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Radiology Journal Club > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Common CT dual phase findings of pancreatic insulinoma vs carcinoma?

“Dual-phase CT angiography in 3 dogs with pancreatic insulinoma.” VRU 49.2 (2008) “Dynamic CT of pancreas in normal dogs and in dog with insulinoma” VRU 48.4 (2007)

A

Insulinomas will have strong, early contrast enhancement during arterial phase (54-85%) - hyperattenuating to surrounding pancreas. Will be hyperechoic to surrounding to parenchyma (to a lesser degree) during portal/venous phase, and isoechoic during late phase. Adenocarcionmas- are hypovascular - will frequently be hypovascular in arterial and portal phase.

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2
Q

Peak enhancement of pancreas? “Dual-phase CT angiography in 3 dogs with pancreatic insulinoma.” VRU 49.2 (2008) “Dynamic CT of pancreas in normal dogs and in dog with insulinoma” VRU 48.4 (2007) “Helical CT of normal canine pancreas” VRU 47.3 (2006)

A

28s +/- 9s using 2ml/kg contrast, with 5ml/s power injector. Time to peak enhancement was used as the scan delay. Pure arterial phase 5-6s. (Time of arrival was about 2s into gastroduodenal artery. **Imaging was started 5s after injection started to allow transit to aorta - so actually may be ~10s

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3
Q

Appearance of pancreas compared to liver (HU) in angiography? “Helical CT of normal canine pancreas” VRU 47.3 (2006)

A

Precontrast: isoattenuating (61 vs 65) Arterial: hyperattenuating (130 vs 94) Venous: hypoattenuating: (129 vs 151) Delayed: hypoattenuating: (91 vs110) Difference in venous/delayed phase is due to biliary excretion in hepatic tissues.

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4
Q

What is highest sensitivity for abdominal US in detecting acute pancreatitis?

A

68%

CE-enhanced US of pancreas in healthy dogs and in dogs with acute pancreatitis VRU pre-published 2015

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5
Q

What values were significant for pancreatitis in the article::

CE-enhanced US of pancreas in healthy dogs and in dogs with acute pancreatitis VRU pre-published 2015

A

Mean and peak pixel intensity was signifiantly higher for dogs with pancreatitis - 311% increase in mean pixel intensity.

Wash-in rates were faster.

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6
Q

What values were not significant for pancreatitis in the article:

CE-enhanced US of pancreas in healthy dogs and in dogs with acute pancreatitis VRU pre-published 2015

A

Wash in to peak enhancement, time to peak enhancement, ratio between the vein and the parenchyma.

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7
Q

What disease states are characterized by decreased perfusion using CE US of the pancreas?

CE-enhanced US of pancreas in healthy dogs and in dogs with acute pancreatitis VRU pre-published 2015.

A

Necrotizing pancreatitis

pancreatic adenocarcionma, fibrosis, pseudocysts, necrosis of the pancreas.

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8
Q

What are some reasons why a pancreas may be hyperechoic? (Humans or dogs)

Variability in US appearance of pancreas in healthy dogs compared to those with hyperadrenocorticism. VRU 56.5

A

1) Obesity and age may be correlated with increased fat deposition in the pancreas
2) Mineralization
3) Fibrosis
4) Steroid administration - mechanism is unknown.

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9
Q

Which group (normal or Cushingoid) were more likely to have a hyperechoic pancreas? heterogeneous?

Variability in US appearance of pancreas in healthy dogs compared to those with hyperadrenocorticism. VRU 56.5

A

Cushing’s - more likely to be hyperechoic (40% vs 8%
Normal - more likely to be heterogeneous ( 40% v 12%)

These findings were signficiant

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10
Q

Was there a correlation between age, body weight and pancreas appearance in normal dogs?

Variability in US appearance of pancreas in healthy dogs compared to those with hyperadrenocorticism. VRU 56.5

A

No

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11
Q

What are some reasons that Cushingoid dogs may have a more hyperechoic pancreas?

A

1) Older, fatter animals (although no correlation was seen in normal patients)
2) Over-production of steroids
3) Cushingoid dogs have been shownt o have elevated cPLi levels (subclinical pancreatitis)
4) mineralization (calcinosis cutis)

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12
Q

What is the most common endocrine neoplasia in dogs, and how does this account for all tumors affecting this organ?

A

Thyroid tumors.
Adenomas account for 30-50% of all thyroid tumors

Prevalence of incidental thyroid nodules in US studies of dogs with hypercalcemia. VRU 56.1

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13
Q

What is the most common exocrine tumor of the pancreas? endocrine tumor?

Description of the use of CE-US in 4 dogs with pancreatic tumors. JSAP 55.

A

Exocrine: adenocarcinoma
Endocrine: insulinoma

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14
Q

What is range of sensitivity of US in detection of pancreatic tumors?

Description of the use of CE-US in 4 dogs with pancreatic tumors. JSAP 55.

A

28-75%

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15
Q

What are CE-US characteristics of insulinoma?

Description of the use of CE-US in 4 dogs with pancreatic tumors. JSAP 55.

A

Arterial phase - hypervascular

Late/portal phase - hypovascular

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16
Q

What are CE-US characteristics of pancreatic adenocarcinoma?

Description of the use of CE-US in 4 dogs with pancreatic tumors. JSAP 55.

A

Arterial - hypovascular

Late/portal phase - hypovascular

17
Q

What are CE-US characteristics of pseudocyts (described in humans)?

Description of the use of CE-US in 4 dogs with pancreatic tumors. JSAP 55.

