Prior history of pancreatic cancer presenting for radiation planning MRI. Abdominal pain and diarrhea. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology without a focal suspicious lesion or vascular abnormality. There is extrahepatic biliary ductal dilatation up to 1.4 cm to the level of the ampulla. There are small dependent filling defects in the common bile duct consistent with choledocholithiasis (series 8 image 28). Small amount of perihepatic ascites. Pneumobilia.SPLEEN: No significant abnormality noted.PANCREAS: Overall there is decreased T1 weighted signal intensity of the pancreatic parenchyma suggesting parenchymal dysfunction. Best appreciated on the postcontrast images there is a subtle hypoenhancing lesion at the level of the distal pancreatic body/proximal tail measuring 1.8 x 1.4 cm (series 9 image 27). There is distal pancreatic parenchymal atrophy and ductal dilatation. The lesion appears to extend towards and encase the SMA. This is better characterized on the recent prior CT. Also better appreciated on the CT is abutment and possible involvement of the distal splenic vein proximal to the SMV/splenic vein confluence.Relatively stable fluid collection anterior to the pancreatic head measuring approximately 3.9 x 2.8 (series 9 image 110). The small collection dorsal to the stomach is not appreciable on this MRI.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Heterogeneous signal of the aortic wall consistent with atherosclerotic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1. Subtle hypoenhancing lesion at the level of distal pancreatic body/proximal tail with distal pancreatic ductal dilatation and parenchymal atrophy. The lesion measures up to 1.8 cm and extends to and encases the SMA. Findings are consistent with the stated history of pancreatic adenocarcinoma. Refer to the recent CT for better spatial resolution.2. Common biliary ductal dilatation with choledocholithiasis.