Pankreas Hastalıklarında Radyolojik Görüntülemenin Yeri
Özet
Pankreas hastalıklarının teşhisinde, organın retroperitoneal yerleşimi ve derin lokalizasyonu nedeniyle fizik muayene yetersiz kalmakta, bu durum anamnez, laboratuvar bulguları ve multimodaliter radyolojik görüntüleme yöntemlerinin entegrasyonunu zorunlu kılmaktadır. Sunulan metin; konjenital anomaliler (pankreas divisum, anüler ve heterotopik pankreas), genetik hastalıklar (kistik fibrozis, Von Hippel-Lindau ve primer hemokromatozis), akut/kronik pankreatit süreçleri ve pankreasın kistik/solid tümörleri (PDAK, PNET, lenfoma ve metastazlar) dahil olmak üzere geniş bir patoloji yelpazesini kapsamlı bir şekilde incelemektedir. Düz karın grafisinden ileri ultrasonografi (USG), endoskopik USG (EUS), bilgisayarlı tomografi (BT), manyetik rezonans görüntüleme (MRG) ve sekretinli MRKP gibi gelişmiş tekniklere kadar her modalitenin tanısal değeri, anatomik çözünürlüğü ve kalsifikasyon, nekroz, fibrozis veya vasküler invazyon gibi spesifik patolojik belirteçleri saptamadaki rolü detaylandırılmaktadır. Özellikle pankreas duktal adenokarsinomu (PDAK) gibi yüksek mortaliteli malignitelerin preoperatif evrelendirilmesinde ve rezektabilite kriterlerinin belirlenmesinde, kontrastlı kesitsel görüntülemelerin (BT/MRG) vasküler yapılarla olan ilişkiyi değerlendirmedeki kritik önemi vurgulanmaktadır. Sonuç olarak çalışma, doğru tanı, tedavi planlaması ve tedaviye yanıtın izlenmesinde yapılandırılmış radyolojik raporlama şablonlarının ve ileri görüntüleme sekanslarının hayati rolünü ortaya koymaktadır.
Due to the retroperitoneal and deep localization of the pancreas, physical examination is insufficient for diagnosing pancreatic diseases, necessitating the integration of anamnesis, laboratory findings, and multimodality radiological imaging. The provided text comprehensively reviews a wide spectrum of pathologies, including congenital anomalies (pancreas divisum, annular and heterotopic pancreas), genetic disorders (cystic fibrosis, Von Hippel-Lindau, and primary hemochromatosis), acute/chronic pancreatitis processes, and cystic/solid pancreatic tumors (PDAC, PNET, lymphoma, and metastases). The diagnostic value, anatomical resolution, and role of each imaging modality—ranging from conventional radiography to advanced techniques like ultrasonography (USG), endoscopic USG (EUS), computed tomography (CT), magnetic resonance imaging (MRI), and secretin-enhanced MRCP—are detailed in detecting specific pathological markers such as calcification, necrosis, fibrosis, or vascular invasion. In particular, the critical importance of contrast-enhanced cross-sectional imaging (CT/MRI) in evaluating the relationship with vascular structures during preoperative staging and determining resectability criteria for high-mortality malignancies like pancreatic ductal adenocarcinoma (PDAC) is emphasized. Consequently, the study demonstrates the vital role of structured radiological reporting templates and advanced imaging sequences in ensuring accurate diagnosis, treatment planning, and treatment response monitoring.
Referanslar
Hrubran R, Wilentz R. ThePancreas. In: Kumar V, Abbas AK, Fausto N, eds. Robbinsandcotranpathologicbasis of disease 7th Ed. Philadelphia, PA: ElsevierSaunders; 2005:939-953.
Martínez-Noguera A, Montserrat E, Torrubia S, Monill JM, Estrada P. Ultrasound of thepancreas: updateandcontroversies. EurRadiol 2001; 11: 1594- 606. [CrossRef])
Pickhardt PJ, Signs in Imaging, theColonCut-offSign Radiology 2000 215:387-89
Varadarajulu S, Eloubeidi MA. The role of endoscopicultrasonography in theevaluation of pancreatico-biliarycancer. SurgClin North Am. 2010; 90:251-263
Al-Hawary MM , Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, et al. Pancreaticductaladenocarcinomaradiologyreportingtemplate: consensusstatement of thesociety of abdominalradiologyandtheamericanpancreaticassociation. Gastroenterology 2014; 146: 291-304. [CrossRef]).