A

Non-vascularized - no signal - remain anechoic during all phases.

18
Q

What are CE-US characteristics of nodular hyperplasia within the liver in spleen (described in humans).

Description of the use of CE-US in 4 dogs with pancreatic tumors. JSAP 55.

A

Arterial: iso or hypoechoic

Late/portal: isoechoic

19
Q

What are CE-CT characteristics of pancreatic carcinoma and insulinomas in humans?

Description of the use of CE-US in 4 dogs with pancreatic tumors. JSAP 55.

A

Carcinoma: Hypoattenuating during arterial phase, increased echogenicity during later phases.

Insulinoma: hyperattenuating in arterial phase, decreasing attenuation in lateral stages.

20
Q

What is the definition of wash-in rate for CE-US?

CE-US of pancreas in healthy dogs and dogs with acute pancreatitis. VRU 57.1

A

30% of peak intensity is reached

21
Q

If no contrast is present in an area of the pancreas with CE-US, what may that represent?

CE-US of pancreas in healthy dogs and dogs with acute pancreatitis. VRU 57.1

A 
Abscess
Necrosis
carcinoma
pseudocyst
fibrosis
22
Q

What are CE-US imaging characteristics of acute pancreatitis when compared to normal pancreas’

CE-US of pancreas in healthy dogs and dogs with acute pancreatitis. VRU 57.1

A

Increased intensity - up to 311% of noraml
Increased wash-in rate
Decreased wash-out rate
Significant decrease in peak intensity when examinations are repeated and compared

23
Q

Approximate % of increased pixel value of acute pancreatitis vs normal?

CE-US of pancreas in healthy dogs and dogs with acute pancreatitis. VRU 57.1

A

311%

24
Q

What is a pancreatic pseudocyst?

Pancreatic pseudocysts in 4 dogs and 2 cats: US and clinicopathologic findings. JVIM 13

A

collection o fluid containing pancreatic enzymes and debris from pancreas that accumulate in a non-epithelialized fibrous tissue sac formed form inflammatory changes in peritoneal, mesenteric and serous linings

25
Q

What are DDX for a cystic lesion in the pancreas?

Pancreatic pseudocysts in 4 dogs and 2 cats: US and clinicopathologic findings. JVIM 13

A 
Pancreatic pseudocyst
cystic neoplasia
abscess
nodular hyperplasia
loculated fluid
26
Q

What are common presenting signs for dogs with pancreatic pseudocysts?

Pancreatic pseudocysts in 4 dogs and 2 cats: US and clinicopathologic findings. JVIM 13

A

Vomiting

27
Q

What were US findings in dogs with pancreatic pseudocysts?

Pancreatic pseudocysts in 4 dogs and 2 cats: US and clinicopathologic findings. JVIM 13

A

Anechoic to slightly echoic cyst like lesion in pancreatic region with distal aoustic enhancement deep to the lesions.

Pancreatic parenchyma was hypoechoic adjacent to pseudocyst and surrounding omentum was hyperechoic (acute panc)

28
Q

What were amylase/lipase findings in the pancreatic pseudoycst fluid compared to serum?

Pancreatic pseudocysts in 4 dogs and 2 cats: US and clinicopathologic findings. JVIM 13

A

Lipase - was elevated in ALL pseudocysts (levels were greater than the serum in 50%). Only 50% of animals had elevated serum levels

Amylase - was elevated in 50% of the patients. Animals with elevated serum amylase also had elevated cystic amylase. Was similar values between the two.

29
Q

What specific values die they evaluate in the fluid drained from the pancreatic pseudocysts?

Pancreatic pseudocysts in 4 dogs and 2 cats: US and clinicopathologic findings. JVIM 13

A

Amylase and lipaes

30
Q

Recurrence rate of pancreatic pseudocysts after drainage in humans?

Pancreatic pseudocysts in 4 dogs and 2 cats: US and clinicopathologic findings. JVIM 13

A

20-83%

31
Q

Why is pancreatiits associated with such high morbidity and mortality in humans?

Combined use of US and CE-CT to evaluate acute necrotizing pancreatitis in 2 dogs VRU 44.1

A

Because of its close association with the colon - the inflammation/vasculitis leads to translocation of the bacteria from the colon into the pancreas resulting in sepsis

32
Q

What were findings of the CE-CT on the normal portions of the pancreas versus the abnormal portions?
Specifically - what did hte necrotic regions of pancreas appear?

Combined use of US and CE-CT to evaluate acute necrotizing pancreatitis in 2 dogs VRU 44.1

A

Normal pancreas - Normal HU vale of 23

Necrotic pancreas - hypoattenuating to ‘normal’ pancreas. No contrast enhancement

Inflamed pancreas - Hyperattenuating to the necrotic regions. Strongly enhanced with contrast - no comparison to this portion with the normal pancreas

33
Q

How does the pancreas receive its arterial blood supply?

Combined use of US and CE-CT to evaluate acute necrotizing pancreatitis in 2 dogs VRU 44.1

A

Left limb: splenic and hepatic veins
Body: gastroduodenal and celiac
Right limb: cranial and caudal pancreaticoduodenal

34
Q

How does the pancreas receive its venous blood supply?

Combined use of US and CE-CT to evaluate acute necrotizing pancreatitis in 2 dogs VRU 44.1

A

Right lobe - caudal pancraticoduodenal
Proximal right limb and body - cranial pancreaticoduodenal
Left limb - splenic

Radiology Journal Club (19 decks)

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