. Meanwhile, vigorous fluid replacement is necessary using Swan-Ganz monitoring. Patients with necrosis do not need surgical intervention unless the clinical course or CT scan-guided aspiration shows infection. The objective of an operation should be to remove all infected tissue and fluid. A preoperative CT scan with vascular enhancement should be used as a guide during the operation to ensure that all foci of infected necrosis or fluid are eliminated. We have found that open packing and irrigation with sodium oxychlorosene are helpful in patients with extensive necrosis or those who become infected early after the onset of symptoms. In all, 40% to 50% of patients treated by closed drainage will require reoperation because of incomplete debridement. Persistent sepsis is an indication for reoperation.     

Pancreatic fine needle aspiration. A comparison of computed tomographic and endoscopic ultrasonographic guidance

OBJECTIVE: To compare the sensitivity and specificity of pancreatic fine needle aspiration (FNA) with computed tomography (CT) and endoscopic ultrasound (EUS) guidance. STUDY DESIGN: A 6-year retrospective review included 137 pancreatic FNAs (CT 51, magnetic resonance imaging 2 or EUS 84). Clinical or histologic follow-up was available for 110 patients. RESULTS: Positive (POS), suspicious (SUS), atypical, negative and unsatisfactory (UNSAT) results represented 25.5%, 7.3%, 7.3%, 40.1% and 19.1% of reported diagnoses, respectively. In detecting malignancy, the sensitivities of POS/SUS results were 71% and 42% for CT and EUS, respectively, with negative predictive value (NPV) of 41% and 45%. Also, 35% of UNSAT results were found to have malignancy. However, EUS was used on more difficult lesions, including 82% of small, cystic ones and 75% of small, solid ones. CONCLUSION: Although the apparent performance of percutaneous CT-guided biopsies surpasses that of EUS, this is due to the choice of endoscopy for more difficult lesions. The specificity and negative predictive value of EUS and CT are similar.     

Percutaneous ultrasonography and computed tomography guided pancreatic cryoablation: Feasibility and safety assessment

Objective

To assess the safety and feasibility of percutaneous cryoablation on pancreatic cancer via ultrasonography (US) and computed tomography (CT) guidance.

Materials and methods

This retrospective review was approved by the institutional review board and of informed consent. Thirty-two patients (18 men and 14 women; median age 62; age range, 30–77 years) with pancreatic cancer (stage II/III/IV, 3/11/18) treated with percutaneous US and CT guided cryoablations between February 2009 and February 2010 were eligible for this review. Thirteen tumors in pancreatic head and 19 in pancreatic body and/or tail measuring 2–11 cm (mean, 5.2 cm ± 8 [standard deviation]) were ablated with 49 procedures in total. Feasibility was analyzed by enhanced CT 1–3 months post procedure and safety was assessed by clinical signs, symptoms and laboratory results.

Results

Neither procedural death nor serious complications occurred. Fifteen tumors (46.9%) smaller than 5 cm were successfully ablated by one session of cryoablation. Twenty-seven patients experienced a ?50% reduction in pain score, 22 experienced a 50% decrease in analgesic consumption and 16 experienced a ?20 increase in Karnofsky Performance Status (KPS) Score. Partial response (PR) and stable disease (SD) turned up in 9 and 21 patients, respectively, lesions in whom were identified controlled by none enhancement on enhanced CT. Mean and median survival was 15.9 and 12.6 months, respectively. The 6-, 12- and 24-month survival rates were 82.8%, 54.7% and 27.3%, respectively.

Conclusion

US and CT guided percutaneous cryoablation is a safe and promising local treatment for pancreatic cancer.     

