Photon-Counting CT Shows Side-Branch Intraductal Papillary Mucinous Neoplasm–Pancreatic Duct Connection

HomeRadiologyVol. 312, No. 2 Previous Reviews and CommentaryFree AccessImages in RadiologyPhoton-Counting CT Shows Side-Branch Intraductal Papillary Mucinous Neoplasm–Pancreatic Duct ConnectionKhanin Khanungwanitkul , Fides R. SchwartzKhanin Khanungwanitkul , Fides R. SchwartzAuthor AffiliationsFrom the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (K.K., F.R.S.); and Department of Radiology, Prince of Songkla University, Songkhla, Thailand (K.K.).Address correspondence to K.K. (email: [email protected]).Khanin Khanungwanitkul Fides R. SchwartzPublished Online:Aug 6 2024https://doi.org/10.1148/radiol.240611MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Supplemental material is available for this article. A 69-year-old woman with known hepatic cirrhosis secondary to hepatitis C virus infection presented to the emergency department with abdominal pain and loss of appetite. The patient's blood tests and clinical examination were normal. Photon-counting CT of the abdomen revealed no acute disease process, but an incidental hypoattenuating lesion in the body of the pancreas was identified (Figs 1, 2; Movie). The photon-counting CT image at 0.4-mm section thickness (Fig 1A) demonstrated a thin connection from the hypoattenuating pancreatic lesion to the pancreatic duct that could not be discerned with more typical CT section thicknesses of 2 mm (Fig 1C) or 4 mm (Fig 1D). An iodine overlay image demonstrated no iodine uptake in the lesion at the site of the connection (Fig 1B).Figure 1: Axial photon-counting CT images at (A) 0.4-mm, (C) 2-mm, and (D) 4-mm section thickness demonstrate an incidental hypoattenuating pancreatic lesion (arrowhead). The lesion communicates with the main pancreatic duct via a connection (arrow) visible at 0.4-mm section thickness. (B) Iodine overlay image at 0.4-mm section thickness displays iodine content in orange, demonstrating no uptake within the hypoattenuating lesion or main duct communication.Figure 1:Download as PowerPointFigure 2: Coronal cinematic rendering of the intraductal papillary mucinous neoplasm (arrowhead) in relation to the pancreatic duct.Figure 2:Download as PowerPoint Movie: Rotating cinematic rendering of the intraductal papillary mucinous neoplasm in relation to the pancreatic duct and other abdominal structures.Download Original Video (9.3 MB) The patient was discharged from the emergency department, and subsequent MR cholangiopancreatography (Fig 3) depicted the cystic lesion within the pancreas but was unable to demonstrate a definite connection to the main pancreatic duct. Based on the communication to the pancreatic duct seen at photon-counting CT, and the absence of enhancement, the lesion was diagnosed as a side-branch intraductal papillary mucinous neoplasm of the pancreas. Additional work is needed to investigate the diagnostic performance of photon-counting CT.Figure 3: Axial T2-weighted image at 5-mm section thickness from MR cholangiopancreatography confirms the cystic nature of the lesion (arrow) but does not show the connection to the main pancreatic duct.Figure 3:Download as PowerPointDisclosures of conflicts of interest: K.K. No relevant relationships. F.R.S. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Siemens Healthineers and support for attending meetings and/or travel from General Electric and Siemens Healthineers.Article HistoryReceived: Mar 5 2024Revision requested: Mar 26 2024Revision received: Apr 4 2024Accepted: Apr 11 2024Published online: Aug 06 2024 FiguresReferencesRelatedDetailsRecommended Articles Pancreatic Cyst Surveillance: Who, Why, How?Radiology2023Volume: 308Issue: 1Interobserver Variability and Diagnostic Performance in Predicting Malignancy of Pancreatic Intraductal Papillary Mucinous Neoplasm with MRIRadiology2023Volume: 308Issue: 1"Biliary Diseases with Pancreatic Counterparts": Cross-sectional Imaging FindingsRadioGraphics2016Volume: 36Issue: 2pp. 374-392Determining Malignant Potential of Intraductal Papillary Mucinous Neoplasm of the Pancreas: CT versus MRI by Using Revised 2017 International Consensus GuidelinesRadiology2019Volume: 293Issue: 1pp. 134-143Hereditary and Sporadic Pancreatic Ductal Adenocarcinoma: Current Update on Genetics and ImagingRadiology: Imaging Cancer2020Volume: 2Issue: 2See More RSNA Education Exhibits Surgery or Follow-up? 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