MRI of Adenocarcinoma of the Pancreas
Frank H. Miller1,
Nancy J. Rini1 and
Ana L. Keppke1
1 All authors: Department of Radiology, Northwestern Memorial Hospital,
Northwestern University, The Feinberg School of Medicine, 676 N. St. Clair,
Ste. 800, Chicago, IL 60611.
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Fig. 1A —49-year-old man with small non-contour-deforming pancreatic
mass caused by adenocarcinoma. Axial contrast-enhanced MDCT image shows
atrophy of pancreatic tail and pancreatic duct dilation (arrow).
Discrete mass is difficult to identify.
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Fig. 1B —49-year-old man with small non-contour-deforming pancreatic
mass caused by adenocarcinoma. Axial T2-weighted HASTE MR image (5-mm slice
thickness) shows pancreatic ductal dilation (arrow) with associated
atrophy of pancreatic tail. Duct dilation is easily seen on T2-weighted images
and may be better seen than on MDCT.
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Fig. 1C —49-year-old man with small non-contour-deforming pancreatic
mass caused by adenocarcinoma. Axial venous-phase gadolinium-enhanced
T1-weighted fat-suppressed gradient-recalled echo MR image shows 1.8-cm
hypointense mass (arrowhead) in pancreatic body, consistent with
pancreatic carcinoma. Pancreatic duct dilation (long arrow) and
pancreatic atrophy upstream from mass are seen. Ill-defined soft tissue
(short arrows) surrounding celiac artery was proven to be
malignant.
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Fig. 2A —31-year-old man with suspected pancreatic mass on MDCT. Axial
contrast-enhanced MDCT image shows prominent pancreatic head (arrow)
suggesting possibility of subtle mass.
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Fig. 2B —31-year-old man with suspected pancreatic mass on MDCT. Axial
T1-weighted in-phase gradient-recalled echo MR image shows prominent
pancreatic head (arrow) with normal signal intensity.
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Fig. 2C —31-year-old man with suspected pancreatic mass on MDCT. Axial
T1-weighted opposed-phase gradient-recalled echo MR image shows signal dropout
in pancreatic head (arrow) because of fatty infiltration without
evidence of underlying mass.
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Fig. 2D —31-year-old man with suspected pancreatic mass on MDCT. Axial
arterial-phase gadolinium-enhanced T1-weighted fat-suppressed
gradient-recalled echo MR image shows normal homogeneous enhancement of head
of pancreas (arrow) without mass.
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Fig. 3A —60-year-old man with mass in uncinate process of pancreas
that proved to be pancreatic adenocarcinoma. Patient had elevated creatinine
and could not receive iodinated contrast material on CT. Coronal T2-weighted
RARE MR cholangiopancreatography image shows dilation of common bile duct
(short arrow) and pancreatic duct (long arrow) with abrupt
termination at confluence of ducts (arrowhead). This double duct sign
is highly suspicious for malignancy.
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Fig. 3B —60-year-old man with mass in uncinate process of pancreas
that proved to be pancreatic adenocarcinoma. Patient had elevated creatinine
and could not receive iodinated contrast material on CT. Axial late
arterial-phase gadolinium-enhanced T1-weighted fat-suppressed
gradient-recalled echo MR image shows 2.5-cm hypointense mass (short
arrow) in head of pancreas responsible for double duct sign seen on MR
cholangiopancreatography. Fat plane between superior mesenteric artery and
pancreatic mass (long arrow) is obscured, suggesting vascular
invasion.
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Fig. 4A —55-year-old man with pancreatic adenocarcinoma and suspected
liver metastases shown by MRI but inconspicuous on MDCT. Axial venous-phase
contrast-enhanced MDCT image shows hypodense mass (arrow) in
pancreatic head. Note homogeneous liver enhancement, without evidence of
metastases.
