A case of pancreatic neuroendocrine tumor with multiple cystic components of various sizes.

The patient was a 51-year-old woman who, while undergoing a thorough health checkup, was found to have a tumor (measuring 60 mm in diameter) in the tail of the pancreas by abdominal ultrasonography. Contrast-enhanced computed tomography revealed delayed contrast enhancement; the tumor also contained numerous low-absorption areas showing poor contrast enhancement. On magnetic resonance imaging, the tumor was visualized as having high signal intensity areas inside the tumor on T2-weighted images. Positron emission tomography revealed an abnormal accumulation in the area corresponding to the tumor. Endoscopic ultrasonography (EUS) revealed a relatively hyperechoic solid area, with a number of echo-free areas of various sizes that assumed a honeycomb appearance. EUS-guided fine needle aspiration was carried out targeting the solid area within the tumor, which led to a diagnosis of pancreatic neuroendocrine tumor (PNET). Histopathological examination of the resected specimen revealed that the tumor was composed of numerous cysts of various sizes and solid components. The cysts contained no evidence of necrosis or bleeding. Immunohistochemically, the cystic as well as solid components were CD56 (+), synaptophysin (+) and chromogranin A (+) with MIB1 labeling index of 5%. On the basis of these findings, the final diagnosis was PNET (G2).

Relationship between 2-deoxy-2-[(18)F]-fluoro-d-glucose uptake and clinicopathological factors in patients with diffuse large B-cell lymphoma.

The aim of this study was to investigate correlations between the standardized uptake value of the biopsy site (BSUVmax) and levels of glucose transporter (GLUT)-1, GLUT-3 and hexokinase-II (HK-II), between BSUVmax and the Ki-67 proliferation index (MIB-1), and between BSUVmax and clinicopathological factors. Sixty-eight patients with diffuse large B-cell lymphoma (DLBCL) were included in this study. BSUVmax was significantly correlated with GLUT-1, GLUT-3 and the International Prognostic Index (IPI) (GLUT-1: r = 0.584, IPI: r = 0.363, p < 0.001; GLUT-3: r = 0.369, p = 0.009; IPI: r = 0.363, p = 0.004), but not with MIB-1 and HK-II. A statistically significant correlation was observed between GLUT-3 expression and each of IPI and gene expression profiling (GEP) (IPI: p = 0.0186; GEP: p = 0.0179). 2-Deoxy-2-[(18)F]-fluoro-d-glucose (FDG) uptake was significantly correlated with the levels of GLUT-1 and GLUT-3 and with IPI. The results indicated that GLUT-3 expression is related to GEP and IPI, and that BSUVmax and GLUT-3 may have a relationship with the prognosis of DLBCL.

Assessment of Chronic Pancreatitis: Use of Whole Pancreas Perfusion With 256-Slice Computed Tomography.

OBJECTIVE: We aimed to compare perfusion computed tomography (CTP) characteristics of the normal pancreas with those of chronic pancreatitis (CP) and to examine the possibility of evaluating pancreatic exocrine function with CTP. METHODS: Thirty-two patients (control group, n = 18; CP group, n = 14) who completed the whole pancreas CT perfusion examination with 256-slice CT were studied. Four parameters, including perfusion (PF), peak enhancement intensity (PEI), time-to-peak (TTP), and blood volume (BV), were measured and compared between the control and CP groups, and between patients with and without exocrine pancreatic insufficiency (EPI) in the CP group. Pancreatic exocrine function was determined via serum trypsinogen. RESULTS: There was no significant difference between the distribution of PF, PEI, and BV in different pancreas regions, namely, the head, body, and tail (P > 0.05). PF, PEI, and BV of the CP group were significantly decreased, and TTP was significantly increased compared with the control group (P < 0.05). A significant decrease of PF, PEI, and BV and increase of TTP were observed in patients with EPI than in patients without EPI (P < 0.05). CONCLUSIONS: Perfusion CT is an appropriate imaging technique to diagnose CP and may be useful as a screening test to rule out early EPI.

Utility of multidetector row CT in diagnosing branch duct IPMNs of the pancreas compared with MR cholangiopancreatography and endoscopic ultrasonography.

