A case of incomplete duplication of the portal vein associated with multiple congenital anomalies.

Double portal veins are a duplication of the portal vein and normal portal vein with an accessory portal vein. We report a case of a 63-year-old asymptomatic female with double portal veins. There was fat accumulation observed in the area which was supplied by the first portal vein in normal position, and fatty sparing of the liver was observed in the area which was supplied by the second portal vein in the preduodenal position. The 2 portal veins were equal in size. Furthermore, the patient presented with multiple congenital anomalies, including double inferior vena cava, splenic lobulation, and accessory liver lobe. Therefore, double portal veins in our case were thought to be an incomplete duplication of the portal vein with multiple congenital anomalies.

Retrospective evaluation of venous phase contrast-enhanced computed tomography images in patients who developed pancreatic adenocarcinomas after treatment for nonpancreatic primary cancer.

OBJECTIVES: To clarify venous phase contrast-enhanced CT findings in early pancreatic adenocarcinomas by retrospectively evaluating CT images of pancreatic adenocarcinomas that developed during follow-up after treatment for non-pancreatic cancers. METHODS: The study cohort comprised six patients who developed pancreatic adenocarcinomas between April 2005 and April 2020 during follow-up after treatment for non-pancreatic primary cancers. Two radiologists retrospectively evaluated CT images and reached consensus on previously reported CT findings that were suggestive of small pancreatic adenocarcinomas; namely pancreatic duct interruption and dilatation, pancreatic parenchymal atrophy, focal hypoattenuated areas, and appearance of cystic lesions. Time intervals between the first CT with these suggestive findings and the latest pre-operative CT were recorded. Doubling times were calculated in patients with hypoattenuated areas on initial CT scans. RESULTS: Small (<10 mm) focal hypoattenuated areas with (n = 2) or without rim enhancement (n = 1) were identified on initial CT images of three patients. Pancreatic duct interruption and dilatation, pancreatic parenchymal atrophy, and cystic lesion were identified in two, one and one patient, respectively. Time intervals between initial and latest preoperative CT examination were 6-19 months (median, 14.5 months). Tumor doubling time according to CT findings was calculated as 46-407 days (median 106 days). CONCLUSION: Venous phase contrast-enhanced CT can provide findings that are suggestive of early pancreatic adenocarcinoma. Pancreatic phase contrast-enhanced CT should therefore be performed in patients with such findings with the aim of early detection of pancreatic adenocarcinoma. ADVANCES IN KNOWLEDGE: Pancreatic adenocarcinoma can develop subsequently in patients with non-pancreatic malignancies. Patients with non-pancreatic cancers are often followed up with monophasic contrast-enhanced CT in venous phase timing. Venous phase contrast-enhanced CT can provide some findings suggestive of early pancreatic adenocarcinoma. Knowledge of these findings is important for early detection of pancreatic adenocarcinoma.

S6 ribosomal protein phosphorylation is associated with malignancy of intraductal papillary mucinous neoplasm of the pancreas.

BACKGROUND: Glucose metabolism of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas is unclear. S6 ribosomal protein (S6) phosphorylation is involved not only in controlling cell growth but also in glucose metabolism in cancer. The aim of this study was to investigate the role of S6 phosphorylation and the significance of glucose metabolic changes in IPMN. METHODS: Records of 39 patients who underwent preoperative FDG-PET and curative resection were enrolled in this study. S6 phosphorylation and GLUT1 expression were evaluated immunohistochemically in these patients. The effect of S6 phosphorylation on glucose uptake was examined in cancer cell lines. To examine the change of glucose metabolism in IPMN clinically, the relation between clinical factors including FDG-PET and malignancy of IPMN was investigated. RESULTS: S6 phosphorylation and GLUT1 expression were significantly higher in carcinoma than in normal cells or adenoma. Cell lines with high level of S6 phosphorylation showed high glucose uptake, and inhibition of S6 phosphorylation reduced glucose uptake. In clinical examination, FDG-PET was the independent factor related to the diagnosis of adenoma or carcinoma (odds ratio = 20.0, 95% confidence interval = 1.837-539.9, P = .012). FDG-PET detected carcinoma with a sensitivity of 81.8%, specificity of 96.4%, and accuracy of 92.3%. CONCLUSION: S6 phosphorylation was associated with glucose uptake and malignancy of IPMN. Moreover, glucose uptake increased in malignant cells of IPMN, and FDG-PET is useful for detecting malignancy of IPMN.

