ARRS 2022 Abstracts

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E2112. Pancreatic Adenocarcinoma and Imitators at MRI
Authors
  1. Pardeep Mittal; Medical College of Georgia
  2. Thomas Estes ; Medical College of Georgia
  3. Manohar Roda; University of Mississippi Medical Center
  4. Abdul Abualruz; Medical College of Georgia
Background
The purpose of this education exhibit is to describe MRI characteristics of neoplastic and non-neoplastic conditions masquerading as pancreatic adenocarcinoma, such as chronic pancreatitis, autoimmune pancreatitis, groove pancreatitis, intra pancreatic spleen, SPEN, cystic neoplasms, lymphoma, mesenchymal tumors, and acinar cell carcinoma. These conditions pose diagnostic challenges to radiologists. Contrast-enhanced MRI is a noninvasive method for evaluation of patients with a suspected pancreatic mass without ionizing radiation. To reach a definite diagnosis, ERCP or EUS with tissue biopsy is needed, but certain MRI characteristics are helpful in narrowing the differential diagnosis. Wrong diagnosis of these conditions may lead to unnecessary surgery. Atypical findings that should suggest diagnoses other than adenocarcinoma include absence of ductal dilatation, hyper vascularity, large size , and intralesional cysts or ducts.

Educational Goals / Teaching Points
This exhibit aims to describe various neoplastic and non-neoplastic conditions imitating pancreatic adenocarcinoma and their MRI characteristics and illustrate the importance of relevant clinical information and key radiological findings for confident pancreatic lesion characterization and differentiation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Solid neoplasms of the pancreas represent a heterogeneous group of conditions than can be classified into neoplastic and non-neoplastic conditions that can masquerade as pancreatic adenocarcinoma including chronic pancreatitis, groove pancreatitis, autoimmune pancreatitis, SPEN, neuroendocrine tumors, lymphoma, mesenchymal tumors, and acinar cell tumors. Accurate diagnosis of pancreatic adenocarcinoma is of critical importance because it has high morbidity and mortality, and missing the diagnosis can lead to unnecessary surgeries and result in devastating patient outcomes. Contrast-enhanced MRI and MRCP is a noninvasive method for evaluating pancreatic lesions due to its superior soft tissue contrast and multiplanar capabilities, which can help narrow down the differential diagnosis. Sometimes ERCP or EUS-guided biopsy is needed to reach a definite diagnosis.

Conclusion
Accurate diagnosis of solid pancreatic lesions can be challenging due to the broad spectrum of neoplastic and non-neoplastic conditions imitating pancreatic adenocarcinoma. Because of its superior soft tissue contrast and multi planar capabilities, MRI plays an important role in the characterization of pancreatic lesions. Knowledge of key radiological findings and relevant clinical information is essential for pancreatic lesion characterization and differentiation.