E2886. Hypervascular Pancreatic Lesions Made Simple
Authors
Ott Le;
University of Texas MD Anderson Cancer Center
Background
Hypervascular lesions can often be found in the pancreas. The differential diagnosis can be varied. We present a systemic approach to arriving at the most likely diagnosis of hypervascular pancreatic lesions. First, pancreatic anatomy and physiology is reviewed. Then, conventional and functional imaging for hypervascular pancreatic lesion explained. Finally, hypervascular pancreatic lesions arising from endocrine or exocrine tumors, metastasis, neurogenic, vascular and developmental etiologies are expounded.
Educational Goals / Teaching Points
Review pancreatic anatomy and physiology. Review conventional and functional imaging and clinical presentation for hypervascular pancreatic lesions. Provide examples of the different etiologies of hypervascular pancreatic lesions and how to arise at the most likely diagnosis. Examples of hypervascular pancreatic lesions such as functional and nonfunctional endocrine tumors, exocrine tumors, metastasis, etc. will be reviewed.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Multiphasic imaging with pancreatic parenchymal phase imaging is the key for hypervascular pancreatic lesion detection and characterization. MRI is more sensitive than CT due to improved tissue contrast. Endoscopic ultrasound-intraoperative ultrasound. Somatostatin receptor scintigraphy for neuroendocrine tumors. (68)Ga-DOTATATE PET/CT improves diagnosis and staging compared with octreotide and conventional imaging. Sensitivity 87 - 100%, specificity 90 - 100%.
Conclusion
Hypervascular pancreatic lesions can be simplified to an accurate diagnosis with the proper understanding of the anatomy, physiology, clinical presentation and conventional and functional imaging techniques.
