Emphysematous pancreatitis: a rare entity with characteristic radiological findings.

The case was a 53-year-old male with a history of acute pancreatitis of biliary origin, and subsequent laparoscopic cholecystectomy, currently hospitalized due to a diagnosis of acute pancreatitis. Seventy-two hours after the onset of symptoms he had fever, uncontrolled pain, and elevated inflammatory markers. An abdominal computed tomography (CT) scan revealed an aerial collection at the pancreatic gland suggestive of emphysematous pancreatitis. Proteus vulgaris was isolated from pancreatic puncture and blood cultures. The patient developed septic shock, which required admission to the intensive care unit. Septic shock was initially controlled by percutaneous drainage. However, surgical debridement was also necessary in the following days.

¹8F-FDG PET/contrast enhanced CT in the standard surveillance of high risk colorectal cancer patients.

OBJECTIVE: To assess the accuracy of FDG-PET/contrast enhanced CT (FDG-PET/ceCT) in the detection of unsuspected recurrence of colorectal cancer (CRC) in patients with high risk of relapse. METHODS: Thirty-three patients (14 females and 19 males, mean age: 62, range: 41-78), with CRC in complete remission, were prospectively included. All patients underwent FDG-PET/ceCT (58 studies). FDG-PET/ceCT was requested in the surveillance setting, and performed following a standardized protocol. A portal venous phase CT scan was performed after the injection of iodinated contrast agent. An individual and combined assessment of both techniques (PET and ceCT) was performed. Concordant and discordant findings of PET, ceCT and FDG-PET/ceCT were compared in a patient-based and a lesion-based analysis. The final diagnosis, recurrence or disease free status (DFS), were established by histopathology or clinical/radiological follow-up of at least 6 months. RESULTS: Seven out of 33 patients had a confirmed recurrence and the rest of patients had a DFS. In a patient-based analysis the sensitivity and specificity of PET, ceCT and PET/ceCT was of 86% and 88%, 86% and 92%, 86% and 85%, respectively. Attending to the lesion-based analysis, the sensitivity for PET, ceCT and PET/ceCT was of 56%, 71% and 97%, respectively. Both techniques showed a good concordance in the establishment of the final patient status. However, on a lesion-based analysis, no concordance was observed between them. CONCLUSION: PET and ceCT seem to have similar value in the detection of unsuspected recurrence of CRC in a patient-based analysis. However, the combined assessment of PET/ceCT improves the accuracy in the lesion-based analysis.

Response assessment of colorectal liver metastases with contrast enhanced CT/18F-FDG PET.

PURPOSE: Evaluate the diagnostic performance of contrast enhanced CT/PET (ceCT/PET) in the response assessment of patients with colorectal cancer liver metastases. METHODS: 33 ce CT/PET studies of 19 patients with colorectal liver metastases were prospectively evaluated. All of them, 13 (68.4%) were males and 6 (31.6%) females. Mean age and range were 63 [42-78]. All patients were treated with neoadjuvant chemotherapy. In all cases post-therapy diagnostic confirmation of liver lesions was obtained. A ce CT PET/was obtained 1h after the injection of 370 MBq of 18F-FDG. Metabolic and morphologic studies were evaluated by two blinded nuclear physicians and radiologists respectively to assess the location, size and suspected diagnosis of lesions (benign or malignant). A combined assessment of both techniques was performed. The final diagnosis was established by histopathology or clinical/radiological follow-up greater than 6 months. RESULTS: A total of 120 liver lesions were identified, 115 were malignant and 5 benign. From the malignant lesions, 105 were identified with the ceCT, 44 with the PET and 109 with ceCT/PET. All of the benign lesions were correctly classified with any of the three imaging techniques. The sensitivity of PET, ceCT and ceCT/PET were of 38%, 91% and 95% respectively and the specificity was 100% in all three of the diagnostic studies. CONCLUSION: Administration of intravenous contrast in the PET/CT is mandatory to evaluate treatment response rate of liver metastases due to the limitations of isolated metabolic images in these cases.

Four cases of solid pseudopapillary tumors of pancreas: imaging findings and pathological correlations.

OBJECTIVE: Solid pseudopapillary tumor of the pancreas (SPTP tumor) is a rare pancreatic neoplasm with low malignant potential, which usually affects female patients in the second or third decades of life. It is a non-functional, slow-growing neoplasm that very often reaches considerable size before the first symptoms appear. Symptomatology is frequently related to tumor size. Surgical excision is usually curative in most cases. Infrequently the tumor can appear in male patients or in aged women, which can make the diagnosis more difficult. Some patients develop liver metastases in the follow-up that can be resected. Our purpose is to review the radiological and pathological findings of SPTP with emphasis on these infrequent cases. SUBJECTS AND METHODS: The medical records and radiological findings of patients who underwent surgery for SPTP between 2000 and 2005 were retrospectively reviewed. Study eligibility required that patients had undergone surgical resection and that a SPTP had been pathologically proved. RESULTS: Four cases of solid pseudopapillary tumor of the pancreas were diagnosed and treated in our institution in the study period. Two of the patients, developed on follow-up liver metastases, and peritoneal, hepatic, and nodal metastases, respectively. CONCLUSION: Solid pseudopapillary tumors are well-encapsulated neoplasms that usually have a good prognosis after surgical excision. A malignant behavior is uncommon and in this case lymph node involvement, hepatic metastases and occasionally peritoneal invasion may also occur. Resection of liver metastases can prolong the long-term survival of the patients.