Evaluation of juxtapapillary duodenal diverticula using multiplanar reformation in MDCT: correlation with ERCP findings.

OBJECTIVE: To determine the ability of multidetector computed tomography (MPR-MDCT) to identify and classify the juxtapapillary duodenal diverticulum (JPDD), with ERCP findings as the gold standard. METHODS: We retrospectively reviewed all ERCP examinations (n: 455) performed between January 2010 to December 2018 and selected 105 patients with JPDD as the inclusion criteria. Of those, 28 patients were excluded because of advanced pancreatic carcinoma, incomplete MDCT examinations and biliary catheter insertion. Finally, MDCT examinations of 77 patients with JPDD were assessed for the presence and type of JPDD. RESULTS: MPR-MDCT was able to identify 71 (92.2%) JPDD in 77 cases with 88.9% accuracy, 83.3% sensitivity, and 91.6% specificity in classifying the type of JPDD. MPR-MDCT performed best in determining type 1 JPDD, with accuracy of 95.4% compared with type 2 (83.3%) and type 3 (87.8%). There was no significant difference between age, gender, incidence of biliary stones and pancreatitis between each type of JPDD. No correlation of sizes with types of JPDD was found. CONCLUSIONS: MPR-MDCT can accurately identify and classify JPDD. This information will be useful in determining the difficulty of ERCP.

Physiological 18F-FDG uptake in the normal adult anal canal: evaluation by PET/CT.

OBJECTIVE: Despite their benefit for detecting primary tumors, data for normal 18F-fluoro-2-deoxy-D-glucose (FDG) uptake in the anal canal are insufficient. Here we used positron emission tomography-computed tomography (PET/CT) to determine the uptake of FDG in the normal adult anal canal (AC) and to evaluate its clinical significance compared with that of anal cancer. METHODS: We conducted a retrospective study of-PET/CT images in the anal region, of 201 consecutive patients without symptoms or pathology taken from January 2015 to August 2019, after excluding two patients (one each with Crohn's disease and hemorrhoid). These patients were included in the normal group, and data of eight patients with anal cancer were collected from January 2011 to August 2019 for comparison. FDG uptake was quantitatively evaluated (compared with the maximum standardized uptake value [SUVmax] to the SUVmax values of liver and distal rectum) and qualitatively (compared with background) in early and delayed phases. Normal grade 3 uptake was qualitatively defined as FDG uptake higher than the surrounding muscles. RESULTS: In the normal group, mean anal canal SUVmax of early phase was: 2.26 (range 1.00-6.30), and delayed phase: 2.52 (range 1.00-8.80). Their ratios to liver SUVmax were early: 0.74 (range 0.24-2.25), and delayed: 0.81 (range 0.23-2.32); ratios to rectal SUVmax were early: 0.87 (range 0.30-1.89), and delayed: 0.90 (range 0.30-1.27). Qualitatively, 25 patients (15.4%) had normal grade 3 uptake during the early and delayed phases. In contrast, qualitative data showed that all patients with anal cancer exhibited high FDG uptake in the anal canal. The mean early- and delayed-phase values of SUVmax of the anal canal and anal cancer group were 11.09 (range 5.40-17.73) and 14.23 (range 6.70-22.85), respectively. There was a significant difference between the mean-early and -delayed anal SUVmax values of the normal grade 3 and anal cancer groups. Furthermore, the ratios to liver SUVmax were significantly different between the two groups. CONCLUSIONS: PET/CT scans occasionally showed high FDG uptake in the anal canal of healthy adults. Comparing the SUVmax values of liver FDG uptake may help differentiate between normal tissue and anal cancer.

Correction To: Where is the Origin of the Last Normal Branch from Feeding Artery of Pulmonary Arteriovenous Malformations?

On page 1852, the first sentence of the second paragraph "In all PAVMs, the mean diameter of the feeding artery was 7.24 ± 0.015 mm, and the mean maximum diameter of the sac was 19.10 ± 0.585 mm" should be corrected to read as follows.

Invasive intraductal papillary mucinous neoplasms of the pancreas: relationships between mural nodules detected on thin-section contrast-enhanced MDCT and invasive components.

