PMC3971848_01
The scans show a multichambered lesion, 3.3 x 2.5 cm in size, localized in the head and in the uncinate process of the pancreas, hypointense in T1-weighted image (a) and hyperintense in T2-weighted image (b). After the intravenous contrast medium administration (c), the enhancement of the capsule and internal septa was shown. (a) Precontrast axial T1-WI FAT SAT. (b) Precontrast axial T2-WI FAT SAT. (c) Postcontrast axial T1 WI. The blue arrow indicates the lesion.
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fig1
T1-weighted fat-suppressed GRE sequences, and T2-weighted half-Fourier single-shot turbo spin-echo (HASTE-TSE). The dynamic study was performed during administration of 0.1 mmol/kg body weight of gadolinium chelates with a four-phase technique: precontrast, pancreatic phase (30-40 s), portal venous phase (80 s), and delayed phase (180 s). The dynamic study used a T1-weighted 3D GRE volumetric interpolated breath-hold examination (VIBE) sequence with chemically selective fat saturation in the axial plane. The MRI revealed a multilobulated lesion, hyperintense in T2 WI and hypointense in T1 WI, 3.3 x 2.5 cm in size, and it is localized in the head and in the uncinate process of the pancreas (Figure 1).
MRCP Coronal HASTE 2D. The scan shows the fusiform dilatation of the Wirsung duct at the head of the pancreas and the cystic lesion. The blue arrow indicates the lesion.
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fig2
To better assess the findings charged to the Wirsung the patient underwent MRCP (Figure 2) and MRCP with secretin stimulation (MRCP-S) (Figure 3).
Single shot T2 WI before (a) and after ((b)-(c)-(d)) secretin stimulation show an increase of the signal intensity of the Wirsung duct of the cystic lesion; the communication of the lesion with the Wirsung duct is now clearly visible and is also possible to appreciate the signs of acinar depletion of the branch ducts.
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fig3
To better assess the findings charged to the Wirsung the patient underwent MRCP (Figure 2) and MRCP with secretin stimulation (MRCP-S) (Figure 3).
Surgical specimen is possible to appreciate a clear correspondence between the specimen (a) and the imaging findings (b). The histological result was IPMN adenocarcinoma. The blue arrow indicates the lesion.
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fig4
The histological result of the specimen (Figure 4) confirmed the diagnosis of adenocarcinoma IPMN.