Original Research

Preoperative contrast-enhanced computed tomographic characterisation of pancreatic cystic lesions: A prospective study

Dar M. Saleem, Wani A. Haseeb, Arshed H. Parry, Robbani Irfan, Najar M. Muzaffar, Gojwari Tariq, Shah O. Javed, Imza Feroz
South African Journal of Radiology | Vol 23, No 1 | a1727 | DOI: https://doi.org/10.4102/sajr.v23i1.1727 | © 2019 Dar M. Saleem, Wani A. Haseeb, Arshed H. Parry, Robbani Irfan, Najar M. Muzaffar, Gojwari Tariq, Shah O. Javed, Imza Feroz | This work is licensed under CC Attribution 4.0
Submitted: 23 February 2019 | Published: 10 June 2019

About the author(s)

Dar M. Saleem, Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
Wani A. Haseeb, Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
Arshed H. Parry, Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
Robbani Irfan, Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
Najar M. Muzaffar, Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
Gojwari Tariq, Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
Shah O. Javed, Department of Surgical Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
Imza Feroz, Department of Surgical Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India


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Abstract

Background: Characterisation of pancreatic cystic lesions has a direct role in their management and computed tomography is the mainstay of investigation for diagnosing and characterising them.

Objectives: The aim of this study was to prospectively assess the diagnostic accuracy of contrast-enhanced computed tomography (CECT) in preoperative characterisation of pancreatic cystic lesions with histopathology as the reference standard.

Method: A total of 38 patients with cystic pancreatic lesions diagnosed after clinical, laboratory and sonographic evaluation, irrespective of age, were preoperatively evaluated with CECT. Images were reviewed for the general characteristics of the lesions on pre-contrast and portal venous phase images and overall diagnostic accuracy calculated. Imaging findings were compared with histopathology, or cytology and/or intra-operative findings.

Results: Serous cystadenoma (SCA) was the most common cystic pancreatic lesion found in 31.6% of patients followed by mucinous cystadenoma (MCA) (26.3%), solid pseudo-papillary tumour (SPT) (21.1%) and intra-ductal papillary mucinous neoplasm (IPMN) (10.5%). Three patients (7.9%) had simple cysts and one patient (2.6%) had a lymphangioma. The diagnostic accuracy of CECT for pancreatic cystic lesions was found to be 72.5%

Conclusion: The diagnostic accuracy of computed tomography (CT) was high for SCA, IPMN and pancreatic cysts, and low for MCA and SPT. Combination of a multiloculated cystic lesion with locule size of less than 20 mm, septal enhancement with relative lack of wall enhancement, central scar and lobulated outline are highly specific for SCA. Unilocular or macro-cystic pattern with locule size of more than 20 mm, female gender and wall enhancement with smooth external contour are pointers towards MCA. Solid cystic pancreatic head lesions in young females may be suggestive of SPT. A dilated main pancreatic duct in a cystic lesion with internal septations may point towards IPMN. Fluid attenuation lesions with imperceptible non-enhancing wall indicate pancreatic cysts. Lastly, pseudocysts and neuroendocrine tumours with cystic components are great mimickers of pancreatic cystic lesions, and a history of pancreatitis and hormonal profile of patients should always be sought.


Keywords

Serous cystadenoma; mucinous cystadenoma; solid pseudo-papillary tumour; intra-ductal papillary mucinous neoplasm; simple pancreatic cyst; pancreatic lymphangioma.

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