Hypervascular pancreatic lesions

Hypervascular pancreatic lesions are findings that enhance more or similarly to the background pancreatic parenchyma in the late arterial phase, on contrast-enhanced CT or MRI.

Anatomical variants

• intrapancreatic accessory spleen: should not be overdiagnosed as a malignant tumor 

Vascular anomalies

• arterial aneurysm ¹
  • involves the pancreaticoduodenal and /or gastroduodenal arteries
  • well-circumscribed
  • communicates with the adjacent vessel
  • enhancement pattern identical to the aorta
  • peripheral atherosclerotic calcifications may be seen
• peripancreatic arterial pseudoaneurysm ¹
  • should be considered after pancreatitis or trauma
  • usually surrounded by inflammation or extravasation of contrast material
  • involves the splenic artery (40%), gastroduodenal artery (30%), and pancreaticoduodenal artery (10 %) 
• venous aneurysm ¹
  • rare
  • enhancement pattern identical to adjacent venous structures
  • luminal communication with adjacent veins
  • usually seen in the setting of cirrhosis and/or portal hypertension
  • involves the splenic and portal veins

Neoplastic

• low risk of malignancy
  • solid pseudopapillary tumors
  • solid serous cystadenomas of the pancreas ⁴
• high risk of malignancy
  • pancreatic acinar cell carcinoma (ACC)
  • hypervascular pancreatic metastases
  • neuroendocrine tumors
    • non-functional neuroendocrine tumors
    • functional neuroendocrine tumors
      • gastrinoma
      • glucagonoma
      • insulinoma
      • somatostatinoma
      • VIPoma