Diseases of the Pancreas

  • Thomas K. Helmberger
  • Riccardo Manfredi


Modern cross-sectional imaging with high spatial and contrast resolution allows a perfect delineation of the pancreas in its retroperitoneal home. The organ typically presents itself with a length between 12 and 15 cm and a diameter at the head area of ~2.5 cm, at the body of ~2 cm, and at the tip of the pancreatic tail of ~1.5 cm. Anatomically, the pancreatic head is defined as the area to the right of the left border of the superior mesenteric vein, the body as the area between the left border of the superior mesenteric vein and the left border of the aorta, and the tail as the area between the left border of the aorta and the hilum of the spleen. The normal pancreatic duct ranges between 1.5 mm at the tail and 3 mm at the head. Usually (~60% of cases), the pancreatic main duct (duct of Wirsung), the duct of Santorini, and the common bile duct join together within the pancreatic head, entering the duodenum via the papilla of Vater. Several conditions that affect function and integrity of the pancreas, such as developmental anomalies and neoplastic and inflammatory diseases, are discussed.


Common Bile Duct Main Pancreatic Duct Intraductal Papillary Mucinous Neoplasm Superior Mesenteric Vein Left Border 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Anupindi SA (2008) Pancreatic and biliary anomalies: imaging in 2008. Pediatr Radiol 38 (Suppl 2):S267–271.PubMedCrossRefGoogle Scholar
  2. 2.
    Yu J, Turner MA, Fulcher AS, Halvorsen RA (2006) Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: part 2, Pancreatic duct and pancreas. AJR Am J Roentgenol 187:1544–1553.PubMedCrossRefGoogle Scholar
  3. 3.
    Nishino T, Toki F, Oi I et al (2006) Prevalence of pancreatic and biliary tract tumors in pancreas divisum. J Gastroenterol 41:1088–1093.PubMedCrossRefGoogle Scholar
  4. 4.
    Flejou JF (2011) [WHO Classification of digestive tumors: the fourth edition]. Ann Pathol 31(5 Suppl):S27–31.PubMedCrossRefGoogle Scholar
  5. 5.
    Tamm EP, Bhosale PR, Lee JH (2007) Pancreatic ductal adenocarcinoma: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR 28:330–338.PubMedCrossRefGoogle Scholar
  6. 6.
    Wong JC, Lu DS (2008) Staging of pancreatic adenocarcinoma by imaging studies. Clin Gastroenterol Hepatol 6:1301–1308.PubMedCrossRefGoogle Scholar
  7. 7.
    Stroszczynski C, Grutzmann R, Kittner T (2008) CT and MR imaging of pancreatic cancer. Recent Results Cancer Res 177:5–14.PubMedCrossRefGoogle Scholar
  8. 8.
    Mori H (2010) New insight of pancreatic imaging: from “unexplored” to “explored”. Abdom Imaging 35:130–133.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Schima W, Ba-Ssalamah A, Goetzinger P et al (2007) State-of-the-art magnetic resonance imaging of pancreatic cancer. Top Magn Reson Imaging 18:421–429.PubMedCrossRefGoogle Scholar
  10. 10.
    Edelman RR (2007) MR imaging of the pancreas: 1.5T versus 3T. Magn Reson Imaging Clin N Am 15:349–353, vi.PubMedCrossRefGoogle Scholar
  11. 11.
    Michl P, Pauls S, Gress TM (2006) Evidence-based diagnosis and staging of pancreatic cancer. Best Pract Res Clin Gastroenterol 20:227–251.PubMedCrossRefGoogle Scholar
  12. 12.
    Balci NC, Semelka RC (2001) Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma. Eur J Radiol 38:105–112.PubMedCrossRefGoogle Scholar
  13. 13.
    Kosmahl M, Pauser U, Peters K et al (2004) Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal. Virchows Arch 445:168–178.PubMedCrossRefGoogle Scholar
  14. 14.
