Increased angiotensin II coupled with decreased Adra1a expression enhances cardiac hypertrophy in pregnancy-associated hypertensive mice.

Cardiac hypertrophy is a crucial risk factor for hypertensive disorders during pregnancy, but its progression during pregnancy remains unclear. We previously showed cardiac hypertrophy in a pregnancy-associated hypertensive (PAH) mouse model, in which an increase in angiotensin II (Ang II) levels was induced by human renin and human angiotensinogen, depending on pregnancy conditions. Here, to elucidate the factors involved in the progression of cardiac hypertrophy, we performed a comprehensive analysis of changes in gene expression in the hearts of PAH mice and compared them with those in control mice. We found that alpha-1A adrenergic receptor (Adra1a) mRNA levels in the heart were significantly reduced under PAH conditions, whereas the renin-angiotensin system was upregulated. Furthermore, we found that Adra1a-deficient PAH mice exhibited more severe cardiac hypertrophy than PAH mice. Our study suggests that Adra1a levels are regulated by renin-angiotensin system and that changes in Adra1a expression are involved in progressive cardiac hypertrophy in PAH mice.

Hepatocyte- or macrophage-specific SREBP-1a deficiency in mice exacerbates methionine- and choline-deficient diet-induced nonalcoholic fatty liver disease.

Sterol regulatory element-binding proteins (SREBPs) are master transcription factors for lipid synthesis, and SREBP-1 is important for fatty acid and triglyceride synthesis. SREBP-1 has two isoforms, SREBP-1a and SREBP-1c, which are splicing variants transcribed from the Srebf1 gene. Although SREBP-1a exhibits stronger transcriptional activity than SREBP-1c, hepatic SREBP-1c is considered more physiologically important. We generated SREBP-1a flox mice using the CRISPR/Cas9 system and hepatocyte- and macrophage-specific SREBP-1a knockout (KO) mice (LKO, liver-knockout; and mΦKO, macrophage-knockout). There were no significant differences among all the mouse genotypes upon feeding with a normal diet. However, feeding with a methionine- and choline-deficient (MCD) diet resulted in exacerbated liver injury in both KO mice. In LKO mice, fatty liver was unexpectedly exacerbated, leading to macrophage infiltration and inflammation. In contrast, in mΦKO mice, the fatty liver state was similar to that in flox mice, but the polarity of the macrophages in the liver was transformed into a proinflammatory M1 subtype, resulting in the exacerbation of inflammation. Taken together, we found that SREBP-1a does not contribute to hepatic lipogenesis, but in either hepatocytes or macrophages distinctly controls the onset of pathological conditions in MCD diet-induced hepatitis.NEW & NOTEWORTHY Hepatocyte- and macrophage-specific SREBP-1a knockout mice were generated for the first time. This study reveals that SREBP-1a does not contribute to hepatic lipogenesis, but in either hepatocytes or macrophages distinctly controls the onset of pathological conditions in methionine- and choline-deficient diet-induced hepatitis.

Starvation-induced transcription factor CREBH negatively governs body growth by controlling GH signaling.

cAMP responsive element-binding protein H (CREBH) is a hepatic transcription factor to be activated during fasting. We generated CREBH knock-in flox mice, and then generated liver-specific CREBH transgenic (CREBH L-Tg) mice in an active form. CREBH L-Tg mice showed a delay in growth in the postnatal stage. Plasma growth hormone (GH) levels were significantly increased in CREBH L-Tg mice, but plasma insulin-like growth factor 1 (IGF1) levels were significantly decreased, indicating GH resistance. In addition, CREBH overexpression significantly increased hepatic mRNA and plasma levels of FGF21, which is thought to be as one of the causes of growth delay. However, the additional ablation of FGF21 in CREBH L-Tg mice could not correct GH resistance at all. CREBH L-Tg mice sustained GH receptor (GHR) reduction and the increase of IGF binding protein 1 (IGFBP1) in the liver regardless of FGF21. As GHR is a first step in GH signaling, the reduction of GHR leads to impairment of GH signaling. These data suggest that CREBH negatively regulates growth in the postnatal growth stage via various pathways as an abundant energy response by antagonizing GH signaling.

