Abstract
Background
We sought to validate computed tomographic virtual pancreatoscopy (CT-VP) created by multidetector row CT (MD-CT) in the clinical diagnosis of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.
Methods
Five cases of pancreatic IPMNs were included in this study. A nasopancreatic drainage tube was inserted and the pancreatic duct was filled with contrast medium, after which an upper abdominal scan was performed by MD-CT. CT-VP and three-dimensional (3D) CT pancreatographic images were created using a workstation and compared with images by conventional diagnostic techniques. All cases were evaluated by endoscopic retrograde pancreatography (ERP) and three cases of main duct type were assessed by intraoperative real pancreatoscopy (RP).
Results
In the main duct cases, papillary projections in the main pancreatic duct and branch orifices were clearly detected by CT-VP. These lesions and structures were confirmed by intraoperative RP, and the CT-VP images were clearer than RP images. In branch cases, a surface-rendering method allowed protruding lesions to be clearly detected in the dilated branches.
Conclusion
Compared with conventional ERP or RP, CT-VP and 3D-CT pancreatographic images were finer in quality, and the procedures were less invasive, faster, and less expensive. The potential shown by CT-VP with 3D-CT pancreatography in the clinical diagnosis of pancreatic IPMNs suggests that this approach may replace ERP in the near future.
Similar content being viewed by others
References
Joresz FA, Lorensen WE, Shinmoto H, et al. (1997) Interactive virtual endoscopy. AJR 169:1229–1235
Ecke U, Klimek L, Mueeller W, et al. (1998) Virtual reality: preparation and execution of sinus surgery. Comput Aid Surg 3:45–50
Gilani S, Norbash AM, Ringl H, et al. (1997) Virtual endoscopy of the paranasal sinus using perspective volume rendered helical sinus computed tomography. Laryngoscope 107:25–29
Lee H (1998) Three-dimensional imaging of the stomach by spiral CT. Comput Assist Tomogr 22:52–58
Rogalla P, Werner-Rustner M, Huitema A, et al. (1998) Virtual endoscopy of the small bowel: Phantom study and preliminary clinic results. Eur Radiol 8:563–567
Springer P, Dessl A, Giacomuzzi SM, et al. (1997) Virtual computed tomography gastroscopy. Endoscopy 29:632–634
Summers RM (1997) Navigation aids for aids for real-time virtual bronchoscopy. AJR 168:1165–1170
Scharling ES, Wolfman NT, Bechtold RE (1996) Computed tomography evaluation of colorectal carcinoma. Semin Roentgenol 31:142–53
Vining DJ (1997) Virtual colonoscopy. Gastrointest Endosc Clin North Am 7:285–291
Ohhashi K, Murakami Y, Takekoshi T (1982) Four cases of “mucin-producing” cancer of the pancreas on specific findings of the papilla of Vater. Prog Dig Endosc 20:348
Kloepple G, Solcia E, Longnecker DS, et al. World Health Organization: international histological classification of tumors, 2nd ed. Berlin: Springer-Verlag, 1996
Itai Y, Ohhashi K, Nagai H, et al. (1986) “Ductectatic” mucinous cystadenoma and cystadenocarcinoma of the pancreas. Radiology 161:697–700
Obara T, Saitoh Y, Maguchi H, et al. (1992) Papillary adenoma of the pancreas with excessive mucin secretion. Pancreas 7:114–117
Ohta T, Nagakawa T, Akiyama T, et al. (1992) The duct-ectatic variant of mucinous cystic neoplasm of the pancreas: clinical and radiologic studies of seven cases. Am J Gastroenterol 87:300–304
Morohoshi T, Kanda M, Asanuma K, Kloppel G (1989) Intraductal papillary neoplasms of the pancreas: a clinicopathologic study of six patients. Cancer 64:1329–1335
Paye F, Sauvanet A, Terris B, et al. (1999) Intraductal papillary mucinous tumors of the pancreas: pancreatic resections guided by preoperative morphological assessment and intraoperative frozen section examination. Surgery 127:536–544
Shyr YM, Su CH, Tsay SH, Lui WY (1996) Mucin-producing neoplasms of pancreas. Intraductal papillary and mucinous cystic neoplasms. Ann Surg 223:141–146
Cuillerier E, Cellier C, Palazzo L, et al. (2000) Outcome after surgical resection of intraductal papillary and mucinous tumors of the pancreas. Am J Gastroenterol 95:441–445
Sho M, Nakajima Y, Kanehiro H, et al. (1998) Pattern of recurrence after resection for intraductal papillary mucinous tumors of the pancreas. World J Surg 22:874–878
Kaneko T, Nakao A, Nomoto S, et al. (1998) Intraoperative pancreatoscopy with the ultrathin pancreatoscope for mucin-producing tumors of the pancreas. Arch Surg 133:263–267
Prassopoulos P, Raptopoulos V, Chuttani R, et al. (1998) Development of virtual CT cholangiopancreatoscopy. Radiology 209:570–574
Nakagohri T, Jolesz FA, Okuda S, et al. (1998) Virtual pancreatoscopy of mucin-producing pancreatic tumors. Comput Aid Surg 3:264–268
Tanizawa Y, Nakagohri T, Konishi M, et al. (2003) Virtual pancreatoscopy of pancreatic cancer. Hepatogastroenterology 50:559–562
Neri E, Boraschi P, Braccini G, et al. (1999) MR virtual endoscopy of the pancreaticobiliary tract: a feasible technique? Abdom Imaging 24:289–291
Neri E, Boraschi P, Braccini G, et al. (1999) MR virtual endoscopy of the pancreaticobiliary tract. Magn Reson Imaging 17:59–67
Xu AM, Cheng HY, Jiang WB, et al. (2002) Multi-slice three-dimensional spiral CT cholangiography: a new technique for diagnosis of biliary diseases. Hepatobiliary Pancreat Dis Int 1:595–603
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sata, N., Kurihara, K., Koizumi, M. et al. CT virtual pancreatoscopy: a new method for diagnosing intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Abdom Imaging 31, 326–331 (2006). https://doi.org/10.1007/s00261-005-0359-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-005-0359-8