CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part II): Imaging of pancreatic carcinoma nerve invasion

Figure 1 Examples of patterns of extrapancreatic neural invasion by pancreatic carcinoma visualized by computed tomography. A: Sixty-three-year-old male with pancreatic carcinoma in the pancreas body. Contrast-enhanced computed tomography (CT) images during the arterial dominant phase show strand-like structure (arrow) around the superior mesenteric artery; B: Sixty-seven-year-old female with pancreatic carcinoma in the pancreas head. Contrast-enhanced CT images during the arterial dominant phase show strand-like structure (arrow) around celiac trunk; C: Histopathology confirmed extrapancreatic neural (asterisk) invasion by pancreatic carcinoma (arrows) (HE, 200 ×); D: Histopathology confirmed extrapancreatic neural (asterisk) invasion by pancreatic carcinoma (arrows) (HE, 200 ×).

Figure 2 Patterns of extrapancreatic neural invasion by pancreatic carcinoma: Computed tomography images in a 70-year-old male with pancreatic carcinoma in the pancreas body and tail. A: Contrast-enhanced computed tomography image shows the coelial plexus invasion (arrow) by the tumor; B: Histological image shows the extrapancreatic perineural (asterisk) invasion by the pancreatic carcinoma (arrows) (HE, 200 ×).

Figure 3 Patterns of extrapancreatic neural invasion by pancreatic carcinoma visualized by computed tomography in a 56-year-old female with pancreatic carcinoma in the pancreas body. Contrast-enhanced computed tomography images (A, B) show the splenic plexus invasion (arrows) by the tumor (asterisk) in the body of pancreas. The appearance of plexus invasion is streaky structure.

Figure 4 Characteristics of extrapancreatic neural invasion by pancreatic carcinoma on computed tomography image. A: Imaging shows the streaky and strand-like structure (arrows) around the tail of pancreas; B: The histological picture confirmed the invasion (asterisk) by the carcinoma (arrows) (HE, 200 ×).

Figure 7 Example of patterns of extrapancreatic neural invasion by pancreatic carcinoma and the characteristics as visualized by magnetic resonance imaging. Fifty-seven-year-old female with pancreatic body carcinoma: magnetic resonance images. The tumor (short arrows) was located at the body of the pancreas which showed hypointensity on T1-weighted imaging (A), arterial phase (C) and venous phase (D), while it showed hyperintensity on T2-weighted imaging (B); there was streak-like signal intensity structure (long arrows) between pancreatic body and abdominal aorta.

Figure 8 Characteristics of tumor and the extrapancreatic neural invasion by pancreatic carcinoma on magnetic resonance images in an 80-year-old female. The tumor was located at the region between head and body of the pancreas and invaded medial to pancreas forming a mass (arrows). A: 3D gradient-echo (GRE) T1-weighted precontrast image; B: Fat-saturated fast recovery fast spin-echo T2-weighted image; C and D: 3D GRE T1-weighted Gd-enhanced arterial and venous phases. Histopathology confirmed extrapancreatic neural invasion by pancreatic carcinoma (arrows); E: HE, 40 ×; F: HE, 200 ×.

Figure 9 Magnetic resonance imaging characteristics of extrapancreatic neural invasion by pancreatic carcinoma in a 48-year-old male. The tumor (arrows) was located at the body of the pancreas and invaded the extrapancreatic neural plexus, forming a mass (curved arrows), and the adjacent celiac trunk. A: 3D gradient-echo (GRE) T1-weighted non-enhanced image; B: Fat-saturated fast recovery fast spin-echo T2-weighted image; C and D: 3D GRE T1-weighted Gd-enhanced arterial and venous phases. Histopathological images showed extrapancreatic neural (asterisk) invasion by pancreatic carcinoma (arrows); E: HE, 40 ×; F: HE, 200 ×.