Perirenal lymphatic systems: Evaluation using spectral presaturation with inversion recovery T2 -weighted MR images with 3D volume isotropic turbo spin-echo acquisition at 3.0T.

PURPOSE: To evaluate the normal anatomy of the perirenal lymphatics using spectral presaturation with inversion recovery (SPIR) T2 -weighted magnetic resonance imaging (MRI) with 3D volume isotropic turbo spin-echo acquisition (VISTA) at 3.0T. MATERIALS AND METHODS: This retrospective study was approved by the two Institutional Review Boards and informed consent was waived. Thin-collimated axial images obtained using SPIR T2 -weighted MR imaging sequences with 3D VISTA at 3.0T from 50 patients (100 kidneys) with normal renal function were retrospectively reviewed. The perirenal lymphatic vessels were defined as fluid signal intensity structures on this MRI sequence. Two readers independently assessed the degree of visualization of the perirenal lymphatics using a 4-point scale in four anatomical regions, including the renal hilar, capsular, communicating pericapsular, and subfascial lymphatics, and interobserver agreement was evaluated with weighted kappa statics. The detectability of each lymphatic system was calculated for each reader using confidence level ratings of grades 1 and 2 as positive and grades 3 and 4 as negative. RESULTS: Interobserver agreement for the visualization grades was almost perfect (kappa value = 0.9). The renal hilar lymphatics along the renal vein were clearly identified in all patients. The detectability of other perirenal lymphatics was 44% for the capsular lymphatics, 39% for communicating pericapsular lymphatics, and 22% for the subfascial lymphatics. There was no laterality regarding the detectability of the perirenal lymphatics. CONCLUSION: The findings of this study support the feasibility of SPIR T2 -weighted MR images with 3D-VISTA at 3.0T for evaluating the perirenal lymphatic systems. J. MAGN. RESON. IMAGING 2016;44:897-905.

Beak-Like Extension of the Pancreatic Uncinate Process on MDCT: Is It Hyperplasia or Movement?

OBJECTIVE: We aimed to evaluate the pancreatic uncinate process with a beak-like extension (BLE) beyond the left border of the superior mesenteric artery, to define the cause of BLE, and to differentiate BLE from hyperplasia. METHODS: We retrospectively reviewed 1042 triple-phase contrast-enhanced multidetector-row computed tomography (3P-CE-MDCT) examinations of 500 patients. Finally, 38 patients (28 men, 10 women; mean age, 66 years) with 140 3P-CE-MDCT images showing BLE were studied regarding BLE size, contour, and cause. The superior mesenteric artery position was also evaluated. RESULTS: Beak-like extensions were found in 7.6% of patients. Most were caused by movement of the small bowel mesentery (n = 21, 55%), with deviation of mesenteric vessels or mass effect from expanded adjacent organs (n = 3, 8%). Seven patients (18.5%) had true hyperplasia. CONCLUSIONS: Beak-like extension is caused by movement of the small bowel mesentery with deviation of mesenteric vessels or by adjacent organ expansion. Beak-like extension closely mimics other pathology on nonenhanced MDCT.

Lymphatic pathway around the pancreatic head and extrahepatic bile duct: evaluation using MR imaging at 3.0-T.

PURPOSE: To evaluate the utility of spectral presaturation with inversion recovery (SPIR) T2-weighted images with 3-dimensional (3D) volume isotropic turbo spin echo acquisition (VISTA) at 3.0-T for the detection of the normal lymphatic systems located around the pancreatic head and extrahepatic bile duct. MATERIALS AND METHODS: Fifty-six patients with suspected hepatic or pancreaticobiliary diseases and diagnosed as normal or benign pathologies were evaluated as having normal lymphatic systems. The protocol consisted of SPIR T2-weighted sequences with 3D-VISTA. The lymphatic systems were defined as fluid signal intensity structures and divided into eight portions and interobserver agreement was evaluated using weighted kappa statistics. Three readers graded the visualization of each portion using a five-point scale. The detectability of each portion was calculated by defining grades 1-2 as detectable and grades 3-5 as undetectable. RESULTS: Interobserver agreement regarding the visualization grades was moderate to almost perfect. All readers rated the detectability of the lymphatic systems of the superior and posterior portions of the pancreatic head, pericholedochal, right abdominoaortic, and interaorticovenous portions as 100%, and that of the anterior portion of the pancreatic head as 98.2%. For the inferior portion of the pancreatic head, the detectability was 100% for reader 2 and 96.4% for readers 1 and 3. CONCLUSION: The lymphatic systems located around the pancreatic head and extrahepatic bile duct could be sufficiently visualized on SPIR T2-weighted images with 3D-VISTA at 3.0-T.

