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E1633. Pancreatic Duct Caliber Change
Authors
  1. Michael Ching; Georgetown University Hospital Radiology
  2. Reena Jha; Georgetown University Hospital Radiology
  3. Emily Winslow; Georgetown University Hospital Radiology
  4. Walid Chalhoub; Georgetown University Hospital Radiology
  5. Mary Sidawy; Georgetown University Hospital Radiology
  6. Joseph Yacoub; Georgetown University Hospital Radiology
Background
Pancreatic duct caliber change is an increasingly common imaging finding, which has a variety of causes from benign to occult neoplasm. Because these entities can have nonspecific clinical presentation, imaging plays a key role in diagnosis. However, there are also overlapping imaging characteristics between these entities. Careful assessment is crucial for the radiologist to provide useful differential diagnoses to guide further workup and appropriate management.

Educational Goals / Teaching Points
This exhibit will review the causes of pancreatic duct caliber change, their management and prognosis, and their imaging features- specifically, the CT, MRI, ultrasound, and endoscopic ultrasound findings that will aid in formulating a differential diagnosis that would best guide management. Attention will also be directed at the multidisciplinary nature of diagnosing and managing the causes of pancreatic duct caliber change.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will briefly review the anatomy of the pancreas and the pancreatic duct, as well as the normal appearance of the pancreas and duct on MRI and CT. The optimal imaging techniques for evaluation of the pancreas and the pancreatic duct will be discussed, as well as the various disease processes that can cause pancreatic duct caliber change. These disease pathologies include: pancreatic ductal adenocarcinoma, solid pseudopapillary tumor of the pancreas, primitive neuroectodermal tumor, intraductal papillary mucinous neoplasm, chronic pancreatitis, groove pancreatitis, autoimmune pancreatitis, trauma, and benign causes such as serous cystadenoma. Various imaging features, signs, and pitfalls will be highlighted in assessing these causes including: presence or absence of abrupt cutoff, degree of ductal dilatation, associated parenchymal changes, cystic changes in the pancreas, parenchymal and intraductal calcification, duct penetrating sign, and pseudo-divisum sign.

Conclusion
Despite there being overlapping imaging characteristics in the etiologies of pancreatic duct caliber change, there are key imaging findings that help the radiologist to differentiate between them. Given the different etiologies that can lead to abrupt pancreatic duct caliber change, the radiologist should be an active participant in the multi-disciplinary team that cares for patients with disorders of the pancreas.