Radiology of the Pancreas

285 Pages·1994·14.477 MB·English

by  Professeur P. M. Dubois (auth.), Professor Albert L. Baert MD, Professor Guy Delorme MD (eds.)

MEDICAL RADI"OLOGY
Diagnostic Imaging and Radiation Oncology
Editorial Board
Founding Editors: L.W. Brady, M.W. Donner(t), H.-P. Heilmann,
F.H.W. Heuck
Current Editors: A.L. Baert, Leuven· L.W. Brady, Philadelphia
H.-P. Heilmann, Hamburg· F.H.W. Heuck,
Stuttgart· J .E. Youker, Milwaukee
Radiology
of the Pancreas
With Contributions by
A.L. Baert . P.H. Bernard· M. Boisserie-Lacroix . P. Cauquil . J.F. Chateil
e. Douws . J. Drouillard· P.M. Dubois· J. Grellet . N. Grenier
G. Kloppel . F. Laurent· E. Ponette . A. Roche· E. Therasse . V. Vilgrain
With the Collaboration of
Y. Ajavon . J.e. Brichaux . J.-M. Bruel . A.M. Brunet· P. Brys
H. Caillet . M. Cauquil . F. Diard . J.-F. Flejou . P. Grelet . B. Maillet
G. Marchal· D. Mathieu· A. Rahmouni . H. Rigauts . B. Suarez
P. Taourel . J.P. Tessier· W. Van Steenbergen· J.P. Verdier
Edited by A.L. Baert
Co-edited by G. Delorme
Foreword by M.W. Donner and F.H.W. Heuck
With 301 Figures and 21 Tables
Springer-Verlag
Berlin Heidelberg New York London Paris
Tokyo Hong Kong Barcelona Budapest
ALBERT L. BAERT, MD
Professor, Department of Radiology
University Hospital K.U.L.
Herestraat 49
B-3000 Leuven
Belgium
GUY DELORME, MD
Professor
Centre H6spitalier
Regional de Bordeaux
H6pital Pellegrin
F-33076 Bordeaux Cedex
France
MEDICAL RADIOLOGY· Diagnostic Imaging and Radiation Oncology
Continuation of
Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
ISBN-13: 978-3-642-97489-2 e-ISBN-13: 978-3-642-97487-8
DOl: 10.1007/978-3-642-97487-8
Library of Congress Cataloging-in-Publication Data. Radiology of the Pancreas/with contributions by A.L. Baert ...
let al.); with collaboration of Y. Ajavon ... let al.); edited by A.L. Baert, co-edited by G. Delorme; foreword by M.W.
Donner and F.H. W. Heuck. p. cm. - (Medical radiology) Includes bibliographical references and index.
ISBN-13: 978-3-642-97489-2 (alk. paper) 1. Pancreas-Radiography. I. Baert, A. L. (Albert L.),
1931- . II. Delorme, G. (Guy) III. Series. [DNLM: 1. Pancreatic Diseases-diagnosis. 2. Pancreas-pathology.
3. Diagnostic Imaging-methods. WI 800 R129 1994) RC857.5.R33 1994 616.3'70754-dc20 DNLMIDLC 94-6222
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© Springer-Verlag Berlin Heidelberg 1994
Softcover reprint of the hardcover 1st edition 1994
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All our knowledge stems from our observation
Leonardo da Vinci
Foreword
For a long time the morphologic diagnosis of diseases of the pancreas - which is the
most hidden organ of the abdomen - by means of radiologic methods was inade
quate. Diagnostic radiology of pancreatic diseases has been revolutionized by new
cross-sectional methods such as computed tomography with volume CT scanning,
further progress in ultrasonography in the form of color duplex Doppler, and
magnetic resonance imaging. Therefore we had the idea of publishing an up-to-date
treatise on radiology of the pancreas in order to convey the contributions made by
various new imaging modalities for the diagnosis of pancreatic disorders.
The editors of this volume are outstanding specialists in diagnostic radiology
of the abdomen. Albert L. Baert is the author of one of the very first books on
computed tomography of the body, published by Springer-Verlag in 1980. Since then
he has published extensively on this method, especially as it is applied to the
abdomen. He is a well-known teacher on computed tomography of the body, and
especially the pancreas, and on diagnostic angiography. As a publisher he is active
on the editorial boards of several radiologic journals. Guy Delorme has published
extensively on the radio diagnosis of the digestive system. Moreover he has been very
active as editor of French textbooks and was the chief editor of the volume dealing
with the liver, biliary ducts, spleen, and pancreas in the prestigious series Traite du
radiodiagnostic covering the whole field of diagnostic radiology. Under his chairman
ship at the Department of Radiology of the University of Bordeaux, talented young
scientists have been able to develop their careers and have contributed to this
book.
The editors of this volume have engaged experts to describe the state of the art of
radiology of the pancreas. The basis for better understanding of the radiologic
features is provided by chapters on embryology, anatomy, pathology, histology,
physiology, and pathophysiology of the pancreas. Both common and more rare
pancreatic lesions are described. The different contributions cover very well the
opportunities for noninvasive evaluation as well as the selection of the most appro
priate techniques to alleviate the patient's problem. New radiologic modalities have
made the diagnostic process more humane. The radiologic approach and inter
pretation are combined with the presentation of clinical observations and important
pathophysiologic knowledge.
The new noninvasive imaging modalities for application in diagnosis and patient
management have made possible the treatment of many disorders of the pancreas,
especially by means of interventional techniques that replace surgical procedures.
The text and illustrations in this book will serve as sources of information for the
continuing education of radiologists and other medical specialists, as well as physicians
in training and students.
Those working within various specialties will find the volume of value in their
everyday clinical work. The excellent quality of the illustrative material is attribut
able to the efforts of Springer-Verlag. As editors of the Medical Radiology series we