Pancreatic neuroendocrine tumor with extensive intraductal invasion of the main pancreatic duct: a case report.

CONTEXT: Pancreatic neuroendocrine tumors account for only 1-3% of all pancreatic neoplasms and the intraductal invasion of the main pancreatic duct (MPD) is rare. CASE REPORT: We report a case of a 26-year-old woman with an endocrine tumor of the pancreas extensively invading into the MPD. She presented abdominal pain and her laboratory data showed abnormal liver function. Contrast-enhanced computed tomography demonstrated a well-enhanced mass on the arterial dominant phase in the head of the pancreas. The mass grew within the lumen of the MPD in the body of the pancreas, with dilatation of the upstream MPD. The contrast-enhancement pattern between the main tumor of the head and the intraductal lesion of the body was different. On T2-weighted magnetic resonance (MR) imaging, the pancreatic head lesion showed non homogeneously low signal intensity, while the intraductal lesion of the pancreatic body showed high signal intensity. MR cholangiopancreatography showed obstruction of the MPD in the pancreatic head to body, with dilatation of the upstream MPD. An endocrine tumor or acinar cell carcinoma of the pancreas was considered as preoperative diagnosis, and pancreaticoduodenectomy was performed. As a result, pancreatic endocrine tumor (G2) was confirmed pathologically. CONCLUSION: A rare case of pancreatic neuroendocrine tumor with extensive growth within the MPD was presented. The intraductal extension is a unique growth pattern of nonfunctioning pancreatic neuroendocrine tumor, and the desmoplastic reaction in this tumor may reflect the increased invasiveness.

Pancreatic mixed acinar-neuroendocrine carcinoma with intraductal growth: A case report with radiologic-pathologic correlations.

Pancreatic mixed acinar-neuroendocrine carcinomas are rare malignant tumors of the pancreas. They are composed histologically of both acinar and neuroendocrine cells. The pancreatic duct is known to be an important site of tumor growth for acinar cell carcinomas, neuroendocrine tumors, and intraductal tubulopapillary neoplasms. To the best of our knowledge, there has been only 1 report of a mixed acinar-neuroendocrine carcinoma growing into the pancreatic duct and no reports detailing imaging findings with this tumor. We here report a 69-year-old man who presented with worsening glycemic control. Multiphase contrast-enhanced computed tomography and magnetic resonance imaging revealed a well-circumscribed mass with poor contrast enhancement in the pancreatic tail region of the pancreatic duct. The intraductal mass showed diffusion restriction on magnetic resonance imaging. These imaging findings are consistent with the expansive, smooth-surfaced polypoid tumor of low vascularity and high cellularity that was diagnosed pathologically. Mixed acinar-neuroendocrine carcinomas should be included in the differential diagnosis of intraductal tumors of the pancreas with poor contrast enhancement and diffusion restriction.

Extrahepatic bile duct cancer: invasion of the posterior hepatic plexuses--evaluation using multidetector CT.