PURPOSE: To elucidate the relationships between mural nodules (MNs) and invasive components in patients with invasive intraductal papillary mucinous neoplasm (IPMN) on the basis of thin-section contrast-enhanced multidetector CT (CE-MDCT) and pathologic findings. METHODS: This retrospective study included 28 patients with surgically confirmed invasive IPMN. Two radiologists independently evaluated the thin-section (1-mm section thickness, no overlap) triple-phase CE-MDCT images for MNs, invasive components, and the continuity between them using a five-point scale (confidence scores of 1-3 as negative, 4 and 5 as positive). Kappa statistic was used to evaluate interobserver agreement. The CE-MDCT findings were correlated with pathologic findings. RESULTS: Interobserver agreement was good or excellent. MNs consisting of tumor cells were recognized in 12 (42.9%) of 28 patients with no discrepancy between the two radiologists. Invasive components were detected in 85.7% and 82.1% in the pancreatic parenchymal phase for radiologist 1 and 2, respectively, and recognized as hypoattenuating areas. Pathologic continuities between MNs and invasive components were confirmed in five (41.7%) of 12 patients with MNs and these were detected on CE-MDCT. When combined seven patients without continuities between MNs and invasive components and 16 patients without MNs, the invasive components pathologically derived from non-nodular low-height papillary epithelium in 23 (82.1%) of 28 patients. CONCLUSIONS: The invasive components derived more often from low-height papillary epithelium without MN appearance on CE-MDCT than from MN. Careful attention should be paid to the existence of an invasive component even in the absence of an enhancing MN.

Coexistence of "extra-gastric afferent-efferent direct connection" with gastric varices: CT evaluation and clinical significance.

PURPOSE: To evaluate the prevalence of extra-gastric direct connection between afferent and efferent veins of gastric varices (GVs) (i.e., EAEDC) and its clinical significance during balloon-occluded retrograde transvenous obliteration (BRTO). MATERIALS AND METHODS: 57 patients who underwent BRTO for GVs obliteration were retrospectively enrolled in this study. Pre-procedural CT images were reviewed for the presence of EAEDC. Patients were categorized into group A (patients with EAEDC) and group B (Patients with no detectable EAEDC). Intraprocedural images were reviewed to see if EAEDCs could be seen and if additional techniques were used to preserve or occlude them. Post-procedural CT images were reviewed for GVs obliteration, portal/splenic vein thrombosis, EAEDC patency, and ascites exacerbation. Post-procedural esophageal varices aggravation was evaluated by upper endoscopy. RESULTS: 39 EAEDCs were identified in CT images of 35 patients (i.e., group A = 61.4%). Among them, only 20 EAEDCs were visualized during BRTO. In the remaining 22 patients, EAEDC was not identified in CT images or during BRTO (i.e., group B = 38.6%). There was no statistically significant difference between group A and B regarding post-BRTO GVs obliteration and portal/splenic vein thrombosis. Use of additional techniques to preserve EAEDC patency had significantly reduced the incidence of ascites and esophageal varices exacerbation (p = 0.036 and 0.028, respectively). In patients with EAEDC diameter ≥ 5 mm, EAEDC preservation or obliteration by coils or balloon had significantly reduced the injected sclerosant volume (p = 0.003). CONCLUSION: CT is very useful for EAEDC detection. EAEDC preservation may decrease the incidence of post-BRTO ascites and esophageal varices exacerbation.

18F-FDG uptake in the normal appendix in adults: PET/CT evaluation.

OBJECTIVE: This study aimed to determine the level of 18F fluorodeoxyglucose (18F-FDG) activity in the normal adult appendix using positron emission tomography/computed tomography (PET/CT). MATERIALS AND METHODS: We performed a retrospective review of PET/CT images using 18F-FDG in 563 consecutive asymptomatic adult patients without appendiceal pathology. We excluded 257 patients for an undetected or obscured appendix and three patients for appendicitis found on CT imaging. FDG uptake in the appendix was qualitatively and quantitatively assessed. The maximum standardized uptake value (SUVmax) was calculated for quantitative analysis with SUVmax of the normal liver for comparison. A total of 303 patients (200 males, 103 females, mean age of 66 years) were included in this study. Medical charts and histories were evaluated for patients who showed positive FDG accumulation. Pearson's correlations between appendiceal SUVmax and age, body mass index, and blood glucose levels were analyzed. RESULTS: The mean appendiceal SUVmax was 1.14 (range 0.52-5.12) with an appendix-to-liver SUVmax ratio of 0.34 (range 0.06-1.28). Three patients qualitatively showed a positive FDG accumulation with appendiceal SUVmax greater than 3.00. There were no correlations between appendiceal SUVmax and age, body mass index, or blood glucose levels. CONCLUSIONS: FDG in the normal adult appendix shows a low activity level and is lower compared with normal liver. However, the normal appendix can rarely show high FDG accumulation. In such cases, differentiation from appendiceal pathology solely by PET/CT images would be difficult.

