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Intrapancreatic accessory spleen: findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis.

Kim SH, Lee JM, Han JK, Lee JY, Kim KW, Cho KC, Choi BI - Korean J Radiol (2008 Mar-Apr)

Bottom Line: In particular, inhomogeneous enhancement of an IPAS in its early phases may be a diagnostic clue.Superparamagnetic iron oxide (SPIO)-enhanced MRI and Levovist-enhanced US, and the mechanisms of which are theoretically similar to that of Tc-99m scintigraphy, can be used as alternative tools to confirm the diagnosis of IPAS.We review and illustrate the differential points between IPAS and hypervascular pancreatic tumors in this manuscript.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Hospital, Seoul, Korea.

ABSTRACT
Although the tail of the pancreas is the second most common site of an accessory spleen, intrapancreatic accessory spleen (IPAS) has rarely been noted radiologically. However, as the imaging techniques have recently advanced, IPAS will be more frequently detected as an incidental pancreatic nodule on CT or MRI. Because accessory spleens usually pose no clinical problems, it is important to characterize accessory spleens as noninvasively as possible. An IPAS has similar characteristics to those of the spleen on the precontrast and contrast-enhanced images of all the imaging modalities. In particular, inhomogeneous enhancement of an IPAS in its early phases may be a diagnostic clue. Superparamagnetic iron oxide (SPIO)-enhanced MRI and Levovist-enhanced US, and the mechanisms of which are theoretically similar to that of Tc-99m scintigraphy, can be used as alternative tools to confirm the diagnosis of IPAS. An IPAS shows a significant signal drop similar to the spleen on the SPIO-enhanced T2 or T2*-weighted imaging and prolonged enhancement on the delayed hepatosplenic phase of contrast-enhanced US. We review and illustrate the differential points between IPAS and hypervascular pancreatic tumors in this manuscript.

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Related in: MedlinePlus

70-year-old man with intrapancreatic accessory spleen. On T2-weighted turbo spin-echo image, intrapancreatic accessory spleen (arrows) shows high signal intensity compared to pancreas. Lesion also has slightly higher signal intensity than spleen (S). Intrapancreatic accessory spleen was confirmed by Tc-99m SPECT.
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Figure 2: 70-year-old man with intrapancreatic accessory spleen. On T2-weighted turbo spin-echo image, intrapancreatic accessory spleen (arrows) shows high signal intensity compared to pancreas. Lesion also has slightly higher signal intensity than spleen (S). Intrapancreatic accessory spleen was confirmed by Tc-99m SPECT.

Mentions: As was the case in our study population, IPAS can have a different white-to-red pulp ratio compared to normal spleen even though the reason for the difference in its ratio is unclear (Fig. 1B). This means that the SI of IPAS on T2-weighted imaging can be different from that of the normal spleen (7) (Fig. 2). Such higher T2 SI may be responsible for observing a higher white-to-red pulp ratio compared to normal spleen (7); consequently, this may lead radiologists to make an incorrect diagnosis. Familiarity with this histologic-radiologic correlation minimizes the chance that the IPAS will be mistaken for pancreatic neoplasm.


Intrapancreatic accessory spleen: findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis.

Kim SH, Lee JM, Han JK, Lee JY, Kim KW, Cho KC, Choi BI - Korean J Radiol (2008 Mar-Apr)

70-year-old man with intrapancreatic accessory spleen. On T2-weighted turbo spin-echo image, intrapancreatic accessory spleen (arrows) shows high signal intensity compared to pancreas. Lesion also has slightly higher signal intensity than spleen (S). Intrapancreatic accessory spleen was confirmed by Tc-99m SPECT.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627219&req=5

Figure 2: 70-year-old man with intrapancreatic accessory spleen. On T2-weighted turbo spin-echo image, intrapancreatic accessory spleen (arrows) shows high signal intensity compared to pancreas. Lesion also has slightly higher signal intensity than spleen (S). Intrapancreatic accessory spleen was confirmed by Tc-99m SPECT.
Mentions: As was the case in our study population, IPAS can have a different white-to-red pulp ratio compared to normal spleen even though the reason for the difference in its ratio is unclear (Fig. 1B). This means that the SI of IPAS on T2-weighted imaging can be different from that of the normal spleen (7) (Fig. 2). Such higher T2 SI may be responsible for observing a higher white-to-red pulp ratio compared to normal spleen (7); consequently, this may lead radiologists to make an incorrect diagnosis. Familiarity with this histologic-radiologic correlation minimizes the chance that the IPAS will be mistaken for pancreatic neoplasm.

Bottom Line: In particular, inhomogeneous enhancement of an IPAS in its early phases may be a diagnostic clue.Superparamagnetic iron oxide (SPIO)-enhanced MRI and Levovist-enhanced US, and the mechanisms of which are theoretically similar to that of Tc-99m scintigraphy, can be used as alternative tools to confirm the diagnosis of IPAS.We review and illustrate the differential points between IPAS and hypervascular pancreatic tumors in this manuscript.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Hospital, Seoul, Korea.

ABSTRACT
Although the tail of the pancreas is the second most common site of an accessory spleen, intrapancreatic accessory spleen (IPAS) has rarely been noted radiologically. However, as the imaging techniques have recently advanced, IPAS will be more frequently detected as an incidental pancreatic nodule on CT or MRI. Because accessory spleens usually pose no clinical problems, it is important to characterize accessory spleens as noninvasively as possible. An IPAS has similar characteristics to those of the spleen on the precontrast and contrast-enhanced images of all the imaging modalities. In particular, inhomogeneous enhancement of an IPAS in its early phases may be a diagnostic clue. Superparamagnetic iron oxide (SPIO)-enhanced MRI and Levovist-enhanced US, and the mechanisms of which are theoretically similar to that of Tc-99m scintigraphy, can be used as alternative tools to confirm the diagnosis of IPAS. An IPAS shows a significant signal drop similar to the spleen on the SPIO-enhanced T2 or T2*-weighted imaging and prolonged enhancement on the delayed hepatosplenic phase of contrast-enhanced US. We review and illustrate the differential points between IPAS and hypervascular pancreatic tumors in this manuscript.

Show MeSH
Related in: MedlinePlus