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Assessment of vascular invasion in pancreatic head cancer with multislice spiral CT: value of multiplanar reconstructions

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Abstract

The use of multiplanar reconstructions (MPRs) generated from multislice spiral CT (MSCT) data sets in the preoperative assessment of vascular invasion in pancreatic cancer was evaluated. Forty patients underwent biphasic high-resolution MSCT prior to surgery for pancreatic head cancer. Image reconstruction included thin-slice axial, sagittal and coronal MPRs as well as an MPR perpendicular to the course of a major peripancreatic vessel in proximity to the tumor. CT criteria for vascular invasion were: (1) circumferential involvement >180° and (2) vessel narrowing. Imaging findings of 52 vessels were correlated with surgical and histopathological reports. Regarding the CT criterion circumferential involvement, vascular invasion was demonstrated on axial MPRs with a sensitivity and specificity of 58 and 97%. For the assessment with coronal and sagittal MPRs sensitivity was only 47%. Vascular invasion was recognized best on perpendicular MPRs with a sensitivity, specificity and accuracy of 74, 97 and 88%, respectively. Vessel narrowing was a less reliable CT criterion for vascular invasion, mainly due to the lower specificity of 91% obtained with each available MPR. Thin-slice MPRs oriented perpendicularly to a possibly invaded vessel exactly depict the grade of circumferential involvement and thus have the capability to improve the assessment of vascular invasion in pancreatic cancer.

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References

  1. Freeny PC, Marks WM, Ryan JA, Traverso LW (1988) Pancreatic ductal adenocarcinoma: diagnosis and staging with dynamic CT. Radiology 166:125–133

    CAS  PubMed  Google Scholar 

  2. Warshaw AL, Fernandez-del Castillo C (1992) Pancreatic carcinoma. N Engl J Med 326:455–465

    CAS  PubMed  Google Scholar 

  3. Allema JH, Reinders ME, van Gulik TM, Koelemay MJW, Van Leeuwen DJ, de Wit LT, Gouma DJ, Obertop H (1995) Prognostic factors for survival after pancreaticoduodenectomy for patients with carcinoma of the pancreatic head region. Cancer 75:2069–2076

    CAS  PubMed  Google Scholar 

  4. Fink C, Grenacher L, Hansmann HJ, Dux M, Leipold R, Spielhaupter E, Kauffmann GW, Richter GM (2001) Prospective study to compare high-resolution computed tomography and magnetic resonance imaging in the detection of pancreatic neoplasms: use of intravenous and oral MR contrast media. Röfo 173:724–730

    Google Scholar 

  5. Schima W, Függer R, Schober E, Oettl C, Wamser P, Grabenwöger F, Ryan JM, Novacek G (2002) Diagnosis and staging of pancreatic cancer: comparison of mangafodipir trisodium-enhanced MR imaging and contrast-enhanced helical hydro-CT. Am J Roentgenol 179:717–724

    Google Scholar 

  6. Schima W, Függer R (2002) Evaluation of focal pancreatic masses: comparison of mangafodipir-enhanced MR imaging and contrast-enhanced helical CT. Eur Radiol 12:2998–3008

    PubMed  Google Scholar 

  7. Del Frate C, Zanardi R, Mortele K, Ros PR (2002) Advances in imaging for pancreatic disease. Curr Gastroenterol Rep 4:140–148

    PubMed  Google Scholar 

  8. Beger HG, Rau B, Gansauge F, Poch B, Link KH (2003) Treatment of pancreatic cancer: challenge of