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Pancreas Divisum: Depiction with Multi–Detector Row CT¹

¹ From the Department of Radiology, Boston University Medical Center, One Boston Medical Center Place, Boston, MA 02118. Received February 23, 2004; revision requested April 15; revision received June 2; accepted July 1. Address correspondence to J.A.S. (e-mail: jorge.soto@bmc.org).

View larger version (132K): [in a new window]   Figure 1a. Pancreas divisum correctly identified by both observers on CT scans in 46-year-old man with history of pancreatitis. (a) Curved-linear reformation of transverse CT data set following the course of the ducts through the gland depicts the dorsal duct (long white arrow), ventral duct (long black arrow), and common bile duct (short black arrow). The dorsal duct is wider than the ventral duct; this is the dominant dorsal duct sign. (b) Frontal image from ERP shows how the injection of contrast material into the major papilla filled the dilated ventral duct (arrow). The duct branches and tapers within the head of the gland and does not communicate with the dorsal duct, thus helping confirm the diagnosis of pancreas divisum. Findings were considered to be consistent with those of chronic pancreatitis. The ventral duct is overdistended owing to the retrograde injection of contrast material, and this accounts for the apparent larger caliber when compared with that seen at CT (a).

View larger version (129K): [in a new window]   Figure 1b. Pancreas divisum correctly identified by both observers on CT scans in 46-year-old man with history of pancreatitis. (a) Curved-linear reformation of transverse CT data set following the course of the ducts through the gland depicts the dorsal duct (long white arrow), ventral duct (long black arrow), and common bile duct (short black arrow). The dorsal duct is wider than the ventral duct; this is the dominant dorsal duct sign. (b) Frontal image from ERP shows how the injection of contrast material into the major papilla filled the dilated ventral duct (arrow). The duct branches and tapers within the head of the gland and does not communicate with the dorsal duct, thus helping confirm the diagnosis of pancreas divisum. Findings were considered to be consistent with those of chronic pancreatitis. The ventral duct is overdistended owing to the retrograde injection of contrast material, and this accounts for the apparent larger caliber when compared with that seen at CT (a).

View larger version (139K): [in a new window]   Figure 2. Transverse CT scan in 62-year-old man with chronic pancreatitis shows markedly dilated dorsal duct (long white arrow) draining into the minor papilla. The smaller-caliber ventral duct (short white arrow) is seen in the uncinate process, medial to the common bile duct (black arrow). Thus, the criteria for the dominant dorsal duct sign are fulfilled in this patient. Both radiologists correctly made the diagnosis of pancreas divisum, which was confirmed at ERP (results not shown).

View larger version (138K): [in a new window]   Figure 3a. (a) Curved-linear reformation of pancreatic duct in 58-year-old woman suspected of having biliary obstruction shows the dorsal duct (long white arrow) draining into the minor papilla (short white arrow). The common bile duct is seen in cross section (black arrow). The ventral duct was not visualized on the CT scans. Thus, the criteria for pancreas divisum were fulfilled. Pancreas divisum was correctly diagnosed by both observers and confirmed at ERP. (b) Frontal image from ERP shows injection into the normal-caliber ventral duct (arrow).

View larger version (134K): [in a new window]   Figure 3b. (a) Curved-linear reformation of pancreatic duct in 58-year-old woman suspected of having biliary obstruction shows the dorsal duct (long white arrow) draining into the minor papilla (short white arrow). The common bile duct is seen in cross section (black arrow). The ventral duct was not visualized on the CT scans. Thus, the criteria for pancreas divisum were fulfilled. Pancreas divisum was correctly diagnosed by both observers and confirmed at ERP. (b) Frontal image from ERP shows injection into the normal-caliber ventral duct (arrow).

View larger version (143K): [in a new window]   Figure 4a. (a) Transverse CT scan in 22-year-old man with a gunshot wound to the abdomen who was suspected of having an injury to the pancreatic duct in the tail of the gland. The image demonstrates stranding of the fat adjacent to the tail of the pancreas (arrows), but the pancreatic duct is not depicted. (b) Left anterior oblique image from ERP shows that injection of contrast material into the minor papilla filled the dorsal duct but not the ventral duct, thus helping confirm the diagnosis of pancreas divisum. Note the surgically placed drains (arrows). This was considered a false-negative interpretation of the CT images.

View larger version (112K): [in a new window]   Figure 4b. (a) Transverse CT scan in 22-year-old man with a gunshot wound to the abdomen who was suspected of having an injury to the pancreatic duct in the tail of the gland. The image demonstrates stranding of the fat adjacent to the tail of the pancreas (arrows), but the pancreatic duct is not depicted. (b) Left anterior oblique image from ERP shows that injection of contrast material into the minor papilla filled the dorsal duct but not the ventral duct, thus helping confirm the diagnosis of pancreas divisum. Note the surgically placed drains (arrows). This was considered a false-negative interpretation of the CT images.

View larger version (106K): [in a new window]   Figure 5a. (a) Curved-linear reformation of CT data set in 45-year-old woman with recurrent abdominal pain shows the pancreatic duct following its usual course through the body and tail of the pancreas. In the head, the duct curves posteriorly (long arrow) and drains into the major papilla (short arrow). Both observers correctly classified this patient as having typical anatomy. (b) Left anterior oblique image from ERP shows that contrast material filled the entire pancreatic duct (arrow); this helped confirm typical pancreatic ductal anatomy.

View larger version (130K): [in a new window]   Figure 5b. (a) Curved-linear reformation of CT data set in 45-year-old woman with recurrent abdominal pain shows the pancreatic duct following its usual course through the body and tail of the pancreas. In the head, the duct curves posteriorly (long arrow) and drains into the major papilla (short arrow). Both observers correctly classified this patient as having typical anatomy. (b) Left anterior oblique image from ERP shows that contrast material filled the entire pancreatic duct (arrow); this helped confirm typical pancreatic ductal anatomy.