Diffuse pancreatic ductal adenocarcinoma: characteristic imaging features.
OBJECTIVE
To evaluate imaging findings of diffuse pancreatic ductal adenocarcinoma.


METHODS
We included 14 patients (4 men and 10 women; mean age, 64.5 years) with diffuse pancreatic ductal adenocarcinoma on the basis of retrospective radiological review. Two radiologists retrospectively reviewed 14 CT scans in consensus with respect to the following: tumor site, peripheral capsule-like structure, dilatation of intratumoral pancreatic duct, parenchymal atrophy, and ancillary findings. Eight magnetic resonance (MR) examinations with MR cholangiopancreatography (MRCP) and seven endoscopic retrograde cholangiopancreatography (ERCP) were also reviewed, focusing on peripheral capsule-like structure and dilatation of intratumoral pancreatic duct.


RESULTS
CT revealed tumor localization to the body and tail in 11 (79%) patients and peripheral capsule-like structure in 13 (93%). The intratumoral pancreatic duct was not visible in 13 (93%). Pancreatic parenchymal atrophy was not present in all 14 patients. Tumor invasion of vessels was observed in all 14 patients and of neighbor organs in 8 (57%). On contrast-enhanced T1-weighted MR images, peripheral capsule-like structure showed higher signal intensity in five patients (71%). In all 11 patients with MRCP and/or ERCP, the intratumoral pancreatic duct was not dilated.


CONCLUSIONS
Diffuse pancreatic ductal adenocarcinoma has characteristic imaging findings, including peripheral capsule-like structure, local invasiveness, and absence of both dilatation of intratumoral pancreatic duct and parenchymal atrophy.
Choi
Young Jun
YJ
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Byun
Jae Ho
JH
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea. Electronic address: jhbyun@amc.seoul.kr.
Kim
Ji-Youn
JY
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Kim
Myung-Hwan
MH
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Jang
Se Jin
SJ
Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Ha
Hyun Kwon
HK
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Lee
Moon-Gyu
MG
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide; D019786:Gadolinium DTPA