European Radiology

, Volume 13, Issue 9, pp 2147–2154 | Cite as

Multidetector CT of pancreatic adenocarcinoma: diagnostic advances and therapeutic relevance

  • Rupert W. Prokesch
  • Wolfgang Schima
  • Lawrence C. Chow
  • R. Brooke Jeffrey
Hepatobiliary–Pancreas

Abstract

Detection and staging of pancreatic malignancies remains a challenge for radiologists. Considering the poor prognosis of pancreatic adenocarcinoma, accurate preoperative staging is the key to a possibly curative surgical treatment. Contrast-enhanced helical CT has been the most commonly used for evaluation of pancreatic cancer in many institutions, although it suffers from many limitations. With the fast pace of advances in multidetector CT (MDCT), and the beginning clinical implementation of 16-row scanners, improvements in spatial resolution in the z-axis with near-isotropic imaging provide exquisite multiplanar reconstructions of pancreatic anatomy. This article provides an overview of current MDCT technique and protocols for assessment of pancreatic adenocarcinoma, and describes new 3D-display methods for effective visualization of large data sets provided by MDCT.

Keywords

Multidetector CT Pancreas Pancreatic cancer Computer applications 

References

  1. 1.
    Horton KM (2002) Multidetector CT and three-dimensional imaging of the pancreas: state of the art. J Gastrointest Surg 6:126–128PubMedCrossRefGoogle Scholar
  2. 2.
    Freeny PC, Marks WM, Ryan JA, Traverso LW (1988) Pancreatic ductal adenocarcinoma: diagnosis and staging with dynamic CT. Radiology 166:125–133PubMedCrossRefGoogle Scholar
  3. 3.
    Freeny PC, Traverso LW, Ryan JA (1993) Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography. Am J Surg 165:600–606PubMedCrossRefGoogle Scholar
  4. 4.
    Lu DSK, Vedantham S, Krasny RM, Kadell B, Berger WL, Reber HA (1996) Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. Radiology 199:697–701PubMedCrossRefGoogle Scholar
  5. 5.
    Boland GW, O'Malley ME, Saez M, Fernandez-Del Castillo C, Warshaw AL, Mueller PR (1999) Pancreatic-phase versus portal-vein-phase helical CT of the pancreas: optimal temporal window for evaluation of pancreatic adenocarcinoma. Am J Roentgenol 172:605–608CrossRefGoogle Scholar
  6. 6.
    O'Malley ME, Boland GW, Wood BJ, Fernandez-Del Castillo C, Warshaw AL, Mueller PR (1999) Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT. Am J Roentgenol 173:1513–1518CrossRefGoogle Scholar
  7. 7.
    Fuhrman GM, Charnsangavej C, Abbruzzese JL et al. (1994) Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms. Am J Surg 167:104–113PubMedCrossRefGoogle Scholar
  8. 8.
    Prokesch RW, Chow L, Beaulieu CF, Nino-Murcia M, Mindelzun RE, Bammer R, Huang J, Jeffrey RB (2002) Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations. Initial experience. Radiology 225:759–765PubMedCrossRefGoogle Scholar
  9. 9.
    Tsiotos GG, Farnell MB, Sarr MG (1999) Are the results of pancreatectomy for pancreatic cancer improving? World J Surg 23:913–919Google Scholar
  10. 10.
    Warshaw AL, Fernandez-Del Castillo C (1992) Pancreatic carcinoma. N Engl J Med 326:455–465PubMedCrossRefGoogle Scholar
  11. 11.
    Warshaw AL, Gu Z, Wittenberg J, Waltman AC (1990) Preopeative staging and assessment of resectability of pancreatic cancer. Arch Surg 125:230–233PubMedCrossRefGoogle Scholar
  12. 12.
    American Cancer Society (1998) Cancer facts and figures 1998. American Cancer Society, AtlantaGoogle Scholar
  13. 13.
    Megibow AJ, Zhou XH, Rotterdam H et al. (1995) Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability. Report of the Radiology Diagnostic Oncology Group. Radiology 195:327–332PubMedCrossRefGoogle Scholar
  14. 14.
    Bluemke DA, Cameron JL, Hruban RH et al. (1995) Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation. Radiology 197:381–385PubMedCrossRefGoogle Scholar
  15. 15.