CT诊断用于胰腺癌侵犯胰周动静脉的临床价值分析

目的：探究CT诊断对于胰腺癌侵犯胰周动静脉的临床价值。方法：随机选取在我院就诊的64例胰腺癌患者,在他们进行手术前全在距离肿瘤边缘1cm内的血管进行分期和诊断进而进行螺旋CT检查。结果：经组织学术后病理切片染色发现胰周动脉29条,静脉48条。运用外科手术探查方法发现86条胰周动脉,89条胰周静脉。在这些血管中,有23条动脉、47条静脉经外科手术证实的确是肿瘤侵犯,并且经过CT诊断,我们最终断定为有25条动脉、46条静脉处于1～4级。结论：胰周动、静脉受到侵犯时,具有不同的CT表现特征,因此在利用CT方法判断胰周动、静脉遭受侵犯时应当根据不同情况不同对待。     

Computed tomography in the diagnosis of mechanic jaundice complicated with diseases of the distal common bile duct]

Computerized tomography (CT) is a noninvasive indirect method of instrumental investigation for imaging the liver, bile ducts and the adjacent organs. CT enables one to confirm objectively the mechanical nature of jaundice, to assess a degree and level of involvement of the biliary tract, to assess the nature and spreading of disease. CT sensitivity for the diagnosis of pancreatic head cancer was 78.8%, specificity-91.3%, that for choledocholithiasis--84.6%, specificity--96.7%. CT in jaundice made it possible to establish diagnosis at various levels of accuracy: from differentiation of mechanical and parenchymatous jaundices to preliminary assessment of malignant tumor resectability facilitating a choice of surgical tactics.     

Percutaneous ultrasonography and computed tomography guided pancreatic cryoablation: Feasibility and safety assessment

ObjectiveTo assess the safety and feasibility of percutaneous cryoablation on pancreatic cancer via ultrasonography (US) and computed tomography (CT) guidance.Materials and methodsThis retrospective review was approved by the institutional review board and of informed consent. Thirty-two patients (18 men and 14 women; median age 62; age range, 30–77 years) with pancreatic cancer (stage II/III/IV, 3/11/18) treated with percutaneous US and CT guided cryoablations between February 2009 and February 2010 were eligible for this review. Thirteen tumors in pancreatic head and 19 in pancreatic body and/or tail measuring 2–11 cm (mean, 5.2 cm ± 8 [standard deviation]) were ablated with 49 procedures in total. Feasibility was analyzed by enhanced CT 1–3 months post procedure and safety was assessed by clinical signs, symptoms and laboratory results.ResultsNeither procedural death nor serious complications occurred. Fifteen tumors (46.9%) smaller than 5 cm were successfully ablated by one session of cryoablation. Twenty-seven patients experienced a ⩾50% reduction in pain score, 22 experienced a 50% decrease in analgesic consumption and 16 experienced a ⩾20 increase in Karnofsky Performance Status (KPS) Score. Partial response (PR) and stable disease (SD) turned up in 9 and 21 patients, respectively, lesions in whom were identified controlled by none enhancement on enhanced CT. Mean and median survival was 15.9 and 12.6 months, respectively. The 6-, 12- and 24-month survival rates were 82.8%, 54.7% and 27.3%, respectively.ConclusionUS and CT guided percutaneous cryoablation is a safe and promising local treatment for pancreatic cancer.     

Fréquence de la fixation physiologique de l’uncus pancréatique en scintigraphie à l’111In-pentétréotide : étude rétrospective chez 198 patients

AimThe aim of this study is to evaluate the frequency of physiological ¹¹¹In-DTPA-octreotide uptake in the pancreatic uncinate process, on SPECT-CT acquisitions.MethodsWe analysed retrospectively 247 patients ¹¹¹In-DTPA-octreotide SPECT-CT images realized in the nuclear medicine department of Haut-Lévêque hospital (CHU of Bordeaux, France) between June 2012 and March 2015. Intensity uptake of pancreas uncinate process was classified in comparison with physiological liver and spleen uptake. When positive, an uptake was considerated as physiologic when radiological investigations (CT, MRI or echoendoscopy) did not show anatomical lesion in the pancreatic head, or if no lesion appeared during clinical and radiological follow-ups.ResultsOne hundred and ninety-eight patients without uncus and cephalic pancreatic lesion were analysed. Forty-two percent had a physiological ¹¹¹In-DTPA-octreotide uptake in the pancreatic uncinate process. Uptake intensity was significant (greater than or equal to liver uptake) in 17%.ConclusionIntense physiological ¹¹¹In-DTPA-octreotide uptake of the pancreatic uncinate process can occur in 17% of cases on SPECT-CT acquisitions. This tracer accumulation can mimic malignancy in pancreatic head. Uptake in the pancreatic uncinate process should be correlated with morphologic examinations, such as CT, MRI or somatostatin PET-CT if available.     

