Pancreatic manifestations of von Hippel-Lindau disease-effect of imaging on clinical management.
OBJECTIVE
To assess the impact of imaging on pancreatic lesion management in von Hippel-Lindau disease (VHL).


METHODS
We reviewed sequential computed tomography (CT) and magnetic resonance examinations (1997-2008) of 33 patients with VHL who had at least 1 pancreatic lesion.


RESULTS
One hundred sixty-seven imaging studies demonstrated innumerable simple pancreatic cysts and 58 complex pancreatic masses: 24 were complex cystic and 34 were solid (30 small [<or=2 cm] and 4 large [>2 cm]). Aggregate annual growth was significant in complex cystic and solid masses (mean, 0.39 cm/y [P = 0.006] and 0.14 cm/y [P = 0.045]). Solid mass growth differed by size (small: 0.06 cm/y [range, -0.09 to 0.31 cm/y]; large: 1.28 cm/y [range, 0-1.98 cm/y]). Thirteen masses were excised. No patient developed metastases. Arterial-phase CT improved (P = 0.0003) solid mass detection, but 28% of studies still underreported the total number.


CONCLUSIONS
Most pancreatic masses in VHL do not require annual surveillance. Arterial-phase CT improves mass detection, but many masses remain prospectively missed.
Davenport
Matthew S
MS
Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA. matdaven@med.umich.edu
Caoili
Elaine M
EM
Cohan
Richard H
RH
Hoff
Carrie N
CN
Ellis
James H
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007472:Iohexol / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult; D006623:von Hippel-Lindau Disease / Q000000981:diagnostic imaging* / Q000473:pathology*
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide; D019786:Gadolinium DTPA