Atlas of Gastrointestinal Imaging Figure 1.3.3 Side branch IPMN

Dr. Perry Pickhardt

Aug 26, 2007

FIGURE 1.3.3 Side branch IPMN. Coronal reformatted CT image (A) shows cystic dilatation of a single side branch in the pancreatic head (arrow). On subsequent ERCP (B), contrast opacifies the same dilated side branch. Coronal T2-weighted SSFSE MR image (C) from a second patient shows a cluster of cystic lesions in the pancreatic head, which on MRCP (D) appears as a branching multicystic structure that communicates with, but does not directly involve, the main pancreatic duct. Contrast-enhanced CT (E) and intraoperative US (F) images from a third patient show a more nonspecific cystic lesion involving the pancreatic tail. Contrast-enhanced CT (G), T2-weighted MR (H), and MRCP (I) images from a final patient show a multicystic-appearing side branch IPMN involving the uncinate process.

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Images depict a 49-year-old female participant with cryptogenic cirrhosis who presented with a 3.2-cm liver lesion. This biopsy-confirmed hepatocellular carcinoma (HCC) with an initial categorization of Liver Imaging Reporting and Data System (LI-RADS) category LR-4 (probably HCC) at CT was upgraded to LR-5 (definitely HCC) at contrast-enhanced ultrasound (CEUS). (A) Precontrast CT images in the liver show vague hypoattenuation in the medial left hepatic lobe (arrows). (B) Arterial phase images demonstrate no definite arterial phase hyperenhancement (arrows). (C) Washout and an enhancing capsule (arrows) on a late-phase image resulted in an LR-4 categorization. (D) B-mode ultrasound shows a round hypoechoic nodule (arrows). (E) An early-phase CEUS image shows clear arterial-phase hyperenhancement (arrows); (F) No washout at one minute (arrows), and (G) late, mild washout at four minutes (arrows) resulted in a CEUS LR-5 categorization.

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