Biological importance of the peptides of the calcitonin family as revealed by disruption and transfer of corresponding genes

The hormone calcitonin (CT) of thyroid C-cell origin, the neuropeptides alpha- and beta-calcitonin gene-related peptide (CGRP), the widely expressed hormone and tissue factor adrenomedullin (AM), and amylin (AMY) that is co-produced with insulin in pancreatic beta-cells, are structurally related peptides. They have in common six or seven amino acid ring structures, linked by disulfide bridges between cysteine residues, and amidated carboxyl termini that are both required for biological activity. The actions of the peptides in vivo have traditionally been studied after intravenous and intracerebroventricular administration. As a result, CT lowers serum calcium and reduces pain perception. alpha- and beta CGRP and AM are highly potent vasodilatory peptides. AMY inhibits food intake through its action in the area postrema of the brain. Physiological actions of the peptides summarized in the present review have been defined through gene knockout and overexpression strategies.     

Is chymotrypsin output a better diagnostic index than the measurement of chymotrypsin in random stool?

This study compares the diagnostic utility of fecal chymotrypsin (CT) output in timed stool collections and random stools using a new photometric enzyme assay. The CT output (mean +/- SD, U/24 h) was 1,487 +/- 1,980 in 127 children with normal fat absorption and negative sweat-chloride test (mean age 45 months), and 1,804 +/- 1,452 in 27 cases with fat malabsorption due to nonpancreatic disease (mean age 41 months). 66 cases of cystic fibrosis (CF) were examined (mean age 119 months). Stool output in 19 newly diagnosed patients before therapy was 85 +/- 94, in 42 patients receiving enzyme replacement therapy was 3,462 +/- 2,841, and in 5 patients with pancreatic sufficiency 1,754 +/- 1,482. Using nonparametric statistics, 120 U/24 h was defined as the lower limit of the 95-percentile for stool CT output. Only 5 of the 127 patients with normal fat absorption had output below that limit. None of the patients with nonpancreatic malabsorption and only 1 treated CF patient had lower values. Sixteen of the newly diagnosed CF patients had stool CT less than 120 U/24 h. The sensitivity of the test is therefore 84% and its specificity 97% at this decision threshold. However, no diagnostic advantage is gained from measuring CT output in timed stool collections as compared to random stools.     

Detection of Pancreatic Carcinomas by Imaging Lactose-Binding Protein Expression in Peritumoral Pancreas Using [18F]Fluoroethyl-Deoxylactose PET/CT

Background

Early diagnosis of pancreatic carcinoma with highly sensitive diagnostic imaging methods could save lives of many thousands of patients, because early detection increases resectability and survival rates. Current non-invasive diagnostic imaging techniques have inadequate resolution and sensitivity for detection of small size (∼2–3 mm) early pancreatic carcinoma lesions. Therefore, we have assessed the efficacy of positron emission tomography and computer tomography (PET/CT) imaging with β-O-D-galactopyranosyl-(1,4′)-2′-deoxy-2′-[¹⁸F]fluoroethyl-D-glucopyranose ([¹⁸F]FEDL) for detection of less than 3 mm orthotopic xenografts of L3.6pl pancreatic carcinomas in mice. [¹⁸F]FEDL is a novel radioligand of hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), which is overexpressed in peritumoral pancreatic acinar cells.

