Case #17 Answers & Discussion
Contributed by Dr. Goyal
Your Score and Answers
| Question | Correct Answer(s) | Your Answer | Your Score |
|---|---|---|---|
| What is the most likely diagnosis? |
Solid papillary epithelial neoplasm |
1 /1 | |
| Which of the following are true about this diagnosis? |
Most are purely solid, This lesion is more common in the pancreatic tail, The treatment is surgical |
1 /1 | |
|
Regarding cystic pancreatic lesions, which of the following is true? |
Worrisome features include pancreatic ductal dilation > 1 cm |
1 /1 | |
|
In MRI, which of the following would improve artifact from the dielectric effect |
Change the field strength from 3T to 1.5 T |
1/1 |
Solid pseudopapillary epithelial neoplasm (SPEN)
- Solid pseudopapillary epithelial neoplasm (SPEN) is a pancreatic neoplasm that mainly occurs in women in 2nd to 4th decades of life.
- Although most lesions are purely solid, the lesion can have varying amounts of cystic components
- It usually involves the pancreatic tail.
- Intratumoral hemorrhage can also be seen. Thus, the T1 hyperintense areas as seen in the tumor represent blood products.
- The solid component will show post contrast enhancement.
- SPEN is usually well encapsulated.
- Pancreatic duct obstruction or vascular involvement are uncommon and should raise concern for adenocarcinoma.
- While most SPENs are benign, it does have a malignant potential so the treatment is surgical.
Physics discussion
- The dielectric effect causes darkening in the center of an MRI image.
- It’s most frequently seen at 3T because when the RF wavelength exceeds the patient’s abdominal diameter, usually in the setting of ascites.
- This artifact is improved at 1.5T
- Consider performing body MRI in patients with ascites at 1.5T
- Paracentesis prior to MRI can also improve this artifact
References
- Choi JY, Kim JH, Kim SH, Lim JS, Oh YT, Chung JJ, et al. Solid Pseudopapillary tumor of pancreas: typical and atypical manifestations. American Journal of Roentgenology. 2006 Aug;187(2):W178-86.
- Sunkara S, Williams TR, Myers DT, Kryvenko ON. Solid pseudopapillary tumours of the pancreas: spectrum of imaging findings with histopathological correlation. The British journal of radiology. 2012 Nov;85(1019):e1140-4.