Where is the Origin of the Last Normal Branch from Feeding Artery of Pulmonary Arteriovenous Malformations?

PURPOSE: Reperfusion via pulmonary-to-pulmonary arterial anastomoses is known as one type of recurrence of pulmonary arteriovenous malformations (PAVMs) after embolization. It is important to occlude the fistulous portion beyond the origin of the last normal branch from feeding artery of PAVMs to prevent recurrence. In this study, we evaluate the origin of the last normal branch by CT as well as its visibility on pulmonary arteriography (PAG). MATERIALS AND METHODS: We reviewed forty patients with 77 PAVMs who underwent coil embolization between October 2007 and December 2017. All patients underwent MDCT before embolization. Axial and MPR CT lung images were reviewed with special interests in the origin of the last normal branch from feeding artery of PAVMs. The origin was classified into three portions, including sac, junction (portion just proximal to the sac) and proximal feeder (more than 5 mm proximal to the sac). We also evaluated whether PAG can depict the normal branches detected by MDCT. RESULTS: MDCT showed that the last normal branch originated from sac in 30 PAVMs (39.0%), junction in 39 (50.6%), and proximal feeder in 8 (10.4%).On selective PAG, the last normal branch could be visualized in 30 PAVMs (39.0%), although it could not be visualized due to high-flow shunt in the other 47 PAVMs. CONCLUSIONS: Selective PAG frequently fails to demonstrate the last normal branch from feeding artery of PAVMs, which often originates from the sac. Pretherapeutic evaluation of CT images of the last normal branch is important to prevent reperfusion of PAVMs. LEVEL OF EVIDENCE: Level 3, local non-random sample.

The scab-like sign: A CT finding indicative of haemoptysis in patients with chronic pulmonary aspergillosis?

OBJECTIVES: The aim of this study was to assess the CT findings that characterise haemoptysis in patients with chronic pulmonary aspergillosis (CPA). METHODS: We retrospectively identified 120 consecutive patients with CPA (84 men and 36 women, 17-89 years of age, mean age 68.4 years) who had undergone a total of 829 CT examinations between January 2007 and February 2017. In the 11 patients who underwent surgical resection, CT images were compared with the pathological results. RESULTS: The scab-like sign was seen on 142 of the 829 CT scans, specifically, in 87 of the 90 CT scans for haemoptysis and in 55 of the 739 CT scans obtained during therapy evaluation. In 48 of those 55 patients, haemoptysis occurred within 55 days (mean 12.0 days) after the CT scan. In the 687 CT scans with no scab-like sign, there were only three instances of subsequent haemoptysis in the respective patients over the following 6 months. Patients with and without scab-like sign differed significantly in the frequency of haemoptysis occurring after a CT scan (p<0.0001). Pathologically, the scab-like sign corresponded to a fibrinopurulent mass or blood crust. CONCLUSIONS: The scab-like sign should be considered as a CT finding indicative of haemoptysis. KEY POINTS: • Haemoptysis is commonly found in patients with CPA. • A CT finding indicative of haemoptysis in CPA patients is described. • Scab-like sign may identify CPA patients at higher risk of haemoptysis.

Retrieval of a migrated N-butyl-2 cyanoacrylate cast using a snare-kit system during dural AVF embolization: A case report.

N-butyl-2 cyanoacrylate (NBCA) is a liquid embolic material that is widely used in various endovascular procedures because of its permanent and rapid vascular occluding effect regardless of the coagulation profile of the patient. However, NBCA migration to unintended vessels may result in serious complications. This report describes the retrieval of a migrated NBCA cast from the transverse-sigmoid sinus during dural arteriovenous fistula embolization using a transvenous snaring technique.

