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MR Cholangiopancreatographic Differentiation of Benign and Malignant Intraductal Mucin- Producing Tumors of the Pancreas

Hiroyuki Irie1, Hiroshi Honda1, Hitoshi Aibe1, Toshiro Kuroiwa1, Kengo Yoshimitsu1, Kenji Shinozaki1, Koji Yamaguchi2, Mitsuo Shimada3 and Kouji Masuda1

1 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka, 812-8582 Japan.
2 Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka, 812-8582 Japan.
3 Department of General Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku Fukuoka, 812-8582 Japan.



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  		Fig. 1. —78-year-old man with benign (adenoma) main duct-type intraductal mucin-producing tumor of pancreas. Maximum-intensity-projection MR cholangiopancreatogram shows main pancreatic duct (long straight arrows) dilated in body and tail, but not in head. Maximum diameter of main pancreatic duct is 12 mm. Nondilated main pancreatic duct (short straight arrows), measuring 4 mm in diameter, and common bile duct (curved arrows) can be seen.

 


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  		Fig. 2. —60-year-old man with malignant (borderline) main duct-type intraductal mucin-producing tumor of pancreas. Maximum-intensity-projection MR cholangiopancreatogram reveals main pancreatic duct with markedly diffuse dilatation. Maximum diameter of main pancreatic duct is 25 mm. PD = pancreatic duct.

 


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  		Fig. 3A. —71-year-old man with malignant (adenocarcinoma) main duct-type intraductal mucin-producing tumor of pancreas. PD = pancreatic duct. Maximum-intensity-projection MR cholangiopancreatogram shows diffuse dilatation of main pancreatic duct (maximum diameter, 20 mm).

 


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  		Fig. 3B. —71-year-old man with malignant (adenocarcinoma) main duct-type intraductal mucin-producing tumor of pancreas. PD = pancreatic duct. Source MR cholangiopancreatographic image reveals filling defects (arrows) in main pancreatic duct of pancreatic body.

 


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  		Fig. 4. —65-year-old man with benign (adenoma) branch duct-type intraductal mucin-producing tumor of pancreas. Single-slice projection MR cholangiopancreatographic image reveals multilocular cystic lesion (arrows) in pancreatic head and communicates with nondilated main pancreatic duct. Maximum diameter of cyst is 20 mm.

 


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  		Fig. 5. —65-year-old man with malignant (borderline) branch duct-type intraductal mucin-producing tumor of pancreas. Maximum-intensity-projection MR cholangiopancreatogram shows grapelike cluster of cysts (straight arrows) with maximum diameter of 55 mm in pancreatic head. Main pancreatic duct in head and body shows mild dilatation. Another small cystic lesion (curved arrow), which was not resected at surgery, is seen in pancreatic tail.

 


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  		Fig. 6. —Scatterplot of cyst size of benign (n = 17) and malignant (n = 7) branch duct-type mucin-producing tumor of pancreas. Graph shows some overlap between them.

 


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  		Fig. 7. —67-year-old man with malignant (borderline) branch duct-type intraductal mucin-producing tumor of pancreas. Maximum-intensity-projection MR cholangiopancreatogram shows multilocular cystic lesion (arrows) in pancreatic head. Maximum size of cyst is 25 mm; however, main pancreatic duct shows mild diffuse dilatation.

 


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  		Fig. 8. —69-year-old man with malignant (adenocarcinoma) branch duct-type intraductal mucin-producing tumor of pancreas. Single-projection MR cholangiopancreatographic image shows cyst with large filling defect (arrows) in pancreatic body. Main pancreatic duct shows mild dilatation in body and tail.

 

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