PURPOSE: To assess the utility of axial and coronal reformatted multidetector computed tomographic (CT) images in the evaluation of the invasion of posterior hepatic plexuses by extrahepatic bile duct cancer. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and informed consent was waived. Forty-three patients (22 men, 21 women; age range, 40-80 years; mean age, 65 years) with surgically resected cancer involving the extrahepatic bile duct between December 2004 and September 2010 were included. Posterior hepatic plexus 1 runs from the superior and middle bile duct to the right celiac ganglion, and posterior hepatic plexus 2 runs between the lower bile duct and right celiac ganglion behind the portal vein. Invasion of the posterior hepatic plexuses was elucidated by using pathologic and postoperative multidetector CT findings. Three radiologists independently evaluated the preoperative axial and coronal reformatted images with a separate viewing session for the invasion of posterior hepatic plexuses that was detected on the basis of the presence of increased attenuation of fat tissue along the nerve routes. Receiver operating characteristic analysis was performed to compare the diagnostic performance of the two image interpretations. RESULTS: Invasion of posterior hepatic plexus 1 and of posterior hepatic plexus 2 was recognized in 10 (23%) and nine (21%) of 43 patients, respectively. The diagnostic performance of coronal reformatted image interpretation was significantly greater than that for axial image interpretation (mean area under the curve, 0.99 vs 0.89, P = .04; mean accuracy, 95% vs 82%, P = .003). In all reviewers, one false-positive diagnosis of the invasion of posterior hepatic plexus occurred on axial and/or coronal image display types because of fibrosis and inflammatory cell infiltration along these plexus routes. CONCLUSION: Coronal reformatted images can be useful for accurate diagnosis of the invasion of posterior hepatic plexuses and may facilitate surgical decision making in regard to the resection of celiac ganglion.

Intraductal papillary mucinous neoplasms of the pancreas complicated with intraductal hemorrhage, perforation, and fistula formation: CT and MR imaging findings with pathologic correlation.

OBJECTIVE: To correlate the CT and MR images with pathologic findings on intraductal papillary mucinous neoplasms (IPMNs) complicated with intraductal hemorrhage, perforation, and fistula. MATERIALS AND METHODS: We retrospectively evaluated the CT (n = 5), MR imaging (n = 4), and pathological features of five IPMN patients complicated with intraductal hemorrhage (n = 5), perforation (n = 1), and fistula into the duodenum and jejunum (n = 1). RESULTS: Intraductal hemorrhage could be detected as high attenuation on non-contrast CT in two of the five cases, and as high signal intensity on fat-suppressed T1-weighted MR images in all four of the cases. Perforation and fistula could be recognized on CT images. In all IPMNs, denuded epitheliums were observed pathologically. Dissolution of the duct wall and extension of mucinous materials were seen at the area of denuded epithelium. Perforations and fistula, without evidence of cancer invasion, were recognized in the dissolved duct wall. Pathogenesis of the perforations and fistula formations appeared to be related to excessive pressure in the dilated ducts and autodigestion of enzyme-rich fluids. CONCLUSION: Complications with IPMN could be recognized on CT and fat-suppressed T1-weighted MR images. Intraductal hemorrhage might be predictive sign of perforation and fistula formation.

"Peripancreatic strands appearance" in pancreatic body and tail carcinoma: evaluation by multi-detector CT with pathological correlation.

OBJECTIVES: In pancreatic body and tail carcinoma, "peripancreatic strands appearance" is frequently seen on multidetector CT (MDCT). The purpose of this study was to clarify the pathological and clinical implications of peripancreatic strands appearance. METHODS: We retrospectively evaluated MDCT images in 17 patients with pancreatic body and tail carcinoma who underwent surgical resection. Peripancreatic strands appearance was defined as the strands structure deriving from the primary lesion and associated with increased CT attenuation of surrounding adipose tissues. All CT examinations were performed by contrast-enhanced MDCT with a multiplanar reformation technique. RESULTS: Peripancreatic strands appearance was detected on MDCT in 13 (76%) patients. The maximum width of the peripancreatic strands seen on MDCT was 1.55 ± 0.36 mm (range, 1.0-2.5 mm). This CT finding was well correlated with extrapancreatic carcinoma invasion with marked fibrotic thickening of adipose tissue septa, including microvessels. This pathological finding was confirmed in all 13 patients with positive CT finding whereas it was not confirmed in the 4 patients with negative CT finding. CONCLUSION: Peripancreatic strands appearance on MDCT in pancreatic body and tail carcinoma reflects extrapancreatic carcinoma invasion with marked fibrotic thickening of adipose tissue septa. This CT finding would indicate the property of carcinoma aggressiveness.

"Honeycomb" appearance in large-duct type pancreatic ductal adenocarcinoma: Case report with radiologic-pathologic correlation.

