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MRI Findings of Intrinsic and Extrinsic Duodenal Abnormalities and Variations.

Dusunceli Atman E, Erden A, Ustuner E, Uzun C, Bektas M - Korean J Radiol (2015)

Bottom Line: This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma.MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Ankara University School of Medicine, Ankara 06100, Turkey.

ABSTRACT
This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

No MeSH data available.


Related in: MedlinePlus

Annular pancreas.On axial T2-weighted MR image (A), pancreatic tissue (black arrow) that covers postbulbar duodenum (white arrow) anterolaterally is detected in accordance with incomplete annular pancreas. On magnetic resonance cholangiopancreatography (MRCP) image of another patient (B), aberrant pancreatic duct is superimposed with 2nd portion of duodenum (arrow). Annular pancreas is abnormal pancreatic tissue band that covers 2nd part of duodenum circumferentially. If complete ring is formed, total duodenal obstruction after birth may occur. If ring is incomplete, obstruction may come to clinical attention much later or may be asymptomatic. MRCP is best non-invasive examination method that reveals ductal anatomy, and with MRI, pathologies can be detected such as chronic pancreatitis, pancreas divisum, and polysplenia that are highly encountered in annular pancreas compared with in general population.
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Figure 8: Annular pancreas.On axial T2-weighted MR image (A), pancreatic tissue (black arrow) that covers postbulbar duodenum (white arrow) anterolaterally is detected in accordance with incomplete annular pancreas. On magnetic resonance cholangiopancreatography (MRCP) image of another patient (B), aberrant pancreatic duct is superimposed with 2nd portion of duodenum (arrow). Annular pancreas is abnormal pancreatic tissue band that covers 2nd part of duodenum circumferentially. If complete ring is formed, total duodenal obstruction after birth may occur. If ring is incomplete, obstruction may come to clinical attention much later or may be asymptomatic. MRCP is best non-invasive examination method that reveals ductal anatomy, and with MRI, pathologies can be detected such as chronic pancreatitis, pancreas divisum, and polysplenia that are highly encountered in annular pancreas compared with in general population.

Mentions: Annular pancreas is a rare congenital anomaly in which the pancreatic tissue band completely or partially surrounds the 2nd segment of the duodenum (17181920). The pancreas beings to develop from the 1 dorsal and 2 ventral buds as the outgrowth of the primitive foregut in the 4th-5th week of gestation. As the left ventral bud regresses, the right ventral bud rotates towards the dorsal as the duodenum expands, and it combines with the dorsal bud in the 7th week. As the ventral bud creates the head of the pancreas together with the uncinate process, the pancreatic body and tail are created from the dorsal bud (1819). Two theories are discussed in the development of annular pancreas. According to Lecco's theory, the left ventral bud regresses while the right ventral bud adheres on the duodenum wall and consequently becomes stretched and elongated together with a rotation towards the dorsal. According to Baldwin's theory, in contrast, the left ventral bud does not regress but rather moves in a contrary direction to that of the right ventral bud around the duodenum and they combine with the dorsal bud; in this way, the duodenum is covered with the pancreatic tissue (71819). Presentation of annular pancreas in children and in adults varies. Although vomiting caused by severe duodenal obstruction is the major symptom in the first year of life, 50% of adults are asymptomatic, and the condition is detected incidentally. The remaining 50%, however, show symptoms such as abdominal pain, vomiting, peptic ulcer, duodenal obstruction and pancreatitis in the 3rd-6th decades; however, the main presentation is pancreatitis (7181920). On MRI, the pancreatic tissue is recorded as completely or partially encircling the descending segment of the duodenum at the ampulla Vateri level or caudally (18). MRCP reveals an aberrant pancreatic duct encircling the duodenum (1819). This aberrant duct may be drained into the intrapancreatic part of the CBD or the Wirsung or Santorini ducts (Fig. 8) (20).


MRI Findings of Intrinsic and Extrinsic Duodenal Abnormalities and Variations.

Dusunceli Atman E, Erden A, Ustuner E, Uzun C, Bektas M - Korean J Radiol (2015)

Annular pancreas.On axial T2-weighted MR image (A), pancreatic tissue (black arrow) that covers postbulbar duodenum (white arrow) anterolaterally is detected in accordance with incomplete annular pancreas. On magnetic resonance cholangiopancreatography (MRCP) image of another patient (B), aberrant pancreatic duct is superimposed with 2nd portion of duodenum (arrow). Annular pancreas is abnormal pancreatic tissue band that covers 2nd part of duodenum circumferentially. If complete ring is formed, total duodenal obstruction after birth may occur. If ring is incomplete, obstruction may come to clinical attention much later or may be asymptomatic. MRCP is best non-invasive examination method that reveals ductal anatomy, and with MRI, pathologies can be detected such as chronic pancreatitis, pancreas divisum, and polysplenia that are highly encountered in annular pancreas compared with in general population.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Figure 8: Annular pancreas.On axial T2-weighted MR image (A), pancreatic tissue (black arrow) that covers postbulbar duodenum (white arrow) anterolaterally is detected in accordance with incomplete annular pancreas. On magnetic resonance cholangiopancreatography (MRCP) image of another patient (B), aberrant pancreatic duct is superimposed with 2nd portion of duodenum (arrow). Annular pancreas is abnormal pancreatic tissue band that covers 2nd part of duodenum circumferentially. If complete ring is formed, total duodenal obstruction after birth may occur. If ring is incomplete, obstruction may come to clinical attention much later or may be asymptomatic. MRCP is best non-invasive examination method that reveals ductal anatomy, and with MRI, pathologies can be detected such as chronic pancreatitis, pancreas divisum, and polysplenia that are highly encountered in annular pancreas compared with in general population.
Mentions: Annular pancreas is a rare congenital anomaly in which the pancreatic tissue band completely or partially surrounds the 2nd segment of the duodenum (17181920). The pancreas beings to develop from the 1 dorsal and 2 ventral buds as the outgrowth of the primitive foregut in the 4th-5th week of gestation. As the left ventral bud regresses, the right ventral bud rotates towards the dorsal as the duodenum expands, and it combines with the dorsal bud in the 7th week. As the ventral bud creates the head of the pancreas together with the uncinate process, the pancreatic body and tail are created from the dorsal bud (1819). Two theories are discussed in the development of annular pancreas. According to Lecco's theory, the left ventral bud regresses while the right ventral bud adheres on the duodenum wall and consequently becomes stretched and elongated together with a rotation towards the dorsal. According to Baldwin's theory, in contrast, the left ventral bud does not regress but rather moves in a contrary direction to that of the right ventral bud around the duodenum and they combine with the dorsal bud; in this way, the duodenum is covered with the pancreatic tissue (71819). Presentation of annular pancreas in children and in adults varies. Although vomiting caused by severe duodenal obstruction is the major symptom in the first year of life, 50% of adults are asymptomatic, and the condition is detected incidentally. The remaining 50%, however, show symptoms such as abdominal pain, vomiting, peptic ulcer, duodenal obstruction and pancreatitis in the 3rd-6th decades; however, the main presentation is pancreatitis (7181920). On MRI, the pancreatic tissue is recorded as completely or partially encircling the descending segment of the duodenum at the ampulla Vateri level or caudally (18). MRCP reveals an aberrant pancreatic duct encircling the duodenum (1819). This aberrant duct may be drained into the intrapancreatic part of the CBD or the Wirsung or Santorini ducts (Fig. 8) (20).

Bottom Line: This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma.MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Ankara University School of Medicine, Ankara 06100, Turkey.

ABSTRACT
This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

No MeSH data available.


Related in: MedlinePlus