Intraductal Papillary Mucinous Neoplasms of the Pancreas: CT Patterns of Recurrence and Multiobserver Performance in Detecting Recurrent Neoplasm After Surgical Resection
Jared A. Christensen1,
J. G. Fletcher2,
Jeff L. Fidler2,
Peter B. Wold2,
Aaron J. Binstock2,
Thomas Smyrk3,
Scott W. Harmsen4,
Brian S. Crownhart4 and
Suresh Chari5
1 Mayo Medical School, Mayo Clinic, Rochester, MN.
2 Department of Radiology, Mayo Clinic Rochester, 200 First St. SW, Rochester,
MN 55905.
3 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester,
MN.
4 Division of Biostatistics, Mayo Clinic, Rochester, MN.
5 Department of Internal Medicine, Division of Gastroenterology, Mayo Clinic,
Rochester, MN.
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Fig. 1A. —Axial contrast-enhanced CT scans of 86-year-old man with
history of distal pancreatectomy for noninvasive intraductal papillary
mucinous neoplasm. Image obtained 19 months after resection shows
postoperative changes from distal pancreatectomy.
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Fig. 1B. —Axial contrast-enhanced CT scans of 86-year-old man with
history of distal pancreatectomy for noninvasive intraductal papillary
mucinous neoplasm. Image obtained slightly inferior to A shows
questionable focal attenuation difference (arrows) at resection
margin.
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Fig. 1C. —Axial contrast-enhanced CT scans of 86-year-old man with
history of distal pancreatectomy for noninvasive intraductal papillary
mucinous neoplasm. Image obtained 26 months after initial resection shows
interval development of large, primarily extrapancreatic, solid mass
(arrows) at resection margin.
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Fig. 1D. —Axial contrast-enhanced CT scans of 86-year-old man with
history of distal pancreatectomy for noninvasive intraductal papillary
mucinous neoplasm. Image obtained slightly inferior to C shows abutment
of mass (arrow) at resection margin and pancreatic neck margin
(arrowhead). CT-guided biopsy confirmed presence of locally recurrent
neoplasm.
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Fig. 2A. —Axial contrast-enhanced CT scans of 62-year-old man who
underwent Whipple procedure 39 months earlier for noninvasive intraductal
papillary mucinous neoplasm of pancreas. Image shows solid extrapancreatic
mass (arrow) adjacent to resection site, abutting celiac axis.
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Fig. 2B. —Axial contrast-enhanced CT scans of 62-year-old man who
underwent Whipple procedure 39 months earlier for noninvasive intraductal
papillary mucinous neoplasm of pancreas. Image also shows that solid mass
(arrow) invades periarterial fat plane around superior mesenteric
artery and superior mesenteric vein (arrowhead). CT-guided biopsy
findings, obtained 2 days after A and B, were consistent with
recurrent intraductal papillary and mucinous neoplasm of pancreas.
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Fig. 3A. —Axial contrast-enhanced CT scans of 45-year-old man after
distal pancreatectomy for noninvasive intraductal papillary mucinous neoplasm.
Image obtained 7 months after initial surgical resection shows cystic
dilatation of main pancreatic duct (arrows) near resection margin.
Completion pancreatectomy 1 month later revealed intraductal papillary
mucinous neoplasm involving pancreatic duct at this location.
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Fig. 3B. —Axial contrast-enhanced CT scans of 45-year-old man after
distal pancreatectomy for noninvasive intraductal papillary mucinous neoplasm.
Image depicts absence of ductal dilatation in head of pancreas.
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Fig. 4A. —74-year-old woman after distal pancreatectomy for invasive
intraductal papillary mucinous neoplasm of pancreas. Axial contrast-enhanced
CT scan obtained 8 months after surgery shows small cyst or dilated side
branch (arrow) adjacent to main pancreatic duct.
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Fig. 4B. —74-year-old woman after distal pancreatectomy for invasive
intraductal papillary mucinous neoplasm of pancreas. CT scan obtained slightly
inferior to A shows small cystic mass (arrow) adjacent to main
pancreatic duct in pancreatic head, anterior to common bile duct.
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Fig. 4C. —74-year-old woman after distal pancreatectomy for invasive
intraductal papillary mucinous neoplasm of pancreas. Axial contrast-enhanced
CT scan obtained 11 months after surgical resection shows equivocal increase
in size of cystic structure (arrow) adjacent to main pancreatic duct
in body of pancreas.
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Fig. 4D. —74-year-old woman after distal pancreatectomy for invasive
intraductal papillary mucinous neoplasm of pancreas. CT scan obtained slightly
inferior to C shows definite growth of cystic mass (arrow)
adjacent to main pancreatic duct in pancreatic head. Completion pancreatectomy
indicated recurrent intraductal papillary mucinous neoplasm.
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Fig. 5A. —Axial contrast-enhanced CT scans of 85-year-old man with
widely metastatic disease after undergoing Whipple procedure 12 months earlier
for invasive intraductal papillary mucinous neoplasm. Image shows large solid
peritoneal mass (white arrow) and focal cystic lesion in pancreatic
tail (black arrow). CT-guided biopsy of peritoneal mass confirmed
metastatic intraductal papillary mucinous neoplasm.
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Fig. 5B. —Axial contrast-enhanced CT scans of 85-year-old man with
widely metastatic disease after undergoing Whipple procedure 12 months earlier
for invasive intraductal papillary mucinous neoplasm. Image obtained superior
to A shows large pleural-based masses (arrows), presumably
pleural metastases.
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Copyright © 2004 by the American Roentgen Ray Society.
