Pancreatic arteriovenous malformation: a case report of hemodynamic and three-dimensional morphological analysis using multi-detector row computed tomography and post-processing methods.
BACKGROUND
Although rare, a pancreatic arteriovenous malformation can have serious consequences. A diagnosis of arteriovenous malformation requires evidence of aberrant communication between the arterial and the venous systems. This report describes a case where the use of multi-detector row CT and specific post-processing methods provided a diagnosis of arteriovenous malformation. This minimally invasive diagnostic approach resulted in a clear, precise and comprehensive visual representation of the pancreatic arteriovenous malformation.


METHODS
A 60-year-old man with right hypochondriac pain presented with a mass in the head of the pancreas. The hypochondriac pain resolved spontaneously and physical examination revealed no abnormal findings. A multi-detector row CT study was performed. The data obtained in the arterial phase demonstrated a high-contrast mass in the head of the pancreas and early enhancement of the portal vein. A maximum intensity projection method clarified the aberrant vascular communication. Changes in Hounsfield numbers were observed using a multi-planar reformation method. A volume-rendering method was used to create a 3D model which demonstrated the spatial relationship between the aberrant vascular communication and the surrounding tissue. An annual follow-up study using this technique showed no significant alteration.


CONCLUSIONS
Multi-detector row CT with specific post-processing methods is a useful diagnostic tool for pancreatic arteriovenous malformation.
Endo
Kazuhiro
K
Department of Surgery, Jichi Medical University, Tochigi, Japan. kendo@jichi.ac.jp
Sata
Naohiro
N
Shimura
Kunihiko
K
Yasuda
Yoshikazu
Y
D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging*; D003198:Computer Simulation; D006439:Hemodynamics; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010179:Pancreas / Q000002:abnormalities / Q000098:blood supply* / Q000000981:diagnostic imaging; D011169:Portal Vein / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011172:Portography / Q000295:instrumentation / Q000379:methods; D011856:Radiographic Image Enhancement / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*