Large-duct type pancreatic ductal adenocarcinoma (PDA) is a rare morphologic variant forming large duct elements. This case report, to our knowledge, is the first report of a large-duct type PDA with a "honeycomb" appearance resembling a serous cystic neoplasm (SCN) on CT and MRI. The patient is an 82-year-old woman who presented with upper abdominal pain. Dynamic contrast-enhanced CT revealed a multilocular cyst with honeycomb loculi, in which the cyst walls showed gradual enhancement. On T2-weighted MRI, the mass displayed inhomogeneous hyperintensity characterized by a honeycomb appearance with irregular and thick hypointense cyst walls. The patient underwent distal pancreatectomy; histopathological diagnosis was large-duct type PDA. Although the imaging features of large-duct type PDA may resemble those of SCN, this distinction between PDA and SCN is important because the treatment options are very different.

Wogonin, a Compound in Scutellaria baicalensis, Activates ATF4-FGF21 Signaling in Mouse Hepatocyte AML12 Cells.

Fibroblast growth factor 21 (FGF21), which is mainly synthesized and secreted by the liver, plays a crucial role in systemic glucose and lipid metabolism, ameliorating metabolic diseases. In this study, we screened the WAKANYAKU library derived from medicinal herbs to identify compounds that can activate Fgf21 expression in mouse hepatocyte AML12 cells. We identified Scutellaria baicalensis root extract and one of its components, wogonin, as an activator of Fgf21 expression. Wogonin also enhanced the expression of activating transcription factor 4 (ATF4) by a mechanism other than ER stress. Knockdown of ATF4 by siRNA suppressed wogonin-induced Fgf21 expression, highlighting its essential role in wogonin's mode of action. Thus, our results indicate that wogonin would be a strong candidate for a therapeutic to improve metabolic diseases by enhancing hepatic FGF21 production.

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.

Pancreatic adenocarcinoma versus chronic pancreatitis: differentiation with triple-phase helical CT.

BACKGROUND: Chronic pancreatitis and pancreatic adenocarcinoma often show similar clinical and imaging appearances. This study aims to differentiate chronic pancreatitis from pancreatic adenocarcinoma by defining enhancement patterns in both pathologic conditions during triple-phase helical CT. METHODS: The study included 42 patients with chronic pancreatitis and 85 patients with pancreatic adenocarcinoma. CT images obtained according to protocol A (scan delays, 30, 60, and 150 s; 300 mg I/mL contrast material) or protocol B (scan delays, 40, 70, and 150 s; 370 mg I/mL contrast material) were retrospectively evaluated. RESULTS: Mean contrast enhancement value of normal pancreas peaked in the first phase (early-washout pattern) while that of chronic pancreatitis peaked in the second phase (delayed-washout pattern), and that of pancreatic adenocarcinoma gradually rose (increasing pattern) in both protocols. Diagnostic indices for pancreatic adenocarcinoma were 82.4% and 94.1% for sensitivity, 83% and 83% for specificity, 82.7% and 90.4% for accuracy in protocols A and B, respectively, when differentiation between chronic pancreatitis and pancreatic adenocarcinoma was performed based on time-attenuation curve patterns. CONCLUSION: Our results indicate that time attenuation curves obtained from triple-phase helical CT in protocol B provide useful information in differentiating chronic pancreatitis from pancreatic adenocarcinoma.

Arterial supply to the pancreas; variations and cross-sectional anatomy.

The pancreas has complex arterial supplies. Therefore, special attention should be paid in pancreatic arterial intervention for patients with acute pancreatitis and pancreatic carcinomas. Knowledge of pancreatic arterial anatomy and arterial territory is important not only to perform pancreatic arterial intervention, but to read the pancreatic angiography and cross-sectional image. We reviewed 226 selective abdominal angiography and CT scans during selective arteriography (CTA) of common hepatic artery, superior mesenteric artery, splenic artery, or peripancreatic arteries including posterior superior pancreaticoduodenal artery, anterior superior pancreaticoduodenal artery, inferior pancreaticoduodenal artery, and dorsal pancreatic artery. CTA images were evaluated to clarify the cross-sectional anatomy of the pancreatic arterial territory. Variations of the peripancreatic arteries were also investigated. In this exhibit, schemes and illustrative cases demonstrate pancreatic arterial territory and variations.