Stuber T, Brambs HJ, Freund W, Juchems MS. Sixty-four MDCT achieveshighercontrast in pancreaswithoptimization of scan time delay. World Radiol 2012; 4: 324-7. [CrossRef]).
Sandrasegaran K, Lin C, Akisik FM, Tann M. State-ofthe-art pancreatic MRI. AJR Am J Roentgenol 2010; 195: 42-53. [CrossRef])
Patel BN Routine MR ImagingforPancreas. MagnResonImagingClin N Am 2018; 26: 315-22.)
Tirkes T, Menias CO, Sandrasegaran K. MR imagingtechniquesforpancreas. RadiolClin North Am 2012; 50: 379-93. [CrossRef])
Wallner BK, Schumacher KA, Weidenmaier W, Friedrich JM. Dilatedbiliarytract: evaluationwith MR cholangiographywith a T2-weighted contrast-enhancedfastsequence. Radiology 1991; 181: 805-8. [CrossRef)
Morgan DE, Logan K, Baron TH, Koehler RE, Smith JK. Pancreasdivisum: implicationsfordiagnosticandtherapeuticpancreatography. AJR Am J Roentgenol 1999;173(1): 193–198
Borghei P, Sokhandon F, Shirkhoda A, Morgan DE. Anomalies, anatomicvariants, andsources of diagnosticpitfalls in pancreaticimaging. Radiology 2013; 266: 28-36. [CrossRef)
Sandrasegaran K, Patel A, Fogel EL, Zyromski NJ, Pitt HA. Annularpancreas in adults. AJR Am J Roentgenol 2009; 193:455–460
Nijs EL, Callahan MJ. Congenitalanddevelopmentalpancreaticanomalies: ultrasound, computedtomography, andmagneticresonanceimagingfeatures. Semin Ultrasound CT MR 2007; 28:395–401.).
(Yu J, Turner MA, Fulcher AS, Halvorsen RA. Congenitalanomaliesand normal variants of thepancreaticobiliarytractandthepancreas in adults: part 2, Pancreaticductandpancreas. AJR Am J Roentgenol 2006; 187:1544–1553)).
Low JP, Williams D, Chaganti JR. Polyspleniasyndromewithagenesis of thedorsalpancreasandpreduodenal portal veinpresentingwithobstructivejaundice--a casereportandliteraturereview. Br J Radiol 2011; 84: e217–e220.)
Chang WI, Kim BJ, Lee JK, et al. Theclinicalandradiologicalcharacteristics of focalmass-formingautoimmunepancreatitis: comparisonwithchronicpancreatitisandpancreaticcancer. Pancreas 2009; 38(4):401–408)
Freeman A.J., Ooi C.Y. Pancreatitisandpancreaticcystosis in cysticfibrosis. J. Cyst. Fibros. 2017 Nov;16(Suppl 2): S79–S86. [PubMed] [Google Scholar]
Tamura K., Nishimori I., Ito T., Yamasaki I., Igarashi H., Shuin T. Diagnosisandmanagement of pancreaticneuroendocrinetumor in vonHippel–Lindaudisease. World J. Gastroenterol. 2010;16(September (36)):4515–4518. [PMC freearticle] [PubMed] [Google Scholar])
Queiroz-Andrade M, Blasbalg R, Ortega CD, Rodstein MA, Baroni RH, Rocha MS, et al. MR imagingfindings of ironoverload. Radiographics 2009; 29: 1575-89. [CrossRef ).
Murphy KP, O’Connor OJ, Maher MM. UpdatedImagingNomenclatureforAcutePancreatitis. Am J Roentgenol. 2014;203: W464–W469. doi: 10.2214/AJR.13.12
Foster BR, Jensen KK, Bakis G, et al. Revised Atlanta ClassificationforAcutePancreatitis: A PictorialEssay. RadioGraphics. 2016;36: 675–687. doi: 10.1148/rg.2016150097. [PubMed] [CrossRef] [Google Scholar)
Colvin SD, Smith EN, Morgan DE, Porter KK. Acutepancreatitis: an update on therevised Atlanta classification. AbdomRadiol. 2019 doi: 10.1007/s00261-019-02214-w. [PubMed] [CrossRef]).
