Pancreatic metastases: CT and MRI findings

ancreatic metastases are rare, with a reported incidence varying from 1.6% to 11% in autopsy studies of patients with advanced malignancy. In clinical series, the frequency of pancreatic metas-tases ranged from 2% to 5% of all pancreatic malignant tumors (1–5). The most common primary tumors to give rise to pancreatic metastases are renal cell carcinoma, lung cancer, breast cancer and colorectal carci-noma followed by malignant melanoma and leiomyosarcoma (1, 6). The disparity in prognosis and management of patients with primary and secondary pancreatic tumors, as well as the fact that in very selected cases a radical surgical resection can be considered as treatment of pancreatic metastases and achieve prolonged survival, underlines the importance of detection and characterization of these lesions on computed tomogra-phy (CT) and magnetic resonance imaging (MRI) (1, 6, 7). CT can also be considered as an important tool in providing guidance in order to obtain a definitive tissue diagnosis in controversial cases (1, 2, 7). Material and methodsIn a period of 5 years, between January 2002 and January 2007, 11 patients with pancreatic metastases, 4 women and 7 men, were exam-ined. Patients’ ages ranged from 27 to 78 years with a mean age of 62.45 years. All patients underwent CT examination and 3 patients were fur-ther evaluated by MRI. CT-guided biopsy was performed in 5 cases. Pa-tients with neoplastic involvement of the pancreas by direct extension from adjacent viscera, as well as patients with metastatic involvement of peripancreatic lymph nodes but not of the pancreas itself, were excluded from the study. CT scans were obtained with a Picker PQ 5000 CT scanner device with slice thickness, 5 mm; pitch, 2; reconstruction interval, 5 mm; FOV, rang-ing from 320–400 mm depending on the patient’s size. Images were ob-tained after contrast agent administration during portal phase (60–70 s after injection). A bolus injection of 120–150 mL (3–4 mL/s) of non-ionic contrast medium was given.MRI scans were obtained with a Siemens 1 T scanner (Siemens Ex-pert Plus, Erlangen, Germany). Before contrast administration, axial and coronal HASTE T2-weighted images (TR, 6 ms; TE, 60 ms) were obtained with a slice thickness of 8 mm; FOV, 340–400 mm depending on pa-tient’s size; and matrix, 256 x 192. After administration of 10 mL of contrast agent axial FLASH T1-weighted images (TR, 11 ms; TE, 4.2 ms) were obtained with a slice thickness of 8 mm; FOV, 340–400 mm, ma-trix, 256 x 192.CT guided pancreatic biopsies were performed using 18 G cutting nee-dles with the coaxial technique (Temno Evolution, Cardinal Health, Or-lando, Florida, USA). All patients were informed and gave their written consent before biopsy.