Pancreatoduodenal Junction: Review of Anatomy and Pathologic Conditions
Tóm tắt
The pancreatoduodenal junction is a small anatomic area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla de Vater, and retroperitoneum converge. Differential diagnosis includes a spectrum of entities that ranges from anatomical variants to malignancies. The aim of this paper was to review the anatomy and different pathologic conditions, whether tumoral, inflammatory, or congenital in origin, in this specific area that involves the pancreatic head, duodenum, duodenal ampulla, distal pancreatobiliary tract junction, and retroperitoneum. Computed tomography (CT) and magnetic resonance (MR) help us to identify specific radiologic signs that allow to divide the pancreatic-duodenal junction abnormalities into three cathegories: (1) normal variants and congenital anomalies (pancreas divisum, santorinicele, annular pancreas,duodenal duplication cyst, choledocal cyst,...); (2) acquired non-tumoral: traumatic, iatrogenic, inflammatory (duodenal hematoma, duodenal iatrogenic perforation, groove pancreatitis, gastroduodenal artery pseudoaneurysm,...); (3) tumoral (pancreatic head adenocarcinoma, periampullary tumors, neuroendocrine pancreatic tumors, duodenal adenocarcinoma,...). The images illustrate morphologic aspects of these entities. CT and MR are the most appropiate imaging modalities to evaluate pancreatoduodenal junction. Knowing the imaging features is crucial to reach the right diagnosis and treatment of the different entities that involve this anatomic area.
Tài liệu tham khảo
Yu J, Fulcher AS, Turner MA, et al. Normal anatomy and disease processes of the pancreatoduadenal groove: imaging features.AJR 2004;183:839–846.
Steinberg, William M.; Chari, Suresh T.; Forsmark, Chris E.; Sherman, Stuart; Reber, Howard A.; Bradley, Edward L. III; DiMagno, Eugene. Controversies in Clinical Pancreatology: Management of Acute Idiopathic Recurrent Pancreatitis. Pancreas: August 2003 - Volume 27 - Issue 2 - pp 103–117
Liechtenstein et al. Imaging interpretation session: 1995. Radiographics 1996;16:215–239.
Manfredi R, Costamagna G, Brizi MG, Spina S, Maresca G, Vecchioli A, Mutignani M, Marano P. Pancreas divisum and “santorinicele”: diagnosis with dynamic MR cholangiopancreatography with secretin stimulation..Radiology November 2000 217:403–408
Sandrasegaran K, Patel A, Fogel EL, Zyromski NJ, Pitt HA. Annular pancreas in adults. AJR 2009; 193:455–460.
Greene FL, Brown JJ, Rubinstein P et al. Choledochocele and recurrent pancreatitis. Diagnosis and surgical management. Am J Surg 1985; 149(2):306–9.
Todani T, Watanabe Y, Narusue M et al. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 1977; 134(2):263–9
Rajnakova A, Goh PM, Ngoi SS, Lim SG. ERCP in patients with periampullary diverticulum. Hepatogastroenterology. 2003 May–Jun;50(51):625–8.)
Megremis S, Segkos N, Andrianaki A, Gavridakis G, Psillakis K, Triantafyllou L, Katsougris N, Michalakis M, Sfakianaki E. Sonographic diagnosis and monitoring of an obstructing duodenal hematoma after blunt trauma: correlation with computed tomographic and surgical findings. J Ultrasound Med 23:1679–1683 • 0278–4297.
Hahn PF, Stark DD, Vici LG, Ferrucci JT Jr. Duodenal hematoma: the ring sign in MR imaging..Radiology May 1986 159:379–382.
Miguel Iuchtman MD PhD, Tzvi Steiner MD, Tzvi Faierman MD, Alla Breitgand MD and Gabriel Bartal MD. Post-Traumatic Intramural Duodenal Hematoma in Children Isr Med Assoc J. 2006 Feb;8(2):95–7.
B.E. Stabile, S.E. Wilson and H.T. Debas, Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis. Arch Surg 118 (1983), pp. 45–51.
M. De Perrot, T. Berney, L. Bühler, X. Delgadillo, G. Mentha and P. Morel, Management of bleeding pseudoaneurysms in patients with pancreatitis. Br J Surg 86 (1999), pp. 29–32.
