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Bile duct angulation and tumor vascularity are useful radiographic features for differentiating pancreatic head cancer and intrapancreatic bile duct cancer

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Abstract

Background and purpose

To perform radical resection without leaving residual cancer, surgeons must distinguish between pancreatic head cancer (PHC) and intrapancreatic bile duct cancer (IPBDC) preoperatively. The aim of this study was to establish the points of difference between these two cancers, especially on preoperative multi-detector computed tomography (MDCT) images.

Methods

The subjects of this study were 28 patients with PHC and proven bile duct invasion who underwent pancreatoduodenectomy (PHC group) and 22 patients with IPBDC and upstream bile duct dilation (IPBDC group). We compared the preoperative clinical and radiographic features, including the bile duct angle, calculated on coronal images of MDCT, and the vascularity of the tumor.

Results

The optimal cut-off values for the bile duct angle, the CT value ratio of the tumor (late arterial phase/non-enhanced), and the main pancreatic duct (MPD) ratio (diameter of MPD/diameter of parenchyma) were 110°, 3.0, and 0.2, respectively. Multivariate analysis revealed that a bile duct angle < 110°, a CT value ratio of the tumor < 3, and an MPD ratio ≥ 0.2 were independently associated with PHC.

Conclusions

A bile duct angle and CT value reflecting the vascularity of the tumor might be useful radiographic features for differentiating PHC and IPBDC, in addition to MPD dilatation.

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan

    Atsushi Kohga, Yusuke Yamamoto, Teiichi Sugiura, Yukiyasu Okamura, Takaaki Ito, Ryo Ashida & Katsuhiko Uesaka

  2. Division of Radiology, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan

    Takeshi Aramaki

  3. Division of Pathology, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan

    Keiko Sasaki

Authors
  1. Atsushi Kohga
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  2. Yusuke Yamamoto
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  3. Teiichi Sugiura
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  4. Yukiyasu Okamura
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  5. Takaaki Ito
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  6. Ryo Ashida
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  7. Takeshi Aramaki
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  8. Keiko Sasaki
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  9. Katsuhiko Uesaka
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Corresponding author

Correspondence to Yusuke Yamamoto.

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We have no direct or indirect commercial or financial incentives associated with publishing this article.

Ethics statement

This retrospective study is for academic communication only and is not for other purposes. This paper does not disclose the personal information of any patients, and the subjects provided informed consent if indicated. The study protocol was approved by the institutional review board. The study does not include any animal experiments.

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Kohga, A., Yamamoto, Y., Sugiura, T. et al. Bile duct angulation and tumor vascularity are useful radiographic features for differentiating pancreatic head cancer and intrapancreatic bile duct cancer. Surg Today 48, 673–679 (2018). https://doi.org/10.1007/s00595-018-1642-y

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  • DOI: https://doi.org/10.1007/s00595-018-1642-y

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