    Richter GM, Wunsch C, Schneider B, Dux M, Klar E, Seelos R, Kaufmann GW (1998) Hydro-CT in detection and staging of pancreatic carcinoma. Radiology 38:279–286CrossRefGoogle Scholar
  16. 16.
    Prokesch RW, Chow CL, Beaulieu CF, Bammer R, Jerffrey RB (2002) Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 224:764–768PubMedCrossRefGoogle Scholar
  17. 17.
    Schima W, Függer R (2002) Evaluation of focal pancreatic masses: comparison of mangafodipir-enhanced MR imaging and contrast-enhanced helical CT. Eur Radiol 12:2998–3008PubMedGoogle Scholar
  18. 18.
    Hommeyer SC, Freeny PC, Crabo LG (1995) Carcinoma of the head of the pancreas: evaluation of the pancreaticoduodenal veins with dynamic CT. Potential for improved accuracy in staging. Radiology 196:133–238CrossRefGoogle Scholar
  19. 19.
    Vedantham S, Lu DSK, Reber HA, Kadell B (1998) Small peripancreatic veins: improved assessment in pancreatic cancer patients using thin-section pancreatic phase helical CT. Am J Roentgenol 170:377–383CrossRefGoogle Scholar
  20. 20.
    Hough TJ, Raptopoulos V, Siewert B, Matthews JB (1999) Teardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas. Am J Roentgenol 173:1509–1512CrossRefGoogle Scholar
  21. 21.
    Cusack JC Jr, Fuhrmann GM, Lee JE, Evans DB (1994) Managing unsuspected tumor invasion of the superior mesenteric-portal venous confluence during pancreaticoduodenectomy. Am J Surg 168:352–354PubMedCrossRefGoogle Scholar
  22. 22.
    Fuhrman GM, Leach SD, Staley CA et al. (1996) Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic tumor study group. Ann Surg 223:154–162PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Kopp AF, Heuschmid M, Claussen CD (2002) Multidetector helical CT of the liver for tumor detection and characterization. Eur Radiol 12:745–752PubMedCrossRefGoogle Scholar
  24. 24.
    Weg N, Scheer MR, Gabor MP (1998) Liver lesions: improved detection with dual-detector-array CT and routine 2.5 mm thin collimation. Radiology 209:417–426PubMedCrossRefGoogle Scholar
  25. 25.
    Kopka L, Grabbe E (1999) Biphasic liver diagnosis with multiplanar-detector spiral CT. Radiology 39:971–978CrossRefGoogle Scholar
  26. 26.
    Hannesson PH, Lundstedt C, Dawiskiba S, Stridbeck H, Ihse I (2002) Transhepatic intravasular ultrasound for evaluation of portal venous involvement in patients with cancer of the pancreatic head region. Eur Radiol 12:1150–1154PubMedCrossRefGoogle Scholar
  27. 27.
    Fischer U, Vosshenrich R, Horstmann O, Becker H, Salamat B, Baum F, Grabbe E (2002) Preoperative local MRI-staging of patients with a suspected pancreatic mass. Eur Radiol 12:167–269Google Scholar
  28. 28.
    Zeman RK, Cooper C, Zeiberg AS et al. (1997) TNM staging of pancreatic carcinoma using helical CT. Am J Roentgenol 169:459–464CrossRefGoogle Scholar
  29. 29.
    Diehl SJ, Lehmann KJ, Sadick M, Lachmann R, Georgi M (1998) Pancreatic cancer: value of dual-phase helical CT in assessing resectability. Radiology 206:373–378PubMedCrossRefGoogle Scholar
  30. 30.
    Lu DSK, Reber HA, Krasny RM, Kadell BM, Sayre J (1997) Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. Am J Roentgenol 168:1439–1443CrossRefGoogle Scholar
  31. 31.
    Nino-Murcia M, Jeffrey RB Jr, Beaulieu CF, Li KCP, Rubin GD (2001) Multidetector CT of the pancreas and bile duct system: value of curved planar reformations. Am J Roentgenol 176:689–693CrossRefGoogle Scholar
  32. 32.
    Fishman EK, Horton KM, Urban BA (2000) Multidetector CT angiography in the evaluation of pancreatic carcinoma: preliminary observations. J Comput Assist Tomogr 24:849–853PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Rupert W. Prokesch
    • 1
  • Wolfgang Schima
    • 1
  • Lawrence C. Chow
    • 2
  • R. Brooke Jeffrey
    • 2
  1. 1.Department of RadiologyUniversity of ViennaViennaAustria
  2. 2.Department of RadiologyStanford University, Lucas MRS CenterStanfordUSA

Personalised recommendations