Invasive carcinomas originating from intraductal papillary mucinous neoplasms of the pancreas: conspicuity and primary sites of the solid masses on triple-phase dynamic CT imaging.

OBJECTIVE: To assess the conspicuity of invasive carcinomas (solid masses) originating from pancreatic intraductal papillary mucinous neoplasms (invasive IPMNs) and the primary sites of the solid masses on thin-slice dynamic CT. METHODS: Twenty patients with pathologically proven invasive IPMNs underwent triple-phase dynamic CT examinations (arterial, portal, and delayed phases). Qualitative and quantitative analyses of conspicuity of the solid masses were performed for all phases. The primary sites [branch duct and/or main pancreatic duct (MPD)] of the solid masses were evaluated on CT in comparison to the pathologic findings. RESULTS: The qualitative and quantitative analyses of the conspicuity of the solid masses showed that the arterial phase images were superior to those of the portal and delayed phases. The primary sites of the solid mass were histopathologically diagnosed as branch ducts in 6 (30%) patients, MPD in 13 (65%), and both branch ducts and the MPD in one (5%). The sensitivity and specificity of the CT evaluation of the primary sites were 100% for the branch ducts, and for the MPD 93% and 100%, respectively. CONCLUSION: Arterial phase images are useful for the diagnosis of invasive IPMNs, and attention should be paid to pancreatic parenchyma surrounding the MPD when detecting invasive carcinomas.

Peripancreatic lymphatic invasion by pancreatic carcinoma: evaluation with multi-detector row CT.

Peripancreatic lymphatic networks are frequently involved in pancreatobiliary carcinoma, affecting the prognosis. However, little attention has been paid to CT imaging of normal and pathological conditions of peripancreatic lymphatic networks. We evaluated multi-detector row CT (MDCT) images of peripancreatic lymphatic networks invaded by pancreatic carcinoma and compared them with those of normal peripancreatic lymphatic networks using imaging reconstruction every 1 mm with a multiplanar reformation technique. Apart from the region around the pancreatic body and tail, normal peripancreatic lymphatic networks were detected as "linear structures" on MDCT. However, peripancreatic lymphatic invasion by pancreatic carcinoma was frequently identified as "reticular," "tubular," or "soft tissue mass" appearances in the peripancreatic fat tissues. Peripancreatic lymphatic invasion by pancreatic carcinoma was more frequently detected around the common hepatic artery, celiac artery, superior mesenteric artery, and left para-aortic area. Depending on the tumor location, positive peripancreatic lymphatic invasion was most frequent at the area around the common hepatic artery in the head region and at the area around the celiac artery in the body and tail regions. Knowledge of CT imaging of normal and pathological peripancreatic lymphatic networks is essential for determining the accurate staging of pancreatic carcinoma.

Fibrous stroma and vascularity of pancreatic carcinoma: correlation with enhancement patterns on CT.

OBJECTIVE: To demonstrate the contrast-enhancement behavior of pancreatic carcinoma on dynamic contrast-enhanced CT (DCE-CT), and the relationship between the degree of contrast-enhancement and the vascularity (vessel density) and amount of fibrous stroma (fibrosis within the tumor) on pathological specimen. METHODS: The contrast-enhancement values were measured by producing the subtracting images for obtaining largest region of interests to reduce measurement errors and variability. Vascularity was determined by immunostaining of the tissue sections with factor 8 and the fibrous stroma was determined by picrosirius staining. Correlation of the findings of DCE-CT with pathological findings was performed in 21 patients with pancreatic carcinoma. RESULTS: All but one patient exhibited a gradually increasing enhancement, but there was considerably wide range in contrast-enhancement values of tumors. Examination of the overall relationship between vascularity and fibrous stroma with contrast-enhancement behavior showed that tumor with more fibrosis and higher vascularity had a higher contrast effect through all phases of dynamic study. Tumors having liver metastases tended to be less fibrotic than tumors without liver metastases. CONCLUSION: The contrast-enhancement behavior of pancreatic carcinoma may be helpful in estimating vascularity and the extent of tumor fibrosis and possibility of liver metastases.

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.