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Comparison of Contrast-Enhanced Sonography and MRI in Displaying Anatomic Features of Cystic Pancreatic Masses

Mirko D'Onofrio1, Alec J. Megibow2, Niccolò Faccioli1, Roberto Malagò1, Paola Capelli3, Massimo Falconi4 and Roberto Pozzi Mucelli1

1 Department of Radiology, University Hospital G. B. Rossi, Piazzale L. A. Scuro 10, University of Verona, Verona 37134, Italy.
2 Department of Radiology, New York University Medical Center, New York, NY.
3 Department of Pathology, University Hospital G. B. Rossi, University of Verona, Verona, Italy.
4 Department of Surgery, University Hospital G. B. Rossi, University of Verona, Verona, Italy.


Figure 1
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  		Fig. 1A —74-year-old man with mucinous cystadenoma. Transabdominal sonogram reveals 3-cm cystic mass in pancreatic tail. Thin septa (arrow) are visible.

 

Figure 2
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  		Fig. 1B —74-year-old man with mucinous cystadenoma. Contrast-enhanced sonogram reveals vascularization of entire thick-walled mural structure with vascularized thin intralesional septa (arrow).

 

Figure 3
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  		Fig. 1C —74-year-old man with mucinous cystadenoma. T2-weighted turbo spin-echo MR image (TR/TE, 4,950/102) confirms presence of mass and shows thin intralesional septa (arrow).

 

Figure 4
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  		Fig. 1D —74-year-old man with mucinous cystadenoma. Photograph of pathologic specimen reveals thin septa (arrow) inside opened mucinous lesion.

 

Figure 5
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  		Fig. 2A —47-year-old woman with mucinous cystadenoma. Transabdominal sonogram reveals 5-cm cystic mass in pancreatic body. Visible inside lesion are thin septa (arrow) along anterior wall and small nodule (arrowhead) along posterior wall.

 

Figure 6
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  		Fig. 2B —47-year-old woman with mucinous cystadenoma. Contrast-enhanced sonogram reveals vascularization of entire thick-walled mural structure with vascularized thin intralesional septa (arrow). Nodule is not evident.

 

Figure 7
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  		Fig. 2C —47-year-old woman with mucinous cystadenoma. Photograph of pathologic specimen reveals thin septa (arrow) inside opened mucinous lesion that does not contain mural nodules.

 

Figure 8
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  		Fig. 3A —68-year-old man with branch duct intraductal papillary mucinous neoplasm. Transabdominal sonogram reveals 2-cm cystic lesion in pancreatic tail. Some internal structure is visible but poorly defined (arrow).

 

Figure 9
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  		Fig. 3B —68-year-old man with branch duct intraductal papillary mucinous neoplasm. Contrast-enhanced sonogram reveals enhancement of nodular structure within mass (arrow).

 

Figure 10
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  		Fig. 3C —68-year-old man with branch duct intraductal papillary mucinous neoplasm. T2-weighted turbo spin-echo MR image (TR/TE, 4,950/102) confirms presence of mass. Low signal intensity within mass results from nodule (arrow) as predicted with contrast-enhanced sonography.

 

Figure 11
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  		Fig. 3D —68-year-old man with branch duct intraductal papillary mucinous neoplasm. Photograph of operative specimen shows whitish nodule (arrow) projecting into mucinous cystic lesion. Final pathologic diagnosis was branch duct intraductal papillary mucinous neoplasm with invasive carcinoma.

 

Figure 12
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  		Fig. 4A —47-year-old woman with cystic endocrine tumor. Transabdominal sonogram reveals 2.5-cm cystic lesion in pancreatic body. Thin internal septum is visible (arrow).

 

Figure 13
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  		Fig. 4B —47-year-old woman with cystic endocrine tumor. Contrast-enhanced sonogram obtained during dynamic examination shows no enhancement of intralesional structures. Absence of intralesional septa and nodules was confirmed at gross pathologic examination. Final pathologic diagnosis was cystic endocrine tumor.

 

Figure 14
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  		Fig. 5A —55-year-old woman with mucinous cystadenoma. Transabdominal sonogram reveals 3.3-cm cystic lesion (asterisk) in pancreatic body. No internal structure is visible.

 

Figure 15
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  		Fig. 5B —55-year-old woman with mucinous cystadenoma. Contrast-enhanced (B) and unenhanced (C) sonograms from same frame of dynamic examination. Contrast-enhanced image (B) shows very small septa (arrow), not visible in unenhanced image (C).

 

Figure 16
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  		Fig. 5C —55-year-old woman with mucinous cystadenoma. Contrast-enhanced (B) and unenhanced (C) sonograms from same frame of dynamic examination. Contrast-enhanced image (B) shows very small septa (arrow), not visible in unenhanced image (C).

 

Figure 17
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  		Fig. 5D —55-year-old woman with mucinous cystadenoma. Photograph shows small septum (arrow) inside resected specimen. Final pathologic diagnosis was mucinous cystadenoma.

 

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