Medical imaging in misdiagnosing serous cystic neoplasms of the pancreas with pancreatic duct dilatation as other pancreatic lessions / 中华肝胆外科杂志

ABSTRACT

Objective:To analyze the medical imaging in misdiagnosing serous cystic neoplasm(SCN) of the pancreas with pancreatic duct dilatation as other pancreatic lesions.Methods:Data of 21 patients with SCN and pancreatic duct dilatation who underwent surgical resection from January 2011 to November 2021 at the First Affiliated Hospital of Naval Medical University were retrospectively analyzed. There were 9 males and 12 females with ages ranging from 25 to 74, mean ± s. d. (57.4±13.4) years. The clinical features, surgical treatments, CT and MRI imaging features, and misdiagnosis were analyzed.Results:Of 11 patients who presented with abdominal pain, 1 patient had backache, 1 patient was jaundice, 1 patient had weight loss, 1 patinet had fatigue and 6 patients were asymptomatic. Ten patients were operated using pancreaticoduodenectomy, 8 distal pancreatectomy, 2 segmental pancreatectomy and 1 total pancreatectomy. For 11 patients, the lesion was located in the head of pancreas, and for 10 patients in the body and tail of pancreas. The tumor size was 23.0-92.0 (45.8±17.8) mm. All 21 patients had upstream pancreatic duct dilatation but no downstream pancreatic duct dilatation. The inner diameter of the pancreatic duct was 4.0-11.0(7.1±2.0) mm. Of 13 patients showed a low signal intensity on T 1-weighted imaging, 18 patients showed a markedly high signal intensity on T 2-weighted imaging, 13 patients showed no limitation on diffusion weighted imaging. Among the 11 patients who underwent CT examination, 5 patients were diagnosed to have intraductal papillary mucinous neoplesm (IPMN), 3 SCN, 1 pancreatic neuroendocrine tumor, 1 pancreatic cancer and 1 cyst. The misdiagnotic rate of CT was 72.7% (8/11). Among the 18 patients who underwent MRI examination, 9 patients were diagnosed to have IPMN, 3 mucinous cystic neoplasm, 3 SCN, 2 pancreatic cancer and 1 solid pseudopapillary tumor. The misdiagnosis rate of MRI was 83.3% (15/18). Conclusion:SCN with pancreatic duct dilatation was easily misdiagnosed as IPMN or other pancreatic solid tumors. The difference between SCN with pancreatic duct dilatation and IPMN was that the downstream pancreatic duct of SCN was normal. SCN showed a markedly high signal intensity on T 2-weighted imaging and no limitation on diffusion weighted imaging, which can help to distinguish SCN from other pancreatic solid tumors.