Small pancreatic ductal carcinomas on triple-phase contrast-enhanced computed tomography: enhanced rims and the pathologic correlation.

PURPOSE: To reveal the prevalence of small (≤ 20 mm) pancreatic ductal carcinomas with enhanced rims on triple-phase contrast-enhanced CT and correlate the CT images with the pathologic findings. MATERIALS AND METHODS: Between April 2005 and April 2016, 45 patients underwent preoperative triple-phase contrast-enhanced CT and were pathologically diagnosed with small pancreatic ductal carcinoma. CT images were independently reviewed by two radiologists. The attenuation values of the enhanced rims, internal areas of the tumors, and surrounding pancreatic parenchyma were compared using Mann-Whitney U test. These areas were also correlated with the pathologic findings. Tumor invasiveness was compared between the tumors with and without enhanced rims using Fisher's exact test. RESULTS: Enhanced rims were identified in 18 tumors (40%) by consensus between the two reviewers. The enhanced rims showed significantly higher mean attenuation values compared with the internal areas of the tumors (p < 0.001) and surrounding pancreatic parenchyma (p < 0.0086), and were most clearly visualized on equilibrium phase. The enhanced rims pathologically reflected the abundant fibrotic stroma with cancer cells in all tumors. There was no statistically significant difference in tumor invasiveness between the tumors with and without enhanced rims (anterior peripancreatic invasion, p = 0.137; posterior peripancreatic invasion, p = 0.758; portal vein invasion, p = 0.639; and lymph node metastases, p = 0.359). CONCLUSIONS: Enhanced rims were detected at a rate of 40% in small pancreatic ductal carcinomas and could be an important finding for diagnosis on CT images, but did not suggest a less aggressive nature.

Chest High-resolution Computed Tomography Findings in 601 Patients with Inflammatory Bowel Diseases.

RATIONALE AND OBJECTIVES: Pulmonary involvement in inflammatory bowel disease may reflect the common embryonic origin of the gastrointestinal tract and the bronchial tree. No studies have compared pulmonary high-resolution computed tomography (HRCT) findings between ulcerative colitis (UC) and Crohn disease (CD). This study aimed to assess the relationship between pulmonary HRCT findings and inflammatory bowel disease activity and to compare HRCT findings between UC and CD. MATERIALS AND METHODS: We retrospectively identified 601 consecutive patients (350 with UC and 251 with CD) who had undergone chest HRCT examinations at our institutions between April 2004 and April 2016. Parenchymal abnormalities, enlarged lymph nodes, and pleural effusion were evaluated on HRCT. RESULTS: One hundred sixty-seven patients (94 men, 73 women; aged 12-86 years, mean: 47.2 years) with UC and 93 patients (61 men, 32 women; aged 12-71 years, mean: 37.9 years) with CD had abnormal findings on chest HRCT. The HRCT findings of UC and CD mainly consisted of centrilobular nodules (in 49.1% and 45.2% of cases, respectively) and bronchial wall thickening (in 31.7% and 54.8%, respectively). There was no relationship between HRCT findings and disease activity. Bronchial wall thickening was significantly more frequent in patients with CD than in those with UC (P < .001). CONCLUSION: The main chest HRCT findings in UC and CD are centrilobular nodules and bronchial wall thickening. There are differences in HRCT findings between UC and CD.

Asymptomatic Bartholin Cyst: Evaluation With Multidetector Row Computed Tomography.

OBJECTIVE: The aim of this study was to determine the frequency, morphology, and attenuation characteristics of Bartholin cysts on multidetector computed tomography (MDCT) in asymptomatic women. METHODS: A total of 3280 consecutive MDCT examinations were assessed for Bartholin cysts. The diagnosis was based on shape, contrast enhancement, and anatomical location. Age, laterality, size, and attenuation patterns were recorded. Scans from patients with paravaginal-related symptoms were excluded, and any available follow-up MDCT scans or magnetic resonance images were evaluated. RESULTS: Asymptomatic Bartholin cysts were seen in 17 patients (0.52%) (mean age, 56 years). The mean maximum cyst diameter was 21.8 mm. High-attenuation cysts comprised 47% of cases, all in older (≥50 years) patients. Follow-up MDCT scans showed minimal changes over time. CONCLUSIONS: High-attenuation Bartholin cysts are more common than previously thought and are usually seen in older women. The size and attenuation of Bartholin cysts show only minimal changes over time.

