The Case for MDCT
Multidetector CT (MDCT) examination with multiphasic acquisition should be advocated as routine study in patient investigated for pancreatic adenocarcinoma. The application of a biphasic protocol gives the best results, using a pancreatic phase for tumor identification and arterial infiltration, and portal phase for the assement of venous infiltration and liver metastasis. Pancreatic adenocarcinoma is classically visualized as an ill-defined solid mass, not capsulated, isodense to the pancreatic parenchyma in pre-contrast scan and hypo-attenuating in the pancreatic-portal phases. Ancillary signs can be helpful in the diagnosis of small tumors (< 2 cm) and isoattenuating adenocarcinoma. Several benign and malignant condition can mimick adenocarcinoma, in this case magnetic resonance and endoscopic ultrasonography biopsy can be helpful in diagnosis. MDCT enables an accurate tumor staging and presents a positive predictive values for unresectability between 89% to 100%; it also allows a complete preoperative planning and presents high accuracy both in surgical complications and tumor recurrence detection.
KeywordsAcute Pancreatitis Chronic Pancreatitis Pancreatic Adenocarcinoma Superior Mesenteric Vein Bile Duct Stone
- Bluemque DA, Cameron JL, Hruban RH et al (1995) Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation. Radiology 197:381–385Google Scholar
- De Cecco CN, Ferrari R, Rengo M, Paolantonio P, Vecchietti F, Laghi A (2009) Anatomic variations of the hepatic arteries in 250 patients studied with 64-row CT angiography. Eur Radiol; doi: 10.1007/s00330-009-1458-7
- Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Hirakawa M et al (2008) Significance of perivascular soft tissue around the common hepatic and proximal superior mesenteric arteries arising after pancreaticoduodenectomy: evaluation with serial MDCT. Abdom Imaging 33:654–661PubMedCrossRefGoogle Scholar
- Ishigami K, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Nishie A, Hirakawa M et al (2009) Diagnostic value of the delayed phase image for iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography. Eur J Radiol 69:139–146PubMedCrossRefGoogle Scholar
- Prokesch RW, Chow LC, Beaulieu CF et al (2002a) Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations-initial experience. Radiography 225:759–765Google Scholar