Banks PA, Bollen TL, Dervenis C, et al. Classification of acutepancreatitis—2012: revision of the Atlanta classificationanddefinitionsbyinternationalconsensus. Gut. 2013; 62:102–111. doi: 10.1136/gutjnl-2012-302779. [PubMed] [CrossRef] [Google Scholar.)
Foster BR, Jensen KK, Bakis G, et al. Revised Atlanta ClassificationforAcutePancreatitis: A Pictorialssay. RadioGraphics. 2016; 36:675–687. doi: 10.1148/rg.2016150097. [PubMed] [CrossRef] [Google Scholar
Garg SK, Sarvepalli S, Campbell JP, et al. Incidence, AdmissionRates, andPredictors, andEconomicBurden of AdultEmergencyVisitsforAcutePancreatitis: Data FromtheNationalEmergencyDepartmentSample, 2006 to 2012. J ClinGastroenterol. 2019; 53:220–225. doi: 10.1097/MCG.0000000000001030. [PubMed] [CrossRef] [Google Scholar].)
Aman Khurana, 1 Leslie W Nelson,1 Charles B Myers,1 Fatih Akisik,2 Brooke R. Jeffrey,3 Frank H. Miller,4 Pardeep Mittal,5 Desiree Morgan,6 Koenraad Mortele,7 Peter Poullos,3 Dushyant Sahani,8 Kumar Sandrasegaran,9 Temel Tirkes,2 Atif Zaheer,10 and Bhavik N. Patel3Reporting of acute pancreatitis by radiologists-time for a systematic change with structured reporting template.AbdomRadiol (NY). 2020; 45(5): 1277–1289.doi: 10.1007/s00261-020-02468-9
Issa Y, Kempeneers MA, vanSantvoort HC, Bollen TL, Bipat S, Boermeester MA. Diagnosticperformance of imagingmodalities in chronicpancreatitis: A systematicreviewand meta-analysis. EurRadiol. 2017;27:3820–44. [PMC freearticle] [PubMed] [Google Scholar)]
Sharma R, Kandasamy D. Imaging in chronicpancreatitis. PancreapediaExocrinePancreasKnowl Base. 2015 [Google Scholar])
Conwell DL, Lee LS, Yadav D, Longnecker DS, Miller FH, Mortele KJ, et al. AmericanPancreaticAssociationPracticeGuidelines in ChronicPancreatitisEvidence-Based Report on DiagnosticGuidelines. Pancreas 2014; 43: 1143-62. [CrossRef])
Balci NC, Perman WH, Saglam S, Akisik F, Fattahi R, Bilgin M. Diffusion-weightedmagneticresonanceimaging of thepancreas. Top MagnResonImaging 2009; 20: 43-7.].
Matos C, Cappeliez O, Winant C, Coppens E, Devière J, Metens T. MR imaging of thepancreas: A pictorialtour. Radiographics. 2002;22:e2. [PubMed] [Google Schola ]
Bian Y, Wang L, Chen C, Lu JP, Fan JB, Chen SY, et al. Quantification of pancreaticexocrinefunction of chronicpancreatitiswithsecretin-enhanced MRCP. World J Gastroenterol. 2013;19:7177–82.
Blasbalg R, Baroni RH, Costa DN, et al. MRI features of groovepancreatitis. AJR 2007; 189:73–80 [Abstract] [Google Scholar]
Raman SP, Salaria SN, Hruban RH, Fishman EK. Groove pancreatitis: Spectrum of imagingfindingsandradiology-pathologycorrelation. AJR Am J Roentgenol 2013; 201: W29-39. [CrossRef
Bodily KD, Takahashi N, Fletcher JG, et al. Autoimmunepancreatitis: pancreaticandextrapancreaticimagingfindings. AJR Am J Roentgenol 2009; 192:431-7)
Sahani DV, Kalva SP, Farrell J, et al. Autoimmunepancreatitis: imagingfeatures. Radiology 2004; 233: 345–52.24
Kalb B, Sarmiento JM, Kooby DA, Adsay NV, Martin DR. MR imaging of cysticlesions of thepancreas. Radiographics 2009; 29: 1749-65. [CrossRef
Dewhurst CE, Mortele KJ. Cystictumors of thepancreas: imagingandmanagement. RadiolClin North Am 2012; 50: 467-86. [CrossRef]].
