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CT Pancreas

The document provides an overview of the pancreas, detailing its anatomy, functions, and vascular supply, as well as indications and contraindications for computed tomography (CT) imaging. It describes the pancreas's structure, including its divisions (head, neck, body, tail) and associated ducts, and outlines the CT technique for optimal imaging. Key indications for CT include epigastric pain, obstructive jaundice, and suspected malignancies, while contraindications include pregnancy and allergies to iodinated contrast agents.

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kaleemmasood
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2 views14 pages

CT Pancreas

The document provides an overview of the pancreas, detailing its anatomy, functions, and vascular supply, as well as indications and contraindications for computed tomography (CT) imaging. It describes the pancreas's structure, including its divisions (head, neck, body, tail) and associated ducts, and outlines the CT technique for optimal imaging. Key indications for CT include epigastric pain, obstructive jaundice, and suspected malignancies, while contraindications include pregnancy and allergies to iodinated contrast agents.

Uploaded by

kaleemmasood
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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COMPUTED TOMOGRAPHY OF THE

PANCREAS
PANCREAS

• Pancreas
• Location and Description
• The pancreas is both an exocrine and an endocrine gland. The exocrine portion of
the gland produces a secretion that contains enzymes capable of hydrolyzing
proteins, fats, and carbohydrates. The endocrine portion of the gland, the
pancreatic islets (islets of Langerhans), produces the hormones insulin and
glucagon, which play a key role in carbohydrate metabolism.
• The pancreas is an elongated structure that lies in the epigastrium and the left
upper quadrant. It is soft and lobulated and situated on the posterior abdominal
wall behind the peritoneum. It crosses the transpyloric plane. The pancreas is
divided into a head, neck, body, and tail .
• The head of the pancreas is disc shaped and lies within the concavity of the
duodenum . A part of the head extends to the left behind the superior mesenteric
vessels and is called the uncinate process.
• The neck is the constricted portion of the pancreas and connects the
head to the body. It lies in front of the beginning of the portal vein and
the origin of the superior mesenteric artery from the aorta
• The body runs upward and to the left across the midline . It is
somewhat triangular in cross section.
• The tail passes forward in the spleenorenal ligament and comes in
contact with the hilum of the spleen .
• Relations
• Anteriorly: From right to left: the transverse colon and the attachment
of the transverse mesocolon, the lesser sac, and the stomach
• Posteriorly: From right to left: the bile duct, the portal and splenic
veins, the inferior vena cava, the aorta, the origin of the superior
mesenteric artery, the left psoas muscle, the left suprarenal gland, the
left kidney, and the hilum of the spleen
PANCREATIC DUCTS

• The main duct of the pancreas begins in the tail and runs the length
of the gland, receiving numerous tributaries on the way . It opens
into the second part of the duodenum at about its middle with the
bile duct on the major duodenal papilla. Sometimes the main duct
drains separately into the duodenum.
• The accessory duct of the pancreas, when present, drains the upper
part of the head and then opens into the duodenum a short
distance above the main duct on the minor duodenal papilla . The
accessory duct frequently communicates with the main duct.
SUPPLIES

• Arteries
The splenic and the superior and inferior pancreaticoduodenal arteries
supply the pancreas.
• Veins
The corresponding veins drain into the portal system.
• Lymph Drainage
Lymph nodes are situated along the arteries that supply the gland. The
efferent vessels ultimately drain into the celiac and superior
mesenteric lymph nodes.
• Nerve Supply
Sympathetic and parasympathetic (vagal) nerve fibers supply the area.
INDICATIONS

1. Epigastric pain
2. Obstructive jaundice
3. Suspected pancreatic malignancy
4. Acute pancreatitis and its complications
5. Chronic pancreatitis and its complications

CT PANCREAS
CONTRAINDICATIONS

1. Pregnancy
2. Allergy to iodinated contrast agents

CT PANCREAS
TECHNIQUE

• Negative (e.g. water) oral contrast is generally preferred. Positive


(e.g. iodinated) contrast may be given if necessary to opacify distal
bowel loops but is contraindicated if CT angiography is to be
performed. Volume and timing of oral contrast agent will depend
upon whether opacification of distal bowel loops is required.
• Venous access is obtained.
• The patient is scanned supine and a scout view is obtained.
• An initial non-contrast-enhanced examination to identify
calcification is no longer indicated, as this will be evident on
vascular phases.

CT PANCREAS
• The volume and strength of the i.v. contrast will depend upon the speed
of the scanner. The volume of i.v. contrast usually varies from 100 to 150
mL s−1 of iodinated contrast at 3–4 mL s−1, with a saline chaser,
depending on the scanner type. Pancreatic parenchymal phase
enhancement (35–40 s after commencement of bolus injection) is
necessary for optimum contrast differentiation between pancreatic
adenocarcinoma and normal pancreatic tissue, with portal venous phase
scans (65–70 s after onset of the injection) included in the protocol to
investigate hepatic metastatic disease. Images should be reconstructed
at 0.625–1.25 mm in the pancreatic phase and 2 mm in the portal venous
phase.
• Islet cell tumours and their metastases may show avid enhancement on
arterial phase scans and become isodense with normal pancreatic tissue
on portal phase scans. A portal phase scan is generally necessary to
investigate flow and the relationship of the tumour to the portal vein.
CT PANCREAS
THANK
YOU

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