Pankreas Görüntülemesi
Özet
Pankreas hastalıklarının teşhis, karakterizasyon ve evrelemesinde kullanılan görüntüleme modalitelerini kapsamlı bir şekilde ele alan bu çalışma, erken tanının morbidite ve mortaliteyi azaltmadaki kritik rolünü vurgulamaktadır. Pankreas görüntülemesinde ultrasonografi (US), maliyeti düşük ve yaygın bir ilk basamak yöntemiyken, endoskopik ultrasonografi (EUS) küçük lezyonların tespiti ve biyopsi imkanıyla öne çıkmaktadır. Multidedektör bilgisayarlı tomografi (MDBT), özellikle akut pankreatit komplikasyonlarının değerlendirilmesi ile solid tümörlerin evrelemesinde altın standart kabul edilmekte ve cerrahi rezektabiliteyi belirlemede yüksek özgüllük sunmaktadır. Manyetik rezonans görüntüleme (MRG) ise yüksek yumuşak doku çözünürlüğü sayesinde kistik lezyonların karakterizasyonunda, vasküler invazyonun saptanmasında ve kronik pankreatitin erken evre teşhisinde MDBT'den daha üstün sonuçlar vermektedir. MR kolanjiopankreatografi (MRKP) kanalları invazif olmayan bir şekilde görüntülerken, eskiden tanısal amaçlı kullanılan ERKP günümüzde daha çok girişimsel işlemler için tercih edilmektedir. Son olarak PET ve SPECT gibi radyonüklid görüntüleme yöntemleri, metabolik bilgiler sağlayarak uzak metastazların tespiti ve tedavi yanıtının izlenmesinde konvansiyonel yöntemleri tamamlayıcı bir rol üstlenmektedir. Sonuç olarak, pankreas patolojilerinin karmaşıklığı nedeniyle farklı görüntüleme yöntemlerinin entegre kullanımı, en doğru klinik yönetimin anahtarıdır.
Comprehensive imaging of the pancreas plays a critical role in the early diagnosis, characterization, and staging of pancreatic diseases, significantly reducing patient morbidity and mortality. While ultrasonography (US) serves as a cost-effective, first-line tool, endoscopic ultrasound (EUS) is superior for detecting small lesions and performing simultaneous biopsies. Multidetector computed tomography (MDCT) is considered the gold standard for evaluating acute pancreatitis complications and staging solid tumors due to its high specificity in determining surgical resectability. Magnetic resonance imaging (MRI) provides exceptional soft tissue contrast, making it more effective than MDCT for characterizing cystic lesions, detecting vascular invasion, and diagnosing early-stage chronic pancreatitis. Magnetic resonance cholangiopancreatography (MRCP) offers non-invasive ductal evaluation, whereas endoscopic retrograde cholangiopancreatography (ERCP) is now primarily reserved for therapeutic interventions. Additionally, radionuclide imaging techniques like PET and SPECT complement conventional radiology by providing metabolic insights, aiding in the detection of distant metastases and monitoring treatment response. Ultimately, the combined use of these diverse imaging modalities is essential for the effective clinical management of complex pancreatic pathologies.
Referanslar
Dimastromatteo J, Brentnall T, Kelly KA. Imaging in pancreatic disease. Nat Rev Gastroenterol Hepatol. 2017;14:97-109. Doi: 10.1038/nrgastro.2016.144.
Karmazanovsky G, Fedorov V, Kubyshkin V, et al. Pancreatic head cancer: accuracy of CT in determination of resectability. Abdom Imaging. 2005;30:488-500. Doi: 10.1007/s00261-004-0279-z.
Fusaroli P, Kypraios D, Caletti G, et al. Pancreatico-biliary endoscopic ultrasound: a systematic review of the levels of evidence, performance and outcomes. World J Gastroenterol. 2012;18:4243-56. Doi: 10.3748/wjg.v18.i32.4243.
Raman SP, Horton KM, Fishman EK. Multimodality imaging of pancreatic cancer-computed tomography, magnetic resonance imaging, and positron emission tomography. Cancer J. 2012;18:511-22. Doi: 10.1097/PPO.0b013e318274a461.
