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Isoattenuating Pancreatic Adenocarcinoma at Multi–Detector Row CT: Secondary Signs¹

¹ From the Department of Radiology, Lucas MRS Center, Stanford University, Stanford, Calif. Received July 26, 2001; revision requested September 24; final revision received March 4, 2002; accepted March 28. R.W.P. supported by a research grant from the Max Kade Foundation. L.C.C. supported in part by a grant from the National Cancer Institute. Address correspondence to R.W.P., Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria (e-mail: rupert.prokesch@univie.ac.at).

PURPOSE: To assess the frequency of isoattenuating pancreatic adenocarcinoma with multi–detector row computed tomography (CT) and determine whether there are specific secondary signs that aid in detection.

MATERIALS AND METHODS: Fifty-three patients with pancreatic adenocarcinoma underwent contrast material–enhanced biphasic multi–detector row CT with curved planar reformation. Tumors were initially deemed isoattenuating or hypoattenuating to normal pancreatic parenchyma on the basis of visual inspection, and the degree of attenuation was confirmed by calculating the mean attenuation differences between normal pancreatic parenchyma and tumor (tumor-pancreas contrast) during the pancreatic phase. Indirect signs of pancreatic tumor were tabulated in patients with an isoattenuating tumor.

RESULTS: Of the 53 patients, six (11%) had isoattenuating tumors with a mean tumor-pancreas contrast of 9.25 HU ± 11.3 during the pancreatic phase and 4.15 HU ± 8.5 during the portal venous phase. The secondary signs of pancreatic tumor in these six patients included an interrupted pancreatic duct (n = 5), dilated biliary and pancreatic ducts (n = 1), atrophic distal pancreatic parenchyma (n = 3), and mass effect and/or convex contour abnormality (n = 3). The mean tumor-pancreas contrast for the remaining 47 patients was 74.76 HU ± 35.61 during the pancreatic phase.

CONCLUSION: With no visible tumor-pancreas contrast for isoattenuating tumors, indirect signs such as mass effect, atrophic distal parenchyma, and an interrupted duct sign are important indicators for the presence of tumor.

© RSNA, 2002

Index terms: Adenocarcinoma, 77.321 • Computed tomography (CT), multi–detector row, 77.12119 • Pancreas, neoplasms, 77.32

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