Reappraising imaging features of pancreatic acinar cystic transformation: be aware of differential diagnoses.

Eur Radiol

Department of Pancreatology and Digestive Oncology, Beaujon University Hospital (APHP), CRMR PaRaDis Pancreatic Rare Diseases, Université Paris Cité, Clichy, France.

Published: December 2024

AI Article Synopsis

  • A study was conducted to analyze the clinical and radiological characteristics of patients with suspected pancreatic acinar cystic transformation (ACT) based on available imaging data from 2003 to 2021.
  • Of the 64 patients included, 53% were classified as having "certain" ACT, while 47% were "uncertain," with no significant difference in the number of imaging criteria between these groups.
  • The findings indicate that the existing imaging criteria for diagnosing ACT often overlap with other conditions, suggesting that these criteria may be inadequate for making definitive diagnoses in some patients.

Article Abstract

Objectives: Imaging features of pancreatic acinar cystic transformation (ACT) have been published. We aimed to describe the clinical and radiological characteristics of patients with a presumed pancreatic ACT diagnosis, reappraising the value of these published imaging criteria.

Materials And Methods: Single-center retrospective study (2003-2021) of consecutive patients with a presumed diagnosis of ACT as suggested by the local expert multidisciplinary case review board. Patients without available imaging (CT or MRI) for review were excluded. Patients were classified into "certain" ACT (if ≥ 2 imaging criteria and no differential diagnosis) or "uncertain" ACT (if ≥ 1 imaging criteria and suggested differential diagnoses).

Results: Sixty-four patients (35 males, [55%]) were included. ACT was considered "certain" for 34 patients (53%) and "uncertain" for 30 patients (47%). The number of ACT criteria did not differ between groups, with 91.2% of patients with ≥ 3 ACT imaging criteria in the "certain" group vs 93.3% in the "uncertain" group (p = 0.88). In the "uncertain" group, the main suggested differentials were branch-duct intraductal papillary mucinous neoplasm (18/30 patients, 60%), calcifying chronic pancreatitis (8/30 patients, 27%), both (three patients, 10%) and serous cystadenoma (one patient, 3%). Calcifications were significantly more frequent in the "uncertain" group (89% vs 63% in the "certain" group, p = 0.02).

Conclusion: Published ACT imaging criteria are frequently associated with features suggesting differential diagnoses. They appear insufficient to reach a final diagnosis in a subset of patients.

Clinical Relevance Statement: ACT displays a heterogeneous morphological imaging presentation challenging the non-invasive diagnostic work-up. Physicians' and radiologists' awareness of this entity is important to better understand its natural history and improve non-invasive diagnostic criteria.

Key Points: The criteria to help diagnose ACT are frequently associated with features suggestive of differentials. The main alternatives suggested when ACT diagnosis was "uncertain" were branch-duct intraductal papillary mucinous neoplasm and calcifying chronic pancreatitis. Published ACT diagnostic imaging criteria can be insufficient for a definite non-invasive diagnosis.

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Source
http://dx.doi.org/10.1007/s00330-024-10823-3DOI Listing

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