    Garcea G, Ong SL, Rajesh A et al (2008) Cystic lesions of the pancreas. A diagnostic and management dilemma. Pancreatology 8:236–251.PubMedCrossRefGoogle Scholar
  15. 15.
    Freeman HJ (2008) Intraductal papillary mucinous neoplasms and other pancreatic cystic lesions. World J Gastroenterol 14:2977–2979.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Crippa S, Salvia R, Warshaw AL et al (2008) Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg 247:571–579.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Suzuki Y, Atomi Y, Sugiyama M et al (2004) Cystic neoplasm of the pancreas: a Japanese multiinstitutional study of intraductal papillary mucinous tumor and mucinous cystic tumor. Pancreas 28:241–246.PubMedCrossRefGoogle Scholar
  18. 18.
    Song SJ, Lee JM, Kim YJ et al (2007) Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. J Magn Reson Imaging 26:86–93.PubMedCrossRefGoogle Scholar
  19. 19.
    Brambs HJ, Juchems M (2008) [Cystic tumors of the pancreas]. Radiologe 48:740–751.PubMedCrossRefGoogle Scholar
  20. 20.
    Sohn TA, Yeo CJ, Cameron JL et al (2004) Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 239:788–797.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Capelli P, Martignoni G, Pedica F et al (2009) Endocrine neoplasms of the pancreas: pathologic and genetic features. Arch Pathol Lab Med 133:350–364.PubMedGoogle Scholar
  22. 22.
    Tamm EP, Kim EE, Ng CS (2007) Imaging of neuroendocrine tumors. Hematol Oncol Clin North Am 21:409–432; vii.PubMedCrossRefGoogle Scholar
  23. 23.
    Rockall AG, Reznek RH (2007) Imaging of neuroendocrine tumours (CT/MR/US). Best Pract Res Clin Endocrinol Metab 21:43–68.PubMedCrossRefGoogle Scholar
  24. 24.
    Chung EM, Travis MD, Conran RM (2006) Pancreatic tumors in children: radiologic-pathologic correlation. Radiographics 26:1211–1238.PubMedCrossRefGoogle Scholar
  25. 25.
    Tatli S, Mortele KJ, Levy AD et al (2005) CT and MRI features of pure acinar cell carcinoma of the pancreas in adults. AJR Am J Roentgenol 184:511–519.PubMedCrossRefGoogle Scholar
  26. 26.
    Akisik MF, Aisen AM, Sandrasegaran K et al (2009) Assessment of chronic pancreatitis: utility of diffusion-weighted MR imaging with secretin enhancement. Radiology 250: 103–109.PubMedCrossRefGoogle Scholar
  27. 27.
    Gillams A, Pereira S, Webster G, Lees W (2008) Correlation of MRCP quantification (MRCPQ) with conventional non-invasive pancreatic exocrine function tests. Abdom Imaging 33:469–473.PubMedCrossRefGoogle Scholar
  28. 28.
    Agarwal B, Krishna NB, Labundy JL et al (2008) EUS and/or EUS-guided FNA in patients with CT and/or magnetic resonance imaging findings of enlarged pancreatic head or dilated pancreatic duct with or without a dilated common bile duct. Gastrointest Endosc 68:237–242.PubMedCrossRefGoogle Scholar
  29. 29.
    Siddiqi AJ, Miller F (2007) Chronic pancreatitis: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR 28:384–394.PubMedCrossRefGoogle Scholar
  30. 30.
    Bodily KD, Takahashi N, Fletcher JG et al (2009) Autoimmune pancreatitis: pancreatic and extrapancreatic imaging findings. AJR Am J Roentgenol 192:431–437.PubMedCrossRefGoogle Scholar
  31. 31.
    Zandieh I, Byrne MF (2007) Autoimmune pancreatitis: a review. World J Gastroenterol 13:6327–6332.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Thomas K. Helmberger
    • 1
  • Riccardo Manfredi
    • 2
  1. 1.Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Klinikum Bogenhausen, Academic Teaching HospitalTechnical University MunichMunichGermany
  2. 2.Department of RadiologyUniversity of VeronaVeronaItaly

Personalised recommendations