title: Beak-Like Extension of the Pancreatic Uncinate Process on MDCT: Is It Hyperplasia or Movement?
abstract: OBJECTIVE
  We aimed to evaluate the pancreatic uncinate process with a beak-like extension (BLE) beyond the left border of the superior mesenteric artery, to define the cause of BLE, and to differentiate BLE from hyperplasia.
  
  
  METHODS
  We retrospectively reviewed 1042 triple-phase contrast-enhanced multidetector-row computed tomography (3P-CE-MDCT) examinations of 500 patients. Finally, 38 patients (28 men, 10 women; mean age, 66 years) with 140 3P-CE-MDCT images showing BLE were studied regarding BLE size, contour, and cause. The superior mesenteric artery position was also evaluated.
  
  
  RESULTS
  Beak-like extensions were found in 7.6% of patients. Most were caused by movement of the small bowel mesentery (n = 21, 55%), with deviation of mesenteric vessels or mass effect from expanded adjacent organs (n = 3, 8%). Seven patients (18.5%) had true hyperplasia.
  
  
  CONCLUSIONS
  Beak-like extension is caused by movement of the small bowel mesentery with deviation of mesenteric vessels or by adjacent organ expansion. Beak-like extension closely mimics other pathology on nonenhanced MDCT.
authors.affiliation: From the Department of Radiology, Oita University Faculty of Medicine, Yufu City, Oita, Japan.
authors.forename: Ahmad Khalid
authors.initials: AK
authors.lastname: Omeri
authors.forename: Shunro
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Maki
authors.initials: M
authors.lastname: Kiyonaga
authors.forename: Ryo
authors.initials: R
authors.lastname: Takaji
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Yamada
authors.forename: Hiromu
authors.initials: H
authors.lastname: Mori
mesh_terms: D016477:Artifacts; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008643:Mesentery / Q000000981:diagnostic imaging* / Q000473:pathology*; D008875:Middle Aged; D009038:Motion; D009068:Movement; D061330:Multidetector Computed Tomography / Q000379:methods*; D015588:Observer Variation; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity