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Dual-Phase CT of Autoimmune Pancreatitis: A Multireader Study

Naoki Takahashi1, Joel G. Fletcher1, Jeff L. Fidler1, David M. Hough1, Akira Kawashima1 and Suresh T. Chari2

1 Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.
2 Department of Internal Medicine, Mayo Clinic, Rochester, MN.


Figure 1
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  		Fig. 1 —74-year-old man with autoimmune pancreatitis. Contrast-enhanced axial CT scan shows diffuse enlargement of pancreas. Multiple small cortical nodules in both kidneys (arrowheads), bile duct wall enhancement (arrow), and retroperitoneal fibrosis are present. All three readers correctly diagnosed autoimmune pancreatitis.

 

Figure 2
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  		Fig. 2 —85-year-old man with autoimmune pancreatitis. Contrast-enhanced axial CT scan shows enlargement of body and tail of pancreas, which is surrounded by capsule-like rim of soft tissue (arrows). Well-circumscribed, wedge-shaped, low-attenuation area surrounding renal cyst is seen involving anterior aspect of right kidney (arrowheads). Bile duct wall is thickened. Pneumobilia and biliary stent also are present. All three readers correctly diagnosed autoimmune pancreatitis.

 

Figure 3
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  		Fig. 3 —65-year-old man with autoimmune pancreatitis. Contrast-enhanced axial CT scan shows infiltrative low-attenuation mass in body of pancreas (arrows) with pancreatic duct dilation and abrupt cutoff. Head of pancreas was not enlarged (not shown), but a biliary stent is in place and bile duct wall is thickened (arrowhead). Wedge-shaped low-attenuation area in right hepatic lobe is thought to be caused by perfusion difference. All three readers correctly diagnosed autoimmune pancreatitis.

 

Figure 4
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  		Fig. 4A —80-year-old man with autoimmune pancreatitis. Contrast-enhanced axial CT scans show ill-defined low-attenuation area in head of pancreas (arrows, B) with dilation of bile duct and pancreatic duct (arrowheads, A). All three readers incorrectly diagnosed pancreatic carcinoma. Note subtle low-attenuation area in cortex of left kidney (curved arrow, A), but this was not recognized by any reader.

 

Figure 5
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  		Fig. 4B —80-year-old man with autoimmune pancreatitis. Contrast-enhanced axial CT scans show ill-defined low-attenuation area in head of pancreas (arrows, B) with dilation of bile duct and pancreatic duct (arrowheads, A). All three readers incorrectly diagnosed pancreatic carcinoma. Note subtle low-attenuation area in cortex of left kidney (curved arrow, A), but this was not recognized by any reader.

 

Figure 6
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  		Fig. 5 —65-year-old woman with pancreatic head carcinoma. Low-attenuation area is present in posterior aspect of pancreatic head (arrowhead), which is enlarged. This area was considered tumor by one reader and capsule-like rim by two readers. Biliary stent is in place. One reader correctly diagnosed carcinoma, and two readers considered diagnosis indeterminate between carcinoma and autoimmune pancreatitis.

 

Figure 7
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  		Fig. 6 —46-year-old man with pancreatic head carcinoma. Subtle low-attenuation mass is present in head of pancreas adjacent to second portion of duodenum (arrows). Biliary stent is in place. All three readers considered diagnosis indeterminate between carcinoma and autoimmune pancreatitis.

 

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