Korean J Radiol.  2011 Apr;12(2):187-195. 10.3348/kjr.2011.12.2.187.

Differentiating Pancreatic Ductal Adenocarcinoma from Pancreatic Serous Cystadenoma, Mucinous Cystadenoma, and a Pseudocyst with Detailed Analysis of Cystic Features on CT Scans: a Preliminary Study

• Lv P
• Mahyoub R
• Lin X
• Chen K
• Chai W
• Xie J

• KMID: 1088563
• DOI: http://doi.org/10.3348/kjr.2011.12.2.187

Abstract

OBJECTIVE
To determine whether or not detailed cystic feature analysis on CT scans can assist in the differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) from serous cystadenoma (SCN), mucinous cystadenoma (MCN), and a pseudocyst.
MATERIALS AND METHODS
This study received Institutional Review Board approval and informed patient consent was waived. Electronic radiology and pathology databases were searched to identify patients with PDAC (n = 19), SCN (n = 26), MCN (n = 20) and a pseudocyst (n = 23) who underwent pancreatic CT imaging. The number, size, location, and contents of cysts, and the contour of the lesions were reviewed, in addition to the wall thickness, enhancement patterns, and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 82) or on a combination of cytological findings, biochemical markers, and tumor markers (n = 6). Fisher's exact test was used to analyze the results.
RESULTS
A combination of the CT findings including irregular contour, multiple cysts, mural nodes, and localized thickening, had a relatively high sensitivity (74%) and specificity (75%) for differentiating PDAC from SCN, MCN, and pseudocysts (p < 0.05). Other CT findings such as location, greatest dimension, or the presence of calcification were not significantly different.
CONCLUSION
The CT findings for PDAC are non-specific, but perhaps helpful for differentiation. PDAC should be included in the general differential diagnosis of pancreatic cystic neoplasms.

Keyword

Computed tomography (CT); Pancreatic ductal adenocarcinoma with cystic features; Serous cystadenoma; Mucinous cystadenoma; Pseudocyst

MeSH Terms

Adenocarcinoma/pathology/*radiography
Adolescent
Adult
Aged
Cystadenocarcinoma, Serous/pathology/*radiography
Cystadenoma, Mucinous/pathology/*radiography
Diagnosis, Differential
Female
Humans
Immunohistochemistry
Male
Middle Aged
Pancreatic Neoplasms/pathology/*radiography
Retrospective Studies
Sensitivity and Specificity
*Tomography, X-Ray Computed
Tumor Markers, Biological/analysis

Figure

• 

  Fig. 1 Transverse CT scan obtained in 62-year-old man with pancreatic ductal adenocarcinoma with cystic features. Image was obtained after intravenous injection of contrast material demonstrated irregular multicystic lesion (long arrow) in head of pancreas. Wall is thick and enhancing on this contrast-enhanced image. Note septum (short arrow).

• 

  Fig. 2 Transverse CT scans obtained in 62-year-old man with pancreatic ductal adenocarcinoma with cystic features. A. Image obtained without intravenous contrast material demonstrates round cystic lesion in tail of pancreas. Wall of lesion was localized and found to be thick (arrow). B. Image obtained after intravenous injection of contrast material reveals enhancement of wall (short arrow). Note varicose veins of spleen (long arrow).

• 

  Fig. 3 Transverse CT scan obtained during portal venous phase in 46-year-old woman with pancreatic ductal adenocarcinoma with cystic degeneration. Image shows lobulated cystic lesion (arrow) in head of pancreas, which was surrounded by thin nonenhancing wall.

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  Fig. 4 Transverse CT scan obtained during portal venous phase in 47-year-old woman with pancreatic ductal adenocarcinoma with retention cysts. Image shows solid tissue surrounded (short arrow) by lobulated cystic lesion (long arrow) in tail of pancreas. Solid tissue component was easily mistaken for normal pancreatic tissue.

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