Abstract
Peripancreatic lymphatic networks are frequently involved in pancreatobiliary carcinoma, affecting the prognosis. However, little attention has been paid to CT imaging of normal and pathological conditions of peripancreatic lymphatic networks. We evaluated multi-detector row CT (MDCT) images of peripancreatic lymphatic networks invaded by pancreatic carcinoma and compared them with those of normal peripancreatic lymphatic networks using imaging reconstruction every 1 mm with a multiplanar reformation technique. Apart from the region around the pancreatic body and tail, normal peripancreatic lymphatic networks were detected as “linear structures” on MDCT. However, peripancreatic lymphatic invasion by pancreatic carcinoma was frequently identified as “reticular,” “tubular,” or “soft tissue mass” appearances in the peripancreatic fat tissues. Peripancreatic lymphatic invasion by pancreatic carcinoma was more frequently detected around the common hepatic artery, celiac artery, superior mesenteric artery, and left para-aortic area. Depending on the tumor location, positive peripancreatic lymphatic invasion was most frequent at the area around the common hepatic artery in the head region and at the area around the celiac artery in the body and tail regions. Knowledge of CT imaging of normal and pathological peripancreatic lymphatic networks is essential for determining the accurate staging of pancreatic carcinoma.
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References
O’morchoe CC (1997) Lymphatic system of the pancreas. Microsc Res Tech 37:456–477
Reynolds BM (1970) Observations of subcapsular lymphatics in normal and diseased human pancreas. Ann Surg 171:559–566
Noto M, Miwa K, Kitagawa H, et al. (2005) Pancreas head carcinoma frequency of invasion to soft tissue adherent to the superior mesenteric artery. Am J Surg Pathol 29:1056–1061
Jin G, Sugiyama M, Tuo H, et al. (2006) Distribution of lymphatic vessels in the neural plexuses surrounding the superior mesenteric artery. Pancreas 32:62–66
Doi R, Kami K, Ito D, et al. (2007) Prognostic implication of para-aortic lymph node metastasis in resectable pancreatic cancer. World J Surg 31:147–154
Shimada K, Sakamoto Y, Sano T, et al. (2006) Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery 139:288–295
Kayahara M, Nagakawa T, Ueno K, et al. (1993) An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging. Cancer 72(7):2118–2123
Kayahara M, Nagakawa T, Futagami F, et al. (1996) Lymphatic flow and neural plexus invasion associated with carcinoma of the body and tail of the pancreas. Cancer 78(12):2485–2491
Gebhardt C, Meyer W, Reichel M, et al. (2000) Prognostic factors in the operative treatment of ductal pancreatic carcinoma. Langenbecks Arch Surg 385(1):14–20
Deki H, Sato T. (1998) An anatomic study of peripancreatic lymphatics. Surg Radiol 10:121–135
Zeman RK, Cooper C, Zeiberg AS, et al. (1997) TNM staging of pancreatic carcinoma using helical CT. AJR 169:459–464
Megibow AJ, Zhou XH, Rotterdam H, et al. (1995) Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of respectability—report of the radiology diagnostic oncology group. Radiology 195:327–332
Muller MF, Meyenberger C, Bertschinger P, et al. (1994) Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging. Radiology 190:745–751
Midwinter MJ, Beveridge CJ, Wilson JB, et al. (1999) Correlation between spiral computed tomography, endoscopic ultrasonography and findings at operation in pancreatic ampullary tumours. Br J Surg 86:189–193
Noto M, Miwa K, Kitagawa H, et al. (2005) Pancreas head carcinoma: frequency of invasion to soft tissue adherent to the superior mesenteric artery. Am J Surg Pathol 29:1056–1061
Itoh T, Itoh H, Konishi J. (1991) Lymphangitic liver metastasis: radiologic-pathologic correlations. J Comput Assist Tomogr 15:401–404
Matsumoto S, Mori H, Ando Y, et al. (2004) Lymphangiosis carcinomatosa of the liver deriving from gastric carcinoma with a unique branching calcification. Eur Radiol 14:1519–1520
Wang PJ, Shang MY, Qian Z, et al. (2006) CT-guided percutaneous neurolytic celiac plexus block technique. Abdom Imaging 31:710–718
Iki K, Fujita Y, Inada H, et al. (2003) Celiac plexus block: evaluation of injectate spread by three-dimensional computed tomography. Abdom Imaging 28:571–573
Yoshioka H, Wakabayashi T. (1958) Therapeutic neurotomy on head of pancreas for relief of pain due to chronic pancreatitis. Arch Surg 76:546–554
Fukuda T, Iwanaga S, Sakamoto I, et al. (1998) CT of neural plexus invasion in common bile duct carcinoma. JCAT 22(3):351–356
Kayahara M, Nagakawa T, Ohta T, et al. (1999) Analysis of para-aortic lymph node involvement in pancreatic carcinoma: a significant indication for surgery? Cancer 85(3):583–590
Shimada K, Sakamoto Y, Sano T, et al. (2006) The role of para-aoritc lymph node involvement on early recurrence and survival after macroscopic curative resection with extended lymphadenectomy for pancreatic carcinoma. J Am Coll Surg 203(3): 345–352
Doi R, Kami K, Ito D, et al. (2007) Prognostic implication of para-aortic lymph node metastasis in resectable pancreatic cancer. World J Surg 31:147–154
Yoshida T, Matsumoto T, Sasaki A, et al. (2004) Outcome of para-aortic node-positive pancreatic head and bile duct adenocarcinoma. Am J Surg 221:721–731
Hayashi S, Miyazaki M (1999) Thoracic duct: visualization at nonenhanced MR lymphography—initial experience. Radiology 212:598–600
Takahashi H, Kuboyama S, Abe H, et al. (2003) Clinical feasibility of noncontrast-enhanced magnetic resonance lymphography of the thoracic duct. Chest 124: 2136–2142
Erden A, Fitoz S, Yagmurlu B, et al. (2005) Abdominal confluence of lymph trunks: detectability and morphology on heavily T2-weighted images. AJR 184(1): 35–40
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Sai, M., Mori, H., Kiyonaga, M. et al. Peripancreatic lymphatic invasion by pancreatic carcinoma: evaluation with multi-detector row CT. Abdom Imaging 35, 154–162 (2010). https://doi.org/10.1007/s00261-008-9461-z
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DOI: https://doi.org/10.1007/s00261-008-9461-z