Role of magnetic resonance imaging in the detection and characterization of solid pancreatic nodules: An update

Pancreatic ductal adenocarcinoma is the most common malignant tumor of the pancreas. The remaining pancreatic tumors are a diverse group of pancreatic neoplasms that comprises cystic pancreatic neoplasms, endocrine tumors and other uncommon pancreatic tumors. Due to the excellent soft tissue contrast resolution, magnetic resonance imaging(MRI) is frequently able to readily separate cystic from noncystic tumors. Cystic tumors are often easy to diagnose with MRI; however, noncystic non-adenocarcinoma tumors may show a wide spectrum of imaging features, which can potentially mimic ductal adenocarcinoma. MRI is a reliable technique for the characterization of pancreatic lesions. The implementation of novel motionresistant pulse sequences and respiratory gating techniques, as well as the recognized benefits of MR cholangiopancreatography, make MRI a very accurate examination for the evaluation of pancreatic masses. MRI has the distinctive ability of non-invasive assessment of the pancreatic ducts, pancreatic parenchyma, neighbouring soft tissues, and vascular network in one examination. MRI can identify different characteristics of various solid pancreatic lesions, potentially allowing the differentiation of adenocarcinoma from other benign and malignant entities. In this review we describe the MRI protocols and MRI characteristics of various solid pancreatic lesions. Recognition of these characteristics may establish the right diagnosis or at least narrow the differential diagnosis, thus avoiding unnecessary tests or procedures and permitting better management.

Primary colonic lymphoma:An incidental finding in a patient with a gallstone attack

We report a case of primary colonic lymphoma incidentally diagnosed in a patient presenting a gallbladder attack making particular attention on the diagnostic findings at ultrasound(US) and total body computed tomography(CT) exams that allowed us to make the correct final diagnosis.A 85-year-old Caucasian male patient was referred to our department due to acute pain at the upper right quadrant,spreaded to the right shoulder blade.Patient had nausea and mild fever and Murphy's maneuver was positive.At physical examination a large bulky mass was found in the right flank.Patient underwent to US exam that detected a big stone in the lumen of the gallbladder and in correspon-dence of the palpable mass,an extended concentric thickening of the colic wall.CT scan was performed and confirmed a widespread and concentric thickening of the wall of the ascending colon and cecum.In addition,revealed signs of microperforation of the colic wall.Numerous large lymphadenopathies were found in the abdominal,pelvic and thoracic cavity and there was a condition of splenomegaly,with some ischemic outcomes in the context of the spleen.No metastasis in the parenchimatous organs were found.These imaging findings suggest us the diagnosis of lymphoma.Patient underwent to surgery,and right hemicolectomy and cholecystectomy was performed.Histological examination confirmed our diagnosis,revealing a diffuse large B-cell lymphoma.The patient underwent to Cyclophosphamide,Hydroxydaunorubicin,Oncovin,Prednisone chemotherapy showing only a partial regression of the lymphadenopathies,being in advanced stage at the time of diagnosis.