Methodology/Principal Findings

Dynamic PET/CT imaging demonstrated rapid accumulation of [¹⁸F]FEDL in peritumoral pancreatic tissue (4.04±2.06%ID/g), bi-exponential blood clearance with half-lives of 1.65±0.50 min and 14.14±3.60 min, and rapid elimination from other organs and tissues, predominantly by renal clearance. Using model-independent graphical analysis of dynamic PET data, the average distribution volume ratio (DVR) for [¹⁸F]FEDL in peritumoral pancreatic tissue was estimated as 3.57±0.60 and 0.94±0.72 in sham-operated control pancreas. Comparative analysis of quantitative autoradiographic images and densitometry of immunohistochemically stained and co-registered adjacent tissue sections demonstrated a strong linear correlation between the magnitude of [¹⁸F]FEDL binding and HIP/PAP expression in corresponding regions (r = 0.88). The in situ analysis demonstrated that at least a 2–4 fold apparent lesion size amplification was achieved for submillimeter tumors and to nearly half a murine pancreas for tumors larger than 3 mm.

Conclusion/Significance

We have demonstrated the feasibility of detection of early pancreatic tumors by non-invasive imaging with [¹⁸F]FEDL PET/CT of tumor biomarker HIP/PAP over-expressed in peritumoral pancreatic tissue. Non-invasive non-invasive detection of early pancreatic carcinomas with [¹⁸F]FEDL PET/CT imaging should aid the guidance of biopsies and additional imaging procedures, facilitate the resectability and improve the overall prognosis.     

胰腺创伤的诊断和治疗进展

胰腺创伤的早期诊断是根据详细的询问病史、全面的体格检查,结合淀粉酶指标、B超、CT扫描、逆行胰胆管造影(ERCP)及磁共振下胰胆管成像(MRCP)等检查做出诊断,必要时应及时行剖腹探查,剖腹探查术是最可靠的早期诊断方法。依据损伤部位及严重程度,选择最佳的手术方式,可提高治愈率,减少并发症的发生,通畅引流是改善预后的关键措施,本文对胰腺创伤的诊治进展作一综述。     

Diagnosis, follow-up, and treatment policy making in patients with acute pancreatitis (CT and MRI evidence)

The paper deals with the use of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis, followup, and treatment policy making in patients with severe acute severe pancreatitis with manifestations as pancreatic necrosis, fluid collections (exudate accumulations in peripancreatic and retroperitoneal spaces), as well as that complicated by infection, abscess, and pseudocysts. The results of examining 502 patients with acute pancreatitis (AP) with different complications, who had been treated at the S.P. Botkin City Clinical Hospital in 2007 to 2010, were used to analyze the data of the study, to detail tactics in the diagnosis and follow-up of patients with AP, by using bolus contrast-enhanced CT in combination with MRI, which allows one to reveal the nature and severity of the disease with a high accuracy, to make its prognosis, and to determine the effective procedure of treatment. Substantiation of the imperfection of the 1992 Atlanta classification and its specifying Balthazar classification figures high in the paper.     

P-12A RETROSPECTIVE AUDIT OF FINE NEEDLE ASPIRATION CYTOLOGY OF PANCREAS

Background:  Fine needle aspiration cytology (FNAC) of pancreas is a widely accepted method of diagnosis of pancreatic mass lesions. We have performed a retrospective analysis of all radiological (CT/ultrasound) and endoscopic ultrasound guided procedures at our institution.
Aim:  (1) To review the results of FNAC of pancreas from January 2000 to April 2006. (2) To calculate the inadequate rate. (3) To account for discrepancies between the cytological and histological diagnoses. (4) To identify any false positive cases if present.
Method:  The results of all pancreatic FNAC reported at our institute from January 2000 to April 2006 were identified from the laboratory system. All results were classified as follows: Inadequate, inconclusive, benign, suspicious and malignant. The results were further categorised depending on whether they were CT/ultrasound guided or EUS guided. The histological diagnosis where available was used as the gold standard and where discrepancies were present the cytological preparations were reviewed.
Results:  Seventy-three patients underwent pancreatic FNAC during the study period. Table 1 illustrates our results.