title: Pancreatic involvement in hereditary hemorrhagic telangiectasia: assessment with multidetector helical CT.
abstract: OBJECTIVE
  To evaluate and describe pancreatic involvement by using multidetector computed tomography (CT) in patients with a diagnosis of hereditary hemorrhagic telangiectasia (HHT).
  
  
  METHODS
  Institutional review board approval was obtained, and all patients provided informed consent. Across 12 months, all consecutive adult patients with a confirmed diagnosis of HHT referred to our pluridisciplinary HHT center for evaluation were enrolled prospectively in the study and underwent contrast material-enhanced multidetector CT of the abdomen. Pancreatic telangiectases and arteriovenous fistulas were noted, and their characteristics were described. Genetic mutation was also investigated.
  
  
  RESULTS
  Thirty-five patients (19 women, 16 men; mean age, 48.4 years) were included. All patients were asymptomatic. A genetic mutation was identified in 28 (80%) patients, including endoglin in 16 (57%), activin type-II-like receptor kinase 1 (ALK1) in 11 (39%), and SMAD4 in one (4%). Eleven (31%) patients exhibited pancreatic involvement. Fifty-four percent of patients with ALK1 mutation had pancreatic involvement. Twenty-three pancreatic telangiectases were identified during the arterial phase in nine patients. Seven pancreatic arteriovenous malformations (AVMs) were identified in four patients.
  
  
  CONCLUSIONS
  Pancreatic involvement commonly is found in patients with HHT (31% in our study), mainly in patients with ALK1 mutation; pancreatic telangiectases or AVMs are only diagnosed duringthe arterial phase at multidetector CT.
authors.affiliation: Department of Radiology, Pluridisciplinary HHT Center, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Université Paris Ile-de-France Ouest, 9, avenue Charles de Gaulle, 92104 Boulogne CEDEX, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Lacout
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pelage
authors.forename: Gilles
authors.initials: G
authors.lastname: Lesur
authors.forename: Thierry
authors.initials: T
authors.lastname: Chinet
authors.forename: Alain
authors.initials: A
authors.lastname: Beauchet
authors.forename: Joëlle
authors.initials: J
authors.lastname: Roume
authors.forename: Pascal
authors.initials: P
authors.lastname: Lacombe
mesh_terms: D030301:Activin Receptors, Type II / Q000235:genetics; D000293:Adolescent; D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications* / Q000000981:diagnostic imaging* / Q000235:genetics; D036542:Tomography, Spiral Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C425364:ACVRL1 protein, human; D030301:Activin Receptors, Type II