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Fig. 4B —55-year-old man with pancreatic adenocarcinoma and suspected
liver metastases shown by MRI but inconspicuous on MDCT. Axial arterial-phase
gadolinium-enhanced T1-weighted fat-suppressed gradient-recalled echo MR image
performed 3 days after MDCT shows several ring-enhancing liver lesions
(short white arrows) suggestive of liver metastases. These lesions
were not bright on T2-weighted images, suggesting bile lakes or abscesses.
Patient was afebrile. These lesions were inconspicuous on MDCT. There is
susceptibility artifact because of biliary stent (arrowhead) with
adjacent dilated pancreatic duct en face (long arrow). Note poorly
defined hypointense mass (black arrow) in pancreatic head.
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Fig. 4C —55-year-old man with pancreatic adenocarcinoma and suspected
liver metastases shown by MRI but inconspicuous on MDCT. Axial venous-phase
gadolinium-enhanced T1-weighted fat-suppressed gradient-recalled echo MR image
confirms the ring-enhancing lesions (arrows).
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Fig. 5A —55-year-old man with metastatic pancreatic adenocarcinoma.
Axial T2-weighted HASTE MR image shows multiple, moderately hyperintense liver
lesions (arrows) caused by metastases.
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Fig. 5B —55-year-old man with metastatic pancreatic adenocarcinoma.
Axial unenhanced T1-weighted fat-suppressed gradient-recalled echo MR image
shows multiple hypointense liver masses (arrows).
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Fig. 5C —55-year-old man with metastatic pancreatic adenocarcinoma.
Axial arterial-phase gadolinium-enhanced T1-weighted fat-suppressed
gradient-recalled echo MR image shows ring-enhancing lesions (white
arrows) and wedge-shaped perilesional enhancement (black arrows)
of metastases.
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Fig. 6 —57-year-old woman with newly diagnosed pancreatic carcinoma
and peritoneal metastases. Axial venous-phase gadolinium-enhanced T1-weighted
fat-suppressed gradient-recalled echo MR image shows right-sided peritoneal
implant (black arrow). Hypointense pancreatic mass (open
arrow) and pseudocyst (short white arrow) are seen. Mass in left
adrenal gland (long arrow) does not have imaging characteristics of
adenoma on other imaging sequences and may represent metastasis or lipid-poor
adenoma.
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Fig. 7A —53-year-old man with pancreatic carcinoma metastatic to liver
and greater omentum. Axial unenhanced T1-weighted fat-suppressed
gradient-recalled echo MR image shows low-signal-intensity lesions
(arrows) in liver, consistent with metastases.
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Fig. 7B —53-year-old man with pancreatic carcinoma metastatic to liver
and greater omentum. Axial gadolinium-enhanced T1-weighted fat-suppressed
gradient-recalled echo MR image shows enhancement along left side of greater
omentum (arrow), consistent with metastases. Hypointense liver
metastases (arrowheads) are also identified.
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Fig. 8A —36-year-old man with clinical history of pancreatitis was
subsequently proven to have pancreatic carcinoma with axillary lymph node
metastases. Axial arterial-phase contrast-enhanced MDCT image shows prominence
of pancreatic tail (arrow), mild peripancreatic fat stranding, and
multiple retroperitoneal lymph nodes (arrowheads).
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Fig. 8B —36-year-old man with clinical history of pancreatitis was
subsequently proven to have pancreatic carcinoma with axillary lymph node
metastases. Axial unenhanced T1-weighted fat-suppressed gradient-recalled echo
MR image shows subtle enlargement of pancreatic tail (arrow) and
multiple small lymph nodes (arrowheads) along celiac artery.
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Fig. 8C —36-year-old man with clinical history of pancreatitis was
subsequently proven to have pancreatic carcinoma with axillary lymph node
metastases. Axial venous-phase gadolinium-enhanced T1-weighted fat-suppressed
gradient-recalled echo MR image shows pancreatic tail mass (arrow),
which proved to be pancreatic carcinoma, more conspicuously than MDCT.
