Imaging of the pancrease Flashcards
What is pancreas divisum
Abscense of the fusion of the anterior and posterior pancreatic ducts
A very important variation, since it exists in almost 25% of the patients suffering from recurrent, idiopathic pancreatitis.
Methods of imaging the pancreas
US - although it requires significant experience to be evaluated accurately. Easily obscured by stomach gas, or free abdominal gas.
CT and MRI are the primary methods for pancreas imaging.
Especially with contrast and arterial, venous, late venous scans.
T1-MR shows:
Differentiates pancreatic carcinoma and Vascular structures
T1-MR shows
Areas of intratumor necrosis
T1-MR with fat suprression
Differentiating chronic pancreatitis from tumors
Fibrotic pancreas has low signal intensity from decreased water content.
Normal pancreas has higher signal.
Cancer has a signal in between the two.
Insulinomas have low intensity on T1 and high on T2.
Acute pancreatitis.
Preferred imaging method and traits
Other images and traits
CT is method of choice
It is characterized by the Balthazar stages
A - normal pancreas
B - focal or diffuse enlargement
C - gland swelling with peripancreatic inflammation/edema
D- pancreatogenous fluid content in one localisation, ie pseudocyst formation in the pancreas
E - two or more areas of fluid or gas content in the pancreas or adjacent regions. ie, extensive pseudocysts.
Ultrasound as well. swelling, edema, pseudocysts.
Potential treatments for acute pancreatitis
Percutaneous drainage of the fluid/pseudocysts/abcesses
Embolization of the vessels draining into a pseudoaneurysm.