Coté GA, Smith J, Sherman S, et al. Technologies for imaging the normal and diseased pancreas. Gastroenterology. 2013;144:1262-71.e1. Doi: 10.1053/j.gastro.2013.01.076.
Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009;69:1251-61. Doi: 10.1016/j.gie.2008.07.043.
Rösch T, Lightdale CJ, Botet JF, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med. 1992;326:1721-6.
Janssen J. (E)US-Elastografie: Heutiger Stand und Perspektiven [(E)US elastography: current status and perspectives]. Z Gastroenterol. 2008;46:572-9. German. Doi: 10.1055/s-2008-1027379.
Balthazar EJ, Freeny PC, vanSonnenberg E. Imaging and intervention in acute pancreatitis. Radiology. 1994;193:297-306. Doi: 10.1148/radiology.193.2.7972730.
Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223:603-13. Doi: 10.1148/radiol.2233010680.
Balthazar EJ. Staging of acute pancreatitis. Radiol Clin North Am. 2002;40:1199-209. Doi: 10.1016/s0033-8389(02)00047-7.
Türkvatan A, Erden A, Türkoğlu MA, et al. Imaging of acute pancreatitis and its complications. Part 2: complications of acute pancreatitis. Diagn Interv Imaging. 2015;96:161-9. Doi: 10.1016/j.diii.2013.12.018.
Shinagare AB, Ip IK, Raja AS, et al. Use of CT and MRI in emergency department patients with acute pancreatitis. Abdom Imaging. 2015;40:272-7. Doi: 10.1007/s00261-014-0210-1.
Ginsberg GG, Kochman ML, Norton ID, et al. (2011). Clinical Gastrointestinal Endoscopy (2nd Edition, p.679), NY: Elsevier.
Khanna L, Prasad SR, Sunnapwar A, et al. Pancreatic Neuroendocrine Neoplasms: 2020 Update on Pathologic and Imaging Findings and Classification. Radiographics. 2020;40:1240-1262. Doi: 10.1148/rg.2020200025.
Lee ES, Lee JM. Imaging diagnosis of pancreatic cancer: a state-of-the-art review. World J Gastroenterol. 2014;20:7864-77. Doi: 10.3748/wjg.v20.i24.7864.
Valls C, Andía E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. Am J Roentgenol. 2002;178:821-6. Doi: 10.2214/ajr.178.4.1780821.
Low G, Panu A, Millo N, et al. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics 2011;31:993-1015. Doi: 10.1148/rg.314105731.
Rockall AG, Reznek RH. Imaging of neuroendocrine tumours (CT/MR/US). Best Pract Res Clin Endocrinol Metab. 2007;21:43-68. Doi: 10.1016/j.beem.2007.01.003.
Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. Am J Roentgenol. 1997;168:1439-43. Doi: 10.2214/ajr.168.6.9168704.
Francis IR. Role of CT and MR in detection and staging of pancreatic adenocarcinoma. Cancer Imaging. 200 1;4:10-4. Doi: 10.1102/1470-7330.2003.0026.
Matos C, Cappeliez O, Winant C, et al. MR imaging of the pancreas: a pictorial tour. Radiographics. 2002;22:e2. Doi: 10.1148/radiographics.22.1.g02jae2e2.
Mitchell DG, Winston CB, Outwater EK, et al. Delineation of pancreas with MR imaging: multiobserver comparison of five pulse sequences. J Magn Reson Imaging. 1995;5:193-9. Doi:0.1002/jmri.1880050215.
Trede M, Rumstadt B, Wendl K, et al. Ultrafast magnetic resonance imaging improves the staging of pancreatic tumors. Ann Surg. 1997;226:393-405; Doi: 10.1097/00000658-199710000-00001.
Hochwald SN, Rofsky NM, Dobryansky M, et al. Magnetic resonance imaging with magnetic resonance cholangiopancreatography accurately predicts resectability of pancreatic carcinoma. J Gastrointest Surg. 1999;3:506-11. Doi: 10.1016/s1091-255x(99)80104-8.
Wang Y, Chen ZE, Yaghmai V, et al. Diffusion-weighted MR imaging in pancreatic endocrine tumors correlated with histopathologic characteristics. J Magn Reson Imaging. 2011;33:1071-9. Doi: 10.1002/jmri.22541.