J.S. Bender and M.A. Levison, Pseudoaneurysm of the gastroduodenal artery arising within a pancreatic pseudocyst. Ann Vasc Surg 6 (1992), pp. 171–172
L. Benoit, J. Fraisse, J.P. Cercueil, A. Cornet and J. Cuisenier, Anévrysme de l’artère gastroduodénale et pancréatite chronique. Ann Chir 50 (1996), pp. 918–920
Triantopoulou C, Dervenis C, Giannakou N, Papailiou J, Prassopoulos P. Groove pancreatitis: a diagnostic challenge. Eur Radiol (2009) 19: 1736–1743
Blasbalg R, Baroni RH, Costa DN, Machado MC MRI features of groove pancreatitis..AJR 2007; 189:73–80.
Chatelain D, Vibert E, Yzet T, et al. Groove pancreatitis and pancreatic heterotopia in the minor duodenal papilla. Pancreas 2005; 30:e92–e95
Stolte M, Weiss W, Volkholz H, Rosch W. A special form of segmental pancreatitis: “groove pancreatitis.” Hepatogastroenterology 1982; 29:198–208
Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying “cystic dystrophy of heterotopic pancreas”, “para-duodenal wall cyst” and “groove pancreatitis”. Sem Diagn Pathol 21:247–254.
Tan CH, Chow PK, Thng CH, Chung AY, Wong WK. Pancreatic adenocarcinoma that mimics groove pancreatitis: case report of a diagnostic dilemma. Dig Dis Sci 51(7):1294–6, 2006.
Balakrishnan V, Chatni S, Radhakrishnan L, Narayanan VA, Nair P. Groove pancreatitis: a case report and review of literature. JOP 8(5):592–7, 2007.
Ahmad SA, Lowy AM, McIntyre BC, Mathew JB. Pancreaticoduodenectomy Journal of Gastrointestinal Surgery 9 (1):138–143, 2005.
Tan CH, Chow PKH, et al. Pancreatic adenocarcinoma that mimics groove pancreatitis: case report of a diagnostic dilemma. Digestive disease and sciences 2006; 51:1294–1296.
Kim J.H., Kim M.J., Chung J.J., et al. Differential diagnosis of periampullary carcinomas at MR imaging. Radiographics 2002; 1335–1352.
Jayaraman M, Mayo-Smith W, Movson JS, et al. CT of the duodenum: an overlooked segment gets its due. Radiographics 2001; 21:S147–S160.
Levy A.D., Remotti H.E., Thompson W.M., et al. Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics 2003; 23:283–304.
Burkill G.J.C., BadranM., Al-Muddlres O., et al. Malignant gastrointestinal stromal tumor: distribution imaging features and pattern of metastasic spread. Radiology 2003; 226:527–532.
Buetow P.C., Miller D.L., Parrino T.V., et al.Islet-cell tumors of the pancreas: clinical, radiologic and pathologic correlation in diagnosis and localization. Radiographics 1997;17:453–472.
Bronstein YL, Loyer EM, Kaur H, et al. Detection of small tumors with multiphasic helical CT. AJR 2004;182:619–623.
Procacci C, Megibow AJ, Carbognin G, et al. Intraductalpapillary mucinous tumor of pancreas: a pictorial essay. Radiographics 1999; 19;1447–1463.
Lim HJ, Lee G, Oh YL. Radiologic spectrum of intraductal papillary mucinous tumor of the pancreas.Radiographics 2001; 21:323–340.).
Periampullary cancers: are there differences? Surg Clin North Am 2001;81:543–555.
Periampullary tumors: high-spatial resolution MR imaging and histopathologic findings in ampullary region specimens. Radiology 2004;231;767–774.
Pancreatic and peripancreatic diseases mimicking primary pancreatic neoplasia. To’o KJ, Raman SS.,Yu NC, et al. Radiographics 2005;25:949–965.
Tuberculosis: a radiologic review. Burrill j, Williams C, et al. Radiographics 2007;27:1255–1273.
SM Harun et al. What cyst is this?. Biomed Imaging Interv J 2007; 3(4):e44