This study aimed to compare the usefulness of multidetector row CT (MDCT), MR cholangiopancreatography (MRCP), and endoscopic ultrasonography (EUS) in diagnosing branch duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Imaging and pathological findings were retrospectively evaluated for 25 patients with branch duct IPMNs of the pancreas who underwent surgical resection (13 adenomas, 4 borderline lesions, and 8 carcinomas). MDCT and MRCP were performed on all 25 patients, whereas EUS was performed on 22 patients. MDCT and MRCP were used to identify features predictive of malignancy, including carcinoma, borderline lesions, and the presence of thickened irregular walls/septa or a solid mass. EUS was used to identify the presence of intramural nodules or a solid mass. Correlations between histopathology and maximum diameter of the main pancreatic duct (MPD) or cyst size detected by MDCT and MRCP were also examined. Presence of a solid mass was highly correlated with malignancy with all imaging methods (MDCT; P=0.001, MRCP; P=0.008, EUS; P<0.001, respectively). Presence of thickened irregular walls/septa on MDCT correlated well with malignancy (P=0.019). In contrast, presence of thickened irregular walls/septa on MRCP and intramural nodules on EUS did not correlate with malignancy. No significant correlation was found between malignancy and average maximum MPD diameter or cyst size (P>0.05), though values tended to be larger in malignant tumors. Our results suggest that the presence of thickened irregular walls/septa or a solid mass on MDCT are highly correlated with malignancy, and that MDCT is useful for diagnosis of branch duct IPMNs of the pancreas.

Comparison of sclerosing cholangitis with autoimmune pancreatitis and infiltrative extrahepatic cholangiocarcinoma: multidetector-row computed tomography findings.

PURPOSE: The aim of this study was to compare multidetector-row computed tomography (MDCT) findings between cases of sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and infiltrative extrahepatic cholangiocarcinoma (IEC). MATERIALS AND METHODS: We retrospectively assessed MDCT findings from 16 IEC cases and 13 SC-AIP cases. MDCT findings were analyzed with regard to location, length, wall thickness, contour, stricture wall enhancement pattern, proximal duct diameter, and the presence of diffuse concentric thickening in the proximal duct and gallbladder wall thickness. RESULTS: Stricture length, stricture wall thickness, and proximal duct diameter were significantly smaller for SC-AIP than for IEC: 19.3 +/- 8.7 vs. 31.8 +/- 12.0 mm (P = 0.004), 2.1 +/- 1.3 vs. 4.1 +/- 1.3 mm (P < 0.001), and 9.2 +/- 3.9 vs. 13.3 +/- 5.0 mm (P = 0.012), respectively. SC-AIP was correlated with stricture location in both the intrapancreatic and hilar hepatic bile ducts, concentric stricture contour (P < 0.001), and diffuse concentric thickening of the proximal bile duct (P = 0.010). Overall values of sensitivity, specificity, and accuracy used to distinguish between SC-AIP and IEC for stricture wall thickness of <3.0 mm and concentric contour were 76.9%, 93.8%, and 86.2%, respectively, and 100%, 87.5%, 93.1%, respectively. CONCLUSION: Concentric contour and stricture wall thicknesses of <3.0 mm may help distinguish between SC-AIP and IEC.

18F-FDG-PET findings of rare case of nonsecretory plasmablastic myeloma.

A 61-year-old woman presented with pancytopenia and underwent a bone marrow biopsy. The patient was diagnosed with nonsecretory myeloma (plasmablastic type) based on both the bone marrow biopsy findings and her laboratory data. Fluorine-18 fluorodeoxyglucose-positron emission tomography ((18)F-FDG-PET) was performed prior to chemotherapy showing diffuse bone marrow uptake, splenic uptake, and focal uptake of the right anterior chest wall. The patient underwent an (18)F-FDG-PET examination to evaluate the curative effects after three cycles of chemotherapy, and no abnormal uptake on (18)F-FDG-PET was found. Bone marrow biopsy to evaluate the curative effect showed no viable tumor cells. We present a rare case of nonsecretory plasmablastic myeloma detected by (18)F-FDG-PET.

Comparison of dynamic MRI at 3.0 T and MDCT of pancreatobiliary disease: evaluation with source, MPR, CPR, and MIP images for image quality and hepatic arterial and portal venous vessel conspicuity.

PURPOSE: To compare contrast material-enhanced three-dimensional (3D) magnetic resonance imaging (MRI) at 3.0T and multidetector row computed tomography (MDCT) in the same patient with regard to image quality of pancreatobiliary disease and hepatic vascular conspicuity. MATERIALS AND METHODS: This study enrolled 32 patients with pancreatobiliary disease who underwent both gadolinium-enhanced 3D dynamic MRI and multiphasic CT using 16-MDCT. Data analysis of image quality was performed by two radiologists based on source images, multiplanar reconstruction (MPR), curved planar reconstruction (CPR), and maximum intensity projection (MIP) reconstruction. Determination of image quality was based on a 4-point image quality rating scale. RESULTS: The overall image quality of the MRI axial images was superior to that of the axial MDCT images. The MRI protocol yielded an average score of 3.8 points versus 3.5 for the CT imaging. No significant difference was found between 3.0T MRI and MDCT images in MPR or CPR image quality. Image quality for visualization of the distal intrahepatic segmental arteries was significantly improved using MDCT imaging. No significant difference was found between the MDCT and 3.0T MR in portal vein branch image quality. CONCLUSION: High-resolution dynamic contrast-enhanced MR imaging at 3.0T is a comprehensive technique which provides high image quality in pancreatobiliary disease.