J Korean Radiol Soc.  1998 Mar;38(3):503-506. 10.3348/jkrs.1998.38.3.503.

Differential Diagnosis of the Pancreatic Diseases: Significance of Perivascular Changes at Celiac trunk andSuperior Mesenteric Artery on CT

• Kwon R
• Kim YH
• Kim KW
• Yu JS
• Kim JH
• Kim DG
• Lee SI
• Ahn CS
• Oh SJ

• KMID: 2201409
• DOI: http://doi.org/10.3348/jkrs.1998.38.3.503

Abstract

PURPOSE: To classify perivascular change in the celiac trunk and SMA occurring in pancreatic disease and toevaluate its significance in differential diagnosis.
MATERIALS AND METHODS
In 73 patients with pancreaticdisease (42, acute pancreatitis; 14, chronic pancreatitis; 17, panreatic cancer) abdominal CT findings wereretrospectively reviewed. We defined " infiltration" as linear or irregular density and "thickening" as presenceof a soft tissue mantle surrounding the vessel, and statistically evaluated the usefulness of these factors forthe differential diagnosis of pancreatic diseases.
RESULTS
In 13/42 cases of acute pancreatitis (31%), 4/14 ofchronic pancreatitis (28.6%), and 6/17 of pancreatic cancer (35.3%), periceliac infiltration was observed; thefrequencies were not statistically significant (p=0.916). Peri-SMA infiltration was demonstrated in 9/42 of acutepancreatitis (21.4%), 4/14 of chronic pancreatitis (28.6%), and 5/17 of pancreatic cancer (29.4%); again, thesefrequencies were not statistically significant (p=0.758). Thickening of the celiac trunk and SMA was observed onlyin pancreatic cancer, in 3/17 (17.6%) and 7/17(41.2%) cases, respectively, with statistical significance (p<0.05).
CONCLUSION
Thickening of the celiac trunk and SMA is a valuable finding in the differential diagnosis ofpancreatic inflammatory disease and pancreatic cancer. When applied to the differential diagnosis of pancreaticdisease, perivaseular change should be classified as either infiltration or thickening.

Keyword

Pancreas, CT; Pancreas, inflammation; Pancreas, neoplasms

MeSH Terms

Diagnosis, Differential*
Humans
Mesenteric Arteries*
Pancreatic Diseases*
Pancreatic Neoplasms
Pancreatitis
Pancreatitis, Chronic
Tomography, X-Ray Computed

Figure

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  Fig. 1. A. Reticular infiltration of perivascular fat is demonstrated at SMA root in chronic pancreatitis 8. Perivascular fat infiltration is shown at celiac root in acute pancreatitis.

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  Fig. 2. Sixty-three year old male patient with pancreatic carcinoma å irregular infiltration is noted at SMA root area.

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  Fig. 3. Fifty-three year old female patient with pancreatic carcinoma å soft tissue material is demonstrated around SMA (thickened vessel).

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