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Imaging classification of pancreatic ductal adenocarcinoma with histological large duct pattern

Authors
Lee, Ji EunLee, SunyoungPark, Hee JunHwang, Jeong AhChoi, Seo-YounLee, Jisun
Issue Date
May-2024
Publisher
SPRINGER
Keywords
Pancreatic neoplasms; Pancreatic ductal carcinoma; Computed tomography; Magnetic resonance imaging
Citation
EUROPEAN RADIOLOGY
Journal Title
EUROPEAN RADIOLOGY
URI
https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/26269
DOI
10.1007/s00330-024-10810-8
ISSN
0938-7994
1432-1084
Abstract
ObjectivesTo investigate the imaging features of pancreatic ductal adenocarcinoma (PDAC) with histological large duct pattern.MethodsOur study included 37 patients (mean age, 66.5 years; 22 women) with surgically proven PDAC with histological large duct pattern, whose imaging features were classified into four types: Type I, solid mass; Type II, predominantly cystic mass with intracystic solid components; Type III, predominantly solid mass with intratumoral cysts; and Type IV, solid mass with peritumoral retention cysts or pseudocysts. Two radiologists independently analyzed both CT and MRI images for the morphological type, presence of abrupt main pancreatic duct (MPD) cutoff, adjacent vascular invasion, diffusion restriction, and reached consensus.ResultsOn CT, 26 patients (70.3%) had Type I tumors, five (13.5%) had Type II, three (8.1%) had Type III, and three (8.1%) had Type IV. Among the 26 patients with Type I tumors on CT, 16 had tumors with multiple intratumoral cysts within the solid mass on MRI and were subsequently classified as Type III. Accordingly, 10 patients (27.0%) were classified as Type I, five (13.5%) as Type II, 19 (51.7%) as Type III, and three (8.1%) as Type IV on MRI. Of the 37 patients, 27 (73.0%) had an abrupt MPD cutoff, 15 (40.5%) had adjacent vascular invasion, and 25 (67.6%) had diffusion restriction on MRI.ConclusionsPredominantly solid pancreatic masses with small intratumoral cysts visualized on MRI may be a characteristic imaging finding of PDAC with histological large duct pattern, and differentiate it from conventional PDAC or other cystic pancreatic tumors.Clinical relevance statementRadiologists should be familiar with the various imaging features of PDAC with histological large duct pattern and should be aware that it may mimic other solid or cystic tumors of the pancreas.Key Points...
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