Fusion anomaly of the pancreatic tail and spleen: a case report.

BACKGROUND: Splenopancreatic fusion is a rare anomaly that is often associated with trisomy 13. Its diagnosis can be important in patients scheduled to undergo distal pancreatectomy or splenectomy, to avoid possible intraoperative or postoperative complications. CASE PRESENTATION: An 82-year-old Japanese man was referred to our hospital for further evaluation and treatment for a solitary hepatocellular carcinoma based on liver cirrhosis. Triple-phase contrast-enhanced multidetector-row computed tomography and magnetic resonance imaging showed a splenopancreatic fusion as well as a solitary hepatocellular carcinoma in segment VIII of his liver. CONCLUSIONS: Fusion of the pancreatic tail and spleen is a rare and asymptomatic anomaly. Its detection can be improved by the use of multidetector computed tomography or magnetic resonance imaging.

Periportal lymphatic system on post-hepatobiliary phase Gd-EOB-DTPA-enhanced MR imaging in normal subjects and patients with chronic hepatitis C.

PURPOSE: We sought to evaluate visualization of periportal lymphatics and lymph nodes (lymphatic system) on Gd-EOB-DTPA-enhanced magnetic resonance (MR) images using a fat-suppressed T2-weighted sequence with 3-dimensional (3D) volume isotropic turbo spin echo acquisition (VISTA) at 3.0 T in normal subjects and patients with chronic hepatitis C. METHODS: MR imaging was performed in 254 subjects between June 2013 and May 2016. After applying inclusion and exclusion criteria, the final population was 31 normal subjects and 34 patients with chronic hepatitis C. Images were acquired after the hepatobiliary phase following intravenous administration of Gd-EOB-DTPA, which causes signal loss in the bile ducts, to facilitate the visualization of the periportal lymphatic system. Two radiologists assessed the visualization of the periportal lymphatic system in 31 normal subjects. The axial dimensions of the main periportal lymphatic system in normal subjects were measured and compared with those of 34 patients with chronic hepatitis C using the Mann-Whitney U-test, and their correlation with a hepatic fibrosis marker, the Fibrosis-4 (FIB-4), was assessed using Spearman's rank correlation test. RESULTS: The periportal lymphatic system was detected as high signal intensity areas surrounding the portal vein up to the third branches by each reader in all normal subjects. The axial dimensions of the main periportal lymphatic system in patients with chronic hepatitis C were significantly larger than those in normal subjects (p < 0.0001), and showed a significantly positive correlation with the FIB-4 score (ρ = 0.73, p < 0.001). CONCLUSIONS: Fat-suppressed T2-weighted MR imaging with 3D-VISTA acquired after the hepatobiliary phase on Gd-EOB-DTPA-enhanced imaging may be a useful noninvasive method for evaluating the periportal lymphatic system and the degree of hepatic fibrosis.

Contour variations of the body and tail of the pancreas: evaluation with MDCT.

PURPOSE: To analyze morphology/contour variations of the pancreatic body and tail in subjects free of pancreatic disease. METHODS: We retrospectively reviewed triple-phase, contrast-enhanced multi-detector row computed tomography (3P-CE-MDCT) examinations of 449 patients who had no clinical or CT evidence of pancreatic diseases. These patients were evaluated for morphologic/contour variations of the pancreatic body and tail, which were classified into two types. In Type I, a portion of normal pancreatic parenchyma protrudes >1 cm in maximum diameter from the body or tail (Ia-anteriorly; Ib-posteriorly). Type II was defined as a morphologic anomaly of the pancreatic tail (IIa-globular; IIb-lobulated; IIc-tapered; IId-bifid). RESULTS: Thirty-eight (8.5%) out of 449 patients had body or tail variations. Of those, 23 patients showed Type I variant: Ia in 21 and Ib in two. Type II variant was identified in 15 patients: IIa in eight, IIb in two, IIc in two and IId in three. Protrusion of the anterior surface of the normal pancreas, especially in the tail, was the most frequently occurring variant. CONCLUSIONS: Recognizing the types and subtypes of morphology/contour variations of the pancreatic body and tail could help prevent misinterpretation of normal variants as pancreatic tumors on unenhanced MDCT.