Pancreatic Morphology/Contour Variations should be Recognized and Remembered

Abstract

Background: Pancreatic contour variations can be detected incidentally on computed tomography (CT). Recognition and remembering  of these variations are important in volumetric measurements and surgery as well as in preventing misdiagnosis.

Aim: This study aims to  evaluate the morphology/ contour variations in the pancreas head-neck, body-tail, and uncinate process with multi‑detector CT (MDCT)  examinations (triple phase CT abdomen).

Material and Method: Around 1662 adult age (>18 years old) patients were evaluated  retrospectively, and after exclusion criteria, 945 patients were included in the study. Aplasia and hypoplasia of the uncinate process were  determined, and pancreatic contour variances were categorized according to the Ross et al. and Omeri et al. classifications. Pancreatic  head–neck variants were categorized into Type I-anterior, Type II-posterior, and Type III-horizontal variations. Pancreatic body–tail  variants were sectioned into Type Ia-anterior protrusion, Type Ib-posterior protrusion, and Types IIa‑globular, IIb‑lobulated, IIc‑tapered,  and IId‑bifid pancreatic tail.

Results: Of the 945 patients, 481 (50.9%) were female. The mean age was 43.28 ± 10.49 (min. 20–max. 68). In  the evaluations made according to the uncinate process morphology variant, hypoplasia was detected in 66 (7%) patients and aplasia in  12 (1.3%) patients. Pancreatic head-neck and body-tail contour variations were observed in 596 (63.1%) patients. The most common head- neck variation was Type II in 233 (24.6%) patients, followed by type III in 96 (10.2%). There were Type Ia in 83 (8.8%) patients and Type Ib  in 14 (1.5%) patients. The pancreatic tail configuration was normal in 792 (83.8%) patients; it was Type IIa in 62 (6.6%) patients and IIb in  50 (5.3%) patients. The most common variation was head and tail in 33 (3.5%) patients.

Discussion: Pancreatic variations detected in CT  examinations for distinct reasons are not rare; these variations should be recognized and remembered.