hope that this volume will - like earlier volumes - be well received by our colleagues
VIII Foreword
in many fields of medicine. We would appreciate every constructive criticism that
might be offered.
MARTIN W. DONNER(t)
Baltimore
FRIEDRICH H.W. HEUCK
Stuttgart
Preface
This volume is designed to provide a comprehensive review of current radiologic
knowledge on diseases of the pancreas.
The explosive development of new radiologic techniques and modalities during
the last decade has opened this "hidden" organ to detailed diagnostic analysis.
In the past radiodiagnostic signs of pancreatic disease were indirect, primarily
being based on changes and modifications of the visceral organs surrounding the
pancreas; this led to much frustration as radiologists rapidly became disappointed by
the limitations and errors of the "new" signs described in the literature of that
period. As could be expected, pancreatic disease had to be very pronounced or at
an advanced stage before the indirect signs became visible, and this limited the
therapeutic possibilities.
The last monograph on radiology of the pancreas published in the series Medical
Radiology - Diagnostic Imaging and Radiation Oncology (previously: Encyclopedia
of Medical Radiology) by J. Rosch dates from more than 25 years ago. Now that
noninvasive methods allow direct detailed morphologic depiction of the anatomy
and gross pathology of the pancreas, rendering precision radiologic diagnosis a
reality, it seemed logical to devote a new volume in the series to this organ. In fact
such an update has long been overdue.
The revolutionary radiologic potential for visualizing pancreatic changes due to
disease has permitted a new therapeutic approach to many of these conditions, such
as acute and chronic pancreatitis or cystic and endocrine tumors of the pancreas.
One can only regret that the earlier diagnosis of pancreatic ductal adenocarcinoma
has not yet led to any substantial improvement in the survival rate of patients
affected by this tumor.
This book attempts to convey the latest knowledge on the possibilities and the
limitations of the new cross-sectional modalities such as ultrasonography, computed
tomography, and magnetic resonance imaging. It has been written by a group of
European radiologists who are recognized experts in their field. A wide variety of
personal case material is provided, combined with a review of current literature.
However, this book is not intended to be just a compilation of modern imaging
techniques of the pancreas. It also aims to provide a better understanding of the
clinical relevance of the radiologic findings. Especially the chapters on the embryo
logy, histopathology, and physiology of the pancreas should provide readers, be they
radiologists, surgeons, or gastroenterologists, with a basis for a better perspective
on the radiologic features. The other chapters deal with the normal radiologic
anatomy and all the common and more rare conditions of the exocrine and endo
crine pancreas.
The availability of so many highly performing radiologic methods that provide
diagnostic information on the pancreas necessitates a critical attitude to select the
most efficient approach for each clinical situation. This book attempts to outline
these guidelines as related to pancreatic diseases.
This book resulted from cooperation between several European academic depart
ments of radiology. Professor Dr. G. Delorme has been extremely successful in
x
Preface
organizing and coordinating the work from the academic centers in Bordeaux and
Paris. I am very much indebted to him for his invaluable help.
ALBERT L. BAERT
Acknowledgments: Special thanks go to the photographers and secretaries of the
different academic departments of radiology in Bordeaux, Leuven, and Paris for
their excellent support.
The editors also acknowledge the help of Dr. S. Gryspeerdt and Dr. L. Van Hoe
for the preparation of the index and of Mrs. D. Pardon for the final editing.
Contents
1 The Exocrine and Endocrine Pancreas: Embryology and Histology
P.M. DUBOIS ..................................................... 1
2 Physiology of the Exocrine Pancreas
P.H. BERNARD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
3 The Normal Radiologic Anatomy of the Pancreas
P. CAUQUIL, M. CAUQUlL, J.P. VERDIER, H. CAILLET, B. SUAREZ,
Y. AJAVON, A.M. BRUNET, and J.P. TESSIER. . . . . . . . . . . . . . . . . . . . . . . . . . 21
4 Pathology of the Pancreas
G. KU)PPEL and B. MAILLET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
5 Pancreatic Diseases in Childhood
J.F. CHATEIL and F. DIARD ......................................... 69
6 Acute Pancreatitis
J. DROUILLARD and F. LAURENT 83
7 Chronic Pancreatitis
F. LAURENT, J. DROUILLARD, E. PONETIE, P. BRYS,
and W. VAN STEENBERGEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 101
8 Ductal Adenocarcinoma
A.L. BAERT, H. RIGAUTS, and G. MARCHAL. . . . . . . . . . . . . . . . . . . . . . . . . .. 129
9 Cystic Tumors of the Pancreas
V. VILGRAIN, D. MATHIEU, J.M. BRUEL, J.-F. FLEJOU, A. RAHMOUNI,
and P. TAOUREL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 173
10 Endocrine Tumors of the Pancreas
A. ROCHE, A.L. BAERT, E. THERASSE, H. RIGAUTS, and G. MARCHAL. . . .. 197
11 Rare and Secondary Tumors of the Pancreas
J. GRELLET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 235
12 Pancreatic Trauma
e. Douws, N. GRENIER, and J.C. BRICHAUX .......................... 247
13 Pancreatic Transplantation
N. GRENIER, C. Douws, and J.e. BRICHAUX .......................... 255
XII Contents
14 The Postoperative Pancreas
M. BOISSERIE-LACROIX and P. GRELET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 267
Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 275
List of Contributors ................................................... 279