0:01

So this is another case of a lesion which was seen

0:04

on chest CT, which was done for another reason,

0:07

and we are trying to characterize that lesion better.

0:10

So on these T2 images, we see most

0:12

of the pancreas is normal looking.

0:13

There is no lesion found anywhere,

0:16

pancreatic duct looks grossly okay.

0:17

But as soon as we reach the pancreatic head,

0:20

we see some of the area of altered intensity here.

0:26

Kind of very ill-defined, difficult

0:28

to perceive, but if you pay attention,

0:30

there is an area which is ill-defined.

0:33

Heterogeneously hyperintense to

0:35

intermediate signal intensity.

0:37

So once we open arterial phase and try

0:41

to see this area, we actually find a

0:45

hyperenhancing focus in the same area.

0:48

And if we pay attention there, there is

0:49

enhancing lesion inside the liver as well,

0:52

which was also seen on T2-weighted images

0:55

as intermediate signal intensity lesion.

0:58

If we correlate this, these findings on high B

1:01

value DWI, we can find a corresponding lesion in

1:05

the liver and a lesion in the pancreatic head.

1:09

For neuroendocrine tumor, if you have a

1:11

doubt, diffusion-weighted images are the

1:13

key images to find the tumors and their

1:16

deposits, whether it is in the liver, on

1:18

retroperitoneum, peripancreatic region,

1:21

or anywhere else in the near the pancreatic head.

1:24

So if you really want to find a small tiny

1:26

deposit from neuroendocrine tumor, look for

1:29

the diffusion-weighted images on high B value.

1:31

You will find those there.

1:33

So in this case, we are seeing

1:34

this deposit in the liver.

1:36

And deposit in the pancreatic head, which has

1:38

corresponding imaging findings on T2 and that

1:42

has corresponding finding on arterial phase,

1:46

hyperenhancing lesion in the pancreatic head.

1:49

As we go to the venous phase, we can see that

1:51

lesion is losing signal because it is washing out.

1:55

It is hypointense relative to the liver,

1:58

but the primary, which was seen as hyper

1:59

enhancing lesion is no longer visualized.

2:02

So basically all of the neuroendocrine

2:04

tumor are better seen on the arterial phase.

2:07

And they are better detected with

2:09

the help of arterial phase as

2:11

well as diffusion-weighted images.

2:13

And they can be easily missed on

2:15

T2-weighted images or delayed venous phase.

2:19

So don't rely on those two sequences.