Sahani DV, Shah ZK, Catalano OA, et al.. Radiology of pancreatic adenocarcinoma: current status of imaging. J Gastroenterol Hepatol. 2008;23:23-33. Doi: 10.1111/j.1440-1746.2007.05117.x.
Macari M, Finn ME, Bennett GL, et al. Differentiating pancreatic cystic neoplasms from pancreatic pseudocysts at MR imaging: value of perceived internal debris. Radiology. 2009;251:77-84. Doi: 10.1148/radiol.2511081286.
Kim DH, Pickhardt PJ. Radiologic assessment of acute and chronic pancreatitis. Surg Clin North Am. 2007;87:1341-58, viii. Doi: 10.1016/j.suc.2007.08.005.
Thomas S, Kayhan A, Lakadamyali H, et al. Diffusion MRI of acute pancreatitis and comparison with normal individuals using ADC values. Emerg Radiol. 2012;19:5-9. Doi: 10.1007/s10140-011-0983-2.
Chaudhary V, Bano S. Imaging of the pancreas: Recent advances. Indian J Endocrinol Metab. 2011;15(Suppl 1):S25-32. Doi: 10.4103/2230-8210.83060.
Akisik MF, Sandrasegaran K, Jennings SG, et al. Diagnosis of chronic pancreatitis by using apparent diffusion coefficient measurements at 3.0-T MR following secretin stimulation. Radiology. 2009;252:418-25. Doi: 10.1148/radiol.2522081656.
Zhang TT, Wang L, Liu HH, et al. Differentiation of pancreatic carcinoma and mass-forming focal pancreatitis: qualitative and quantitative assessment by dynamic contrast-enhanced MRI combined with diffusion-weighted imaging. Oncotarget. 2017;8:1744-1759. Doi: 10.18632/oncotarget.12120.
Bilbao MK, Dotter CT, Lee TG, et al. Complications of endoscopic retrograde cholangiopancreatography (ERCP). A study of 10,000 cases. Gastroenterology. 1976;70:314-20.
Delbeke D, Rose DM, Chapman WC, et al. Optimal interpretation of FDG PET in the diagnosis, staging and management of pancreatic carcinoma. J Nucl Med. 1999;40:1784-91.
Bares R, Klever P, Hauptmann S, et al. F-18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer. Radiology. 1994;192:79-86. Doi: 10.1148/radiology.192.1.8208970.
Higashi T, Saga T, Nakamoto Y, et al. Diagnosis of pancreatic cancer using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) --usefulness and limitations in "clinical reality". Ann Nucl Med. 2003;17:261-79. Doi: 10.1007/BF02988521.
Yokose T, Kitago M, Matsusaka Y, et al. Usefulness of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography for predicting the prognosis and treatment response of neoadjuvant therapy for pancreatic ductal adenocarcinoma. Cancer Med. 2020;9:4059-4068. Doi: 10.1002/cam4.3044.
Ilhan H, Fendler WP, Cyran CC, et al. Impact of (68)Ga-DOTATATE PET/CT on the surgical management of primary neuroendocrine tumors of the pancreas or ileum. Ann Surg Oncol. 2015;22:164-71. Doi: 10.1245/s10434-014-3981-2.
Gabriel M, Decristoforo C, Kendler D, et al. 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med. 2007;48:508-18. Doi: 10.2967/jnumed.106.035667.
Schillaci O, Spanu A, Palumbo B, et al. SPECT/CT in neuroendocrine tumours. Clin Transl Imaging. 2014;2:477-489. Doi:10.1007/s40336-014-0091-x.
Hofmann M, Maecke H, Börner R, et al. Biokinetics and imaging with the somatostatin receptor PET radioligand (68)Ga-DOTATOC: preliminary data. Eur J Nucl Med. 2001;28:1751-7. Doi: 10.1007/s002590100639.
Kowalski J, Henze M, Schuhmacher J, et al. Evaluation of positron emission tomography imaging using [68Ga]-DOTA-D Phe(1)-Tyr(3)-Octreotide in comparison to [111In]-DTPAOC SPECT. First results in patients with neuroendocrine tumors. Mol Imaging Biol. 2003;5:42-8. Doi: 10.1016/s1536-1632(03)00038-6.