Burk KS, Knipp D, Sahani DV. CysticPancreaticTumors. MagnResonImagingClin N Am 2018; 26: 405- 20. [CrossRef]
Pozzessere C, CastañosGutiérrez SL, Corona-Villalobos CP, Righi L, Xu C, Lennon AM, et al. Diffusion-WeightedMagneticResonanceImaging in DistinguishingBetweenMucin-ProducingandSerousPancreaticCysts. J ComputAssistTomogr 2016; 40: 505-12. [CrossRef )
Shankar PR, Wasnik AP, Al-Hawary MM, Francis IR, Kaza RK: Hypervascularpancreatic ‘lesions': a pattern-basedapproachtodifferentiation. AbdomRadiol (NY) 2018;43:1013-1028
Tanaka M, Chari S, Adsay V, et al. International consensusguidelinesformanagement of intraductalpapillarymucinousneoplasmsandmucinouscysticneoplasms of thepancreas. Pancreatology 2006;6 (1-2):17–32 )
Lee JH, Yu JS, Kim H, Kim JK, Kim TH, Kim KW, et al. Solid pseudo-papillarycarcinoma of thepancreas: differentiationfrombenignsolidpseudopapillarytumorusing CT and MRI. ClinRadiol 2008; 63: 1006- 14. [CrossRef])[
Shrikhande SV, Barreto SG, Goel M, Arya S. Multimodalityimaging of pancreaticductaladenocarcinoma: a review of theliterature. HPB (Oxford) 2012;14:658–668. [PMC freearticle] [PubMed] [Google Scholar])
Li H, Zeng MS, Zhou KR, Jin DY, Lou WH. Pancreaticadenocarcinoma: signs of vascularinvasiondeterminedbymulti-detectorrow CT. Br J Radiol. 2006;79:880–887. [PubMed] [Google Scholar])
Al-Hawary MM, Francis IR, Chari ST et al (2014) Pancreaticductaladenocarcinomaradiologyreportingtemplate: consensusstatement of theSociety of AbdominalRadiologyandtheAmericanPancreaticAssociation. Radiology 270:248–260. https://doi.org/10.1148/radiol.13131184)
Sandrasegaran K, Lin C, Akisik FM, Tann M. State-of-the-art pancreatic MRI. AJR Am J Roentgenol 2010; 195: 42-53.
Soloff EV, Zaheer A, Meier J, Zins M, Tamm EP. Staging of pancreaticcancer: resectable, borderlineresectable, andunresectabledisease. AbdomRadiol (NY) 2018; 43: 301-13. [CrossRef].
Ahualli J. Thedoubleductsign. Radiology 2007; 244: 314-5. [CrossRef])
Elmas N, Oran I, Oyar O, Ozer H. A newcriterion in differentiation of pancreatitisandpancreaticcarcinoma: artery-to-veinratiousingthesuperiormesentericvessels. AbdomImaging 1996; 21: 331-3. [CrossRef])))
Dromain C, Déandréis D, Scoazec JY, Goere D, Ducreux M, Baudin E, et al. Imaging of neuroendocrinetumors of thepancreas. DiagnIntervImaging 2016; 97: 1241-57. [CrossRef]]).
Low G, Panu A, Millo N, Leen E. Multimodalityimaging of neoplasticandnonneoplasticsolidlesions of thepancreas. Radiographics 2011; 31: 993- 1015. [CrossReff)
Tamm EP, Kim EE, Ng CS (2007) Imaging of neuroendocrinetumors. HematolOncolClin North Am 21:409–432)
O’Grady HL, Conlon KC (2008) Pancreaticneuroendocrinetumours. Eur J SurgOncol 34:324–332)
Boninsegna E, Zamboni GA, Facchinelli D, Triantopoulou C, Gourtsoyianni S, Ambrosetti MC, et al CT imaging of primary pancreatic lymphoma: experience from three referralcentres for pancreaticdiseases. InsightsImaging 2018; 9: 17-24. [CrossRef].)
Tsitouridis I, Diamantopoulou A, Michaelides M, Arvanity M, Papaioannou S. Pancreaticmetastases: CT and MRI findings. DiagnIntervRadiol. 2010;16:45-51. [PubMed] [Cited in ThisArticle: 3]))
