Abstract

Imaging of the pancreas is challenging because of its anatomical location in the retroperitoneum and its intricate relationship with major blood vessels and bowel. Pancreatic cysts are common with prevalence of 49.1% and an incidence of 12.9% during 5 year follow up. Pancreatic cancer estimates approximately 3% of all cancers and is the 4^th most frequent cause of cancer related death. The incidence is increasing and the overall survival has been altered a little in the recent years. The overall 5 year survival rate of pancreatic cancer ranges from 0.4% to 4%, the lowest for any cancer. CT has been the imaging modality of choice for evaluation of pancreatic pathology.

Aims & Objectives

• To evaluate the pancreatic lesions by computed tomography (CT)
• To determine the role of CT in detection of pancreatic lesions
• To assess the role of CT in characterizing pancreatic lesions into cystic/benign/malignant
• To diagnose various complications of pancreatic mass lesions

Materials & Methods: The present hospital based cross sectional study was conducted in the Department of Radio-Diagnosis. CT scan of abdomen using a GE 16 slice helical CT machine using non-ionic iodine contrast injection with dose of 1.5-2ml/kg body weight was administered by intravenous route. For all cases, pancreatic size, morphology and duct was assessed. Calcifications in pancreatic parenchyma or duct was taken into consideration. Peripancreatic fluid whether present or not was analysed. Whether the peripancreatic fat planes were maintained or obliterated were taken into account. Any loculated collections in pancreatic parenchyma itself or elsewhere in relation to the pancreas were noted. Peripancreatic vasculature was also assessed for any thrombus or perivascular fat infiltration.

Results: In the present study, 85.29% were benign masses and 14.7% were malignant masses with head and uncinate process as the most commonly part (47.05%). Among the benign lesions, acute pancreatitis was most common (32.35%), followed by chronic pancreatitis (17.64%) and Carcinoma pancreas was seen in 8.82%. The most common CT signs of acute pancreatitis were diffuse gland involvement (61.53%), regular contour (69.23%), homogenous density (30.76%), necrosis (31%), fluid accumulation (53.61%), phlegmatous change (30.54%), pseudocyst (15.26%) and ascites in 7.63%. The most common CT signs of chronic pancreatitis were diffuse atrophy (57.14%), focal atrophy (28.57%), psudocyst(14.28%). Pancreatic duct dilation was seen in 57.14%, calculus in 42.85%. Similarly CBD duct dilation was seen in 85.71%, calculus in 14.28%.Calcification was seen in 42.85%. Among the cases with acute pancreatitis, 46.15% were mild, 38.46% were moderate and 15.38% were of severe grade according to CTSI.

Conclusion: Contrast-enhanced multiphase pancreatic imaging by multislice computerized tomography along with its post-processing techniques is considered as the imaging modality of choice for diagnosis of pancreatic mass lesions and characterizing them into cystic, solid and in case of malignancy further playing a role in resectability. CT plays an important role in detecting as well as staging pancreatic cancer, grading of pancreatitis, and trauma cases. Better optimization of the imaging protocols with thinner sections aids in better resolution.

Keywords: Pancreatic masses, CT scan, Acute pancreatitis.