The Prevalence of Non-Alcoholic Fatty Pancreas by Abdominal Ultrasonography

( Nyam Biziya ),( Bayarmaa Nyamaa ),( Bolormaa Purev ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Pancreatic steatosis or fatty pancreas refers to the fat accumulation in the pancreas, which can lead to inflammation and fibrosis, β-cell dysfunction, fibrosis, and, possibly, pancreatic cancer. The aim of this study was to investigate the prevalence and risk factors of fatty pancreas in patients referred to an ultrasonography center of Dornod Medical center. Methods: A cross-sectional study. During 12 months, 627 patients who were referred to our abdominal ultrasonography center for various reasons were evaluated for fatty pancreas. Fatty pancreas was defined as hyperechoic pancreas echotexture compared with spleen echotexture. All patients had gone through laboratory tests and abdominal ultrasonography. Results: The prevalence of fatty pancreas was 45.8%. The fatty pancreas patients had higher levels of aspartate aminotransferase, alanine aminotransferase, serum uric acid, fasting blood glucose, total cholesterol, triglycerides and low-density lipoprotein, and lower levels of high-density lipoprotein than did the non-fatty pancreas patients (all p < 0.05). Conclusions: Fatty pancreas is a common disorder. The prevalence of fatty pancreas in the examined population is approximately 45.8%. Increased age, central obesity and fatty liver disease are independent risk factors for fatty pancreas.

나선 CT에서 췌장 및 주변 혈관의 조영증강에 대한 정량적 연구

김형석 대한영상의학회 1997 대한영상의학회지 Vol.37 No.3

Purpose:To determine by quantitative evaluation of pancreatic and adjacent vascular enhancement during spiral CT, the ideal scan delay for examination of the pancreas. Materials and Methods:Dual(n-90) and triple(n=90) phase spiral CT scans of patients whose pancreas showed no pathologic condition were retrospectively evaluated. Dual-phase scans were performed at 43 seconds(early), and 5-6 minutes(delayed) after the injection of 120-140ml of contrast material at an injection rate of 2-4ml/sec, and ten patients also underwent precontrast scanning. CT attenuation values (HU) were measured in the head, body and tail of the pancreas, aorta, and main portal vein during each phase of all scans. Triple-phase protocol was used to measure the effect of different total volumes and injection rates on enhancement of the pancreas and adjacent vessels. Results:There was no significant difference in the degree of enhancement of the pancreas head, body and tail during each phase(p>0.05). The pancreas was maximally enhanced on 43 second delayed scan(132$\pm$20HU)(p<0.05), and the aorta, on 25-second delayed scan(207$\pm$44HU)(p<0.05). Different total volume of contrast material did not change the enhancement of the pancreas and adjacent vessels. At an injection rate of 2ml/sec, peak enhancement of the pancreas, aorta and portal vein was obtained on 60-65 second delayed scan, and at 4ml/sec, peak enhancement was obtained on 25 second delayed scan(p<0.05). Conclusion:Observing the usual protocols for abdominal spiral CT scanning, the pancreas was most effectively using a 43-second delayed scan. An increased injection rate resulted in earlier enhancement of the pancreas, aorta and portal vein.

문맥 윤상 췌장 2예

장지영 ( Ji Young Jang ),정용은 ( Young Eun Chung ),강창무 ( Chang Moo Kang ),최성훈 ( Sung Hoon Choi ),황호경 ( Ho Kyoung Hwang ),이우정 ( Woo Jung Lee ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.1

Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery. (Korean J Gastroenterol 2012;60:52-55)

원발성 췌장 T세포 림프종: 1예 보고

이경식,박길선,이승영,배일헌,김성진,한기석,차상훈,이옥준 대한영상의학회 2006 대한영상의학회지 Vol.55 No.3

Primary pancreatic lymphoma is a rare extranodal manifestation of any histopathologic subtype of non-Hodgkin's lymphoma that predominantly involves the pancreas, and it comprises less than 0.5% of all pancreatic malignancies. Histopathologically, most primary pancreatic lymphomas are the B-cell phenotypes, and Tcell lymphomas are extremely rare. We describe here the ultrasonography and computed tomography (CT) findings of a pathologically confirmed pancreatic T-cell lymphoma in a 37-year-old female patient. Ultrasonography showed diffuse pancreatic enlargement and a slightly bulging mass in the head and tail of pancreas that had markedly heterogeneous echogeneity. The lesion abutted onto the adjacent vessels, but there was no evidence of luminal narrowing or obstruction. The CT scan showed diffuse enlargement of the pancreas and the bulging contoured mass at the pancreatic head and tail with inhomogeneous enhancement, including multiple hypodense areas. It also showed the patent peripancreatic vessels and multiple LN enlargements around the pancreas. 원발성 췌장 림프종은 췌장 종양의 0.5% 이하에서 발생하는 드문 질환으로, 조직병리학적으로 대부분이 B 세포 비호치킨림프종이며, T 세포 림프종은 특히 빈도가 낮다. 저자들은 20일 전부터 발생한 황달을 주소로 내원하여 원발성 췌장 T 세포 림프종으로 확진된 37세 여자 환자의 초음파검사와 전산화단층촬영 소견을 기술하고자 한다. 초음파 검사에서 불균질한 에코의 미만성 췌장 비대가 있고, 두부와 미부에서는 돌출하는 양상의 종괴를 형성하고 있었다. 주변 혈관을 압박하는 부위도 있었지만 혈류는 유지되어 있었다. 전산화단층촬영에서는 췌장 내부에 다발성의 저밀도 부위를 포함하는 불균질한 조영증강이 있었고, 주변에는 림프절 비대가 있었다. 주변 혈관은 내강이 유지되어 있었고, 간내담관과 총수담관은 광범위한 확장이 있었으나 주췌관의 확장은 없었다.

췌장의 림프상피성 낭종

윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim),박용현(Yong Hyun Park),김용일(Yong Il Kim),김우호(Woo Ho Kim),김선희(Sun Whe Kim),김재규(Jae Gyu Kim),한준구(Joon Koo Han) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.4

Cystic lesions of the pancreas can be histologically classified into several distinct categories including pseudocyst, congenital true cyst, acquired true cyst, and cystic neoplasm. A lymphoepithelial cyst of the pancreas is a distinctive lesion characterized by the presence of mature, keratinizing squamous lining surrounded by lymphoid tissue and is reported mostly as a single case. We report the first case of a lymphoepithelial cyst of the pancreas proven histologically in Korea. A 60-year-old woman presented a pancreatic mass. Six months ago, a 5 to 10 mm multiple papular skin rash developed and was associated with fever and pruritus. Thereafter, jaundice, fatigue, and anorexia developed. These symptoms and signs resolved spontaneously 20 days later. At that time, ultrasonography of the abdomen demonstrated a 4.5 cm predominantly cystic mass arising from the body of the pancreas. Her past medical history indicated no alcohol intake, gallbladder disease or previous pancreatitis. On admission, physical examination of the abdomen was unremarkable. Serum amylase and the liver function test were also unremarkable. Serum CEA was 9.2 ng/mL. Computed tomography of the abdomen showed a 4.5 c cystic low attenuation mass in the body of the pancreas. Fine needle aspiration was performed. The CEA was 1252 ng/mL and amylase was 2840 U/dL. The cytologic examination revealed some degenerated epithelial cells and lymphocytes. At laparotomy, a smooth, encapsulated, well-circumscribed mass was found in the body of the pancreas. The mass did not invade the pancreas or other adjacent structures. The mass was completely excised. The specimen consisted of a 4 cm thin walled cyst filled with yellowish fluid. The lining was smooth and trabecular in part. Microscopically, the cyst was lined by a squamous epithelium and the epithelial lining was surrounded by lymphoid tissues with scattered germinal centers. (Korean J Gastroenterol 1997; 30:559-563)

췌장의 림프상피성 낭종 1예

김재규,윤용범,김정룡,한준구,김선회,박용현,김우호,김용일 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.4

흰쥐 췌장을 지배하는 운동 및 감각신경세포체의 표지부위

이창현,정순용,차영옥,정승호,송창호,이무삼 대한해부학회 1995 Anatomy & Cell Biology Vol.28 No.6

미소낭과 대낭성 변이가 혼합된 췌장의 장액성 낭선종: 1예 보고

조소희,나성은,변재영,조송미 대한영상의학회 2001 대한영상의학회지 Vol.45 No.1

췌장의 장액성 낭선종은 일반적으로 미소낭성 선종으로 알려져 있다 장액성 낭선종의 전형적인 소견은 2 cm 이하의 수많은 작은 미세소낭으로 구성되어 단면상 스폰지 모양을 보이는 분엽상의 종괴로. 특징적인 중심부 반흔이나 석회화를 흔히 동반하는 것으로 알려져 있다. 그러나 최근 장액성 낭선종의 비전형적인 유형으로 2 cm이상의 대낭성 (macrocystic) 장액성 낭선종이나 단방성 (unilocular) 장액성 낭선종 등의 변종이 보고되고 있다. 저자들은 2 cm이하의 수많은 미세소낭으로 이루어지고 중심부 석회화를 동반한 전형적 형태와 주변부 석회화를 동반하고 2 cm이상의 대낭으로 이루어진 변이 형태가 나란히 존재하여 하나의 장액성 낭선종를 형성한 증례 1 예를 경험하였기 에 병리 조직소견과 함께 CT 및 MR 영상소견을 보고한다. Serous cystadenomas of the pancreas are generally considered to be microcystic adenomas. Typical serous cystadenomas of the pancreas are encapsulated tumors composed of tiny cysts less than 2 cm in size showing sponge-like appearance with a central stellate scar or calcification on the cross-section. It has been recently reported, however, that serous cystadenomas may have macrocystic variants (major cysts more than 2 cm in sized that are radiologically indistinguishable from mucinous cystadenomas of the pancreas. We report the CT and MR imaging findings in a patient with mixed microcystic and macrocystic serous cystadenoma of the pancreas, indicating the histopathologic correlation. The mass was composed of two different types of cyst: multiple, small ( < 2 ctrl with central calcification; and large ( >2 cm) with peripheral calcification.

위에 생긴 이소성 췌장의 진단에 있어 경구 조영제로 물을 사용한 후 조영증강 역동적 CT의 가치

조준식,신경숙 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

To describe the usual and unusual CT findings of heterotopic pancreatic of the stomach and to evaluate the usefulness of dynamic contrast-enhanced CT with water as an oral contrast agent in diagnosing heterotopic pancreas We retrospectively reviewed CT findings in 10 patients with pathologically proved gastric heterotopic pancreas by operation (n=9) or endoscopic resection (n=1). In three patients, conventional CT with diluted Gastrografin solution as an oral contrast agent was performed. In seven patients, two-phase dynamic CT scans after ingestion of 600-800 ml of water were obtained in the early phase and equilibrium phase. Dynamic CT findings of heterotopic pancreas were correlated with histopathologic findings. All 10 heterotopic pancreatic rests were detected with conventional CT or dynamic CT. In seven cases who underwent dynamic CT after ingestion of water, highly enhanced mucosal layers overlying the lesions were identified and all lesions were well delineated in the submucosal layer In four of these seven cases, heterotopic pancreas showed high enhancement similar to that of adjacent normal pancreatic enhancement in the early phase of dynamic CT. The usual CT findings of gastric heterotopic pancreas were oval-shaped submucosal masses (<3cm) in the gastric antrum. The unusual CT findings were infiltrating heterotopic pancreas into the muscle layer in one, cystic dilatation of heterotopic pancreatic ducts in two, and malignant change with mucin secreting cystadencoarcinoma in one. Gastric heterotopic pancreas usually showed oval-shaped submucosal masses (<3cm) in the gastric antrum with high enhancement similar the that of pancreatic enhancment in the early phase of dynamic CT. Our results suggest that contrast-enhanced dynamic CT after ingestion of water may be helpful in diagnosing gastric heterotopic pancreas.

복부 CT 영상에서 췌장의 불확실성을 고려한 계층적 네트워크 기반 자동 췌장 분할

윤현담(Hyeon Dham Yoon),김현진(Hyeonjin Kim),홍헬렌(Helen Hong) Korean Institute of Information Scientists and Eng 2021 정보과학회논문지 Vol.48 No.5

Pancreas segmentation from abdominal CT images is a prerequisite step for understanding the shape of the pancreas in pancreatic cancer detection. In this paper, we propose an automatic pancreas segmentation method based on a deep convolutional neural network(DCNN) that considers information about the uncertain regions generated by the positional and morphological diversity of the pancreas in abdominal CT images. First, intensity and spacing normalizations are performed in the whole abdominal CT images. Second, the pancreas is localized using 2.5D segmentation networks based on U-Net on the axial, coronal, and sagittal planes and by combining through a majority voting. Third, pancreas segmentation is performed in the localized volume using a 3D U-Net-based segmentation network that takes into account the information about the uncertain areas of the pancreas. The average DSC of pancreas segmentation was 83.50%, which was 10.30%p, 10.44%p, 6.52%p, 1.14%p, and 3.95%p higher than the segmentation method using 2D U-Net at axial view, coronal view, sagittal view, majority voting of the three planes, and 3D U-Net at localized volume, respectively.