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CT, Endoscopic Sonography, and a Combined Protocol for Preoperative Evaluation of Pancreatic Insulinomas

Hervé Gouya1, Olivier Vignaux1, Joelle Augui1, Bertrand Dousset2, Laurent Palazzo3, André Louvel4, Stanislas Chaussade3 and Paul Legmann1

1 Department of Radiology, Université René Descartes, Hôpital Cochin, 27 rue du Fg Saint Jacques, 75679 Paris Cedex 14, France.
2 Department of Surgery, Université René Descartes, Hôpital Cochin, 75679 Paris Cedex 14, France.
3 Department of Gastroenterology, Université René Descartes, Hôpital Cochin, 75679 Paris Cedex 14, France.
4 Department of Pathology, Université René Descartes, Hôpital Cochin, 75679 Paris Cedex 14, France.



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  		Fig. 1. —35-year-old man with two insulinomas of pancreas. Axial contrast-enhanced helical CT scan obtained in early phase shows two hyperattenuating lesions: one 14-mm lesion in head of pancreas (arrowhead) and one 9-mm lesion in tail of pancreas close to splenic vein (arrow). This latter lesion was not seen on endoscopic sonography (not shown).

 


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  		Fig. 2. —42-year-old man with 10-mm insulinoma of body of pancreas. Endoscopic sonogram shows small 10-mm lesion (arrow) in body of pancreas that was not revealed on thin-section helical CT (not shown).

 


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  		Fig. 3A. —50-year-old woman with 10-mm insulinoma of body of pancreas. Axial contrast-enhanced helical CT scan obtained in early phase shows hyperattenuating 10-mm lesion (arrow) in body of pancreas.

 


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  		Fig. 3B. —50-year-old woman with 10-mm insulinoma of body of pancreas. Endoscopic sonogram shows lesion seen in A as hypoechoic mass (arrow).

 

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