Contrast-enhanced magnetic resonance pancreatography with gadoteridol by heavily T2-weighted three-dimensional fluid-attenuated inversion recovery: preliminary results in healthy subjects.

The purpose of this study was to investigate the feasibility of contrast-enhanced magnetic resonance (MR) pancreatography with intravenously administered gadolinium-based contrast material (GBCM) in healthy subjects. Eight healthy male subjects (age: 29-53 years old, median: 37 years old) were enrolled. Contrast-enhanced MR pancreatography was scanned with heavily T2-weighted three-dimensional fluid-attenuated inversion recovery (hT2W-3D-FLAIR) before and after intravenous GBCM administration. Two radiologists evaluated the images, referring to three-dimensional MR pancreatography by consensus. Scanning was performed five times at 1.5-h intervals (at 0.5, 2, 3.5, 5, and 6.5 h) after GBCM administration. In all subjects, pre-contrast-enhanced hT2W-3D-FLAIR images demonstrated no visualization of the main pancreatic duct. After GBCM administration, the main pancreatic duct was visualized in all subjects at 0.5 h (n=4, 50%) and/or 2 h (n=7, 88%). The mean signal intensity of the main pancreatic duct was 3.17 ± 0.78 at pre-contrast enhancement, 7.96 ± 4.60 at 0.5 h, and 8.08 ± 4.64 at 2 h. The signal intensity ratio of the main pancreatic duct against the pancreatic parenchyma was statistically higher (P < 0.01) at the 0.5-h and 2-h scans than that of pre-contrast-enhanced scan. Intravenously administered GBCM seeped into the pancreatic duct in sufficient concentration to alter the appearance of the main pancreatic duct by hT2W-3D-FLAIR in healthy subjects.

Differentiation of focal-type autoimmune pancreatitis from pancreatic carcinoma: assessment by multiphase contrast-enhanced CT.

OBJECTIVES: To evaluate the utility of multiphase contrast-enhanced computed tomography (CT) findings alone and in combination for differentiating focal-type autoimmune pancreatitis (f-AIP) from pancreatic carcinoma (PC). METHODS: The study group comprised 22 f-AIP lesions and 61 PC lesions. Two radiologists independently evaluated CT findings. Frequencies of findings were compared between f-AIP and PC. Statistical, univariate and multivariate analyses were performed. RESULTS: Homogeneous enhancement during the portal phase (AIP, 59 % vs. PC, 3 %; P < 0.001), dotted enhancement during the pancreatic phase (50 % vs. 7 %; P < 0.001), duct-penetrating sign (46 % vs. 2 %; P < 0.001), enhanced duct sign (36 % vs. 2 %; P < 0.001) and capsule-like rim (46 % vs. 3 %; P < 0.001) were more frequently observed in AIP. Ring-like enhancement during the delayed phase (5 % vs. 46 %; P < 0.001) and peripancreatic strands with a length of at least 10 mm (5 % vs. 39 %; P = 0.001) were more frequently observed in PC. AIP was identified with 82 % sensitivity and 98 % specificity using four of these seven findings. Multivariate analysis revealed significant differences in dotted enhancement (P = 0.004), duct-penetrating sign (P < 0.001) and capsule-like rim (P = 0.007). CONCLUSIONS: The combination of CT findings may allow improvements in differentiating f-AIP from PC. KEY POINTS: • f-AIP can mimic PC on imaging findings. • The differentiation of f-AIP from PC is important in patient management. • Some CT findings can be used to identify AIP. • The combination of CT findings will improve differentiation from PC.

[A case of secondary pulmonary malignant lymphoma with multiple pulmonary nodules and spiculation].

A 72-year-old man presented to our hospital with fatigue and anemia. Chest CT showed multiple nodular shadows. We first suspected lung cancer and multiple metastatic lesions because some nodules had spiculation. However, PET-CT revealed the small intestine, thyroid and rib as well as these nodules to be positive for FDG uptake, suggesting malignant lymphoma and lung involvement. For diagnosis, lung biopsy by video-assisted thoracic surgery (VATS) was performed. Pathologic examination of the lung biopsy specimen showed diffuse large B-cell lymphoma. We diagnosed secondary pulmonary malignant lymphoma.