Clinical significance of main pancreatic duct dilation on computed tomography: single and double duct dilation.
OBJECTIVE
To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases.


METHODS
Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records.


RESULTS
Seventy-seven patients were identified in this study. Chronic pancreatitis and pancreatic cancer were the most common causes of the main pancreatic duct dilation on CT. Although the majority of patients with isolated dilation of the main pancreatic duct (single duct dilation) had chronic pancreatitis, one-third of patients with single duct dilation but without chronic pancreatitis had pancreatic malignancies, whereas most of patients with concomitant biliary duct dilation (double duct dilation) had pancreatic cancer.


CONCLUSIONS
Patients with pancreatic double duct dilation need extensive work up and careful follow-up since a majority of these patients are ultimately diagnosed with pancreatic cancer. Patients with single duct dilation, especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.
Edge
Mark-D
MD
Division of Digestive Diseases, 1365 Clifton Road, NE, Suite B1262, Emory University School of Medicine, Atlanta, GA 30322, USA.
Hoteit
Maarouf
M
Patel
Amil-P
AP
Wang
Xiaoping
X
Baumgarten
Deborah A
DA
Cai
Qiang
Q
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging* / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D050500:Pancreatitis, Chronic / Q000150:complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed