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Duodenal Cancer
Patient History
A 38 year old women had occult upper abdominal pain with anorexia for half an year. All lab findings were normal. Gastroscope examination showed normal esophagus and stomach, but missed the duodenum. CT examination in local hospital showed the enlargement of pancreatic head and suspected cancer of pancreatic head. 10 days later, the patient arrived in our department of general Surgery because of ascites.
Image Findings
The coronal 2D FLASH 2D fs shows dark ascites around the liver and slight enlargement of whole pancreas with normal signal intensity. The duodenum becomes blurry and solid, with an unclear margin.
The thick slice HASTE MRCP shows mild dilatation of both bile ducts and main pancreatic duct. The point of obstruction is located in ampulla of Vater without an obvious mass.
The coronal TrueFISP also shows the enlargement of pancreatic head and mild dilatation of both bile ducts and main pancreatic duct. One can't differentiate pancreatic head from duodenum.
The arterial phase image of 3D Flash (VIBE) shows normal homogenous enhancement after administration of 20ml Gd-DTPA. The solid duodenum has moderate enhancement.
The image of portal venous phase shows unclear duodenum and infiltration toward contiguous organ.
The dorsal slice shows biliary obstruction at duodenal papilla.
Results and Discussions
We presented the case with disease of duodenum. This case report indicates that the combination of various MR sequences, including brethhold FLASH 2D T1WI with FS or without FS, TSE T2WI, thick and thin slice of MRCP, 2D flash and 3D flash dynamic scanning, can characterize the lesions in the regions of pancreatic head and duodenum. The combination can effectively evaluate the mass, mesentery vessels, biliary system and pancreatic duct. It has potential advantages over CT and helps us to overcome difficulties in differential diagnostic. The diagnosis MR Examination takes about 20 minutes.