Multiple retroperitoneal lymph nodes (arrowheads) are also identified
around celiac artery.
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Fig. 9A —59-year-old man with unexplained acute recurrent pancreatitis
on MDCT examinations performed 2 years apart. The patient subsequently proved
to have pancreatic carcinoma. Axial arterial-phase contrast-enhanced MDCT
image from 2002 shows nonenhancing, ill-defined pancreatic body (white
arrow) with moderate peripancreatic fat stranding and fluid
(arrowheads), which is consistent with pancreatitis. Normal
enhancement in pancreatic tail is seen (black arrow).
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Fig. 9B —59-year-old man with unexplained acute recurrent pancreatitis
on MDCT examinations performed 2 years apart. The patient subsequently proved
to have pancreatic carcinoma. Axial arterial-phase contrast-enhanced MDCT
image from 2004 shows poorly defined, nonenhancing pancreatic body and tail
suggestive of necrosis (white arrow). There were findings suggestive
of pancreatic mass (black arrow).
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Fig. 9C —59-year-old man with unexplained acute recurrent pancreatitis
on MDCT examinations performed 2 years apart. The patient subsequently proved
to have pancreatic carcinoma. Axial T2-weighted HASTE MR image performed 3
weeks after MDCT (B) shows pancreatic duct dilation and atrophy of
pancreatic tail (arrow).
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Fig. 9D —59-year-old man with unexplained acute recurrent pancreatitis
on MDCT examinations performed 2 years apart. The patient subsequently proved
to have pancreatic carcinoma. Axial unenhanced T1-weighted fat-suppressed
gradient-recalled echo MR image at lower level than C shows mass
(arrow) in body of pancreas. Bowel (arrowhead) is seen
adjacent to pancreatic mass.
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Fig. 9E —59-year-old man with unexplained acute recurrent pancreatitis
on MDCT examinations performed 2 years apart. The patient subsequently proved
to have pancreatic carcinoma. Axial gadolinium-enhanced T1-weighted
fat-suppressed gradient-recalled echo MR image shows hypointense mass
(arrow) suspicious for tumor in body of pancreas. Endoscopic
sonography with biopsy showed adenocarcinoma. Bowel (arrowhead) is
seen adjacent to pancreatic mass.
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Fig. 10A —55-year-old man with metastatic pancreatic carcinoma. Axial
T2-weighted HASTE MR image shows multiple periaortic lymph nodes (white
arrows) and hyperintense metastasis (black arrow) in liver and
paraspinal muscles (arrowhead).
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Fig. 10B —55-year-old man with metastatic pancreatic carcinoma. Axial
gadolinium-enhanced T1-weighted fat-suppressed gradient-recalled echo MR image
shows multiple, ring-enhancing, periaortic lymph nodes (short
arrows). Ring-enhancing liver metastasis (arrowhead) and
multiple enhancing foci (long arrows) in paraspinal muscles caused by
metastases are seen.
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Fig. 11A —49-year-old man with locally advanced pancreatic carcinoma.
Axial gadolinium-enhanced T1-weighted fat-suppressed gradient-recalled echo MR
image shows abnormal enhancing soft tissue (arrows) surrounding
celiac artery, which is suspicious for vascular encasement.
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Fig. 11B —49-year-old man with locally advanced pancreatic carcinoma.
Coronal gadolinium-enhanced T1-weighted fat-suppressed gradient-recalled echo
MR image shows abnormal soft tissue (arrow) surrounding origin of
celiac and superior mesenteric arteries. This tissue was positive for
malignancy by fine-needle aspiration.
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Fig. 11C —49-year-old man with locally advanced pancreatic carcinoma.
Corresponding axial MDCT image shows abnormal soft tissue surrounding celiac
axis (arrows).
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Copyright © 2006 by the American Roentgen Ray Society.
