Hypervascular pancreatic metastasis: an easy imaging diagnostic?

Learning objectives. To review the computed tomograpy (CT) and magnetic resonance imaging (MRI) features of hypervascular pancreatic metastases (HPM). To discuss the main differential diagnosis of HPM. Materials and method. We retrospectively analyzed images from the CT and MRI evaluations of six patients who were diagnosed with HPM by morphopathological examination in the last ten years. Results. In our study, hypervascular pancreatic metastases corresponded to renal cell carcinoma, breast carcinoma and uterine leiomyosarcoma. In non-enhanced CT (NECT), all lesions were isodense or slightly hypodense. After i.v. injection of contrast medium (CM), hypervascular pancreatic metastases have displayed an early arterial phase enhancement, followed by rapid washout in the portal and delayed phases images. Contrast-enhanced CT showed for pancreatic metastases from uterine leio­myo­sarcoma a gradual enhancement. The common ap­pea­rance in MRI for HPM was hypointense in T1 weighted image (wi), heterogeneous aspect in T2 wi or mo­de­ra­tely hyperintense signal with restricted diffusion. After Gd-based CM i.v. injection, HPM showed the same dy­namic as in CT evaluation. Conclusions. HPM may create a diagnostic challenge, therefore the pathological exa­mi­na­tion remains essential and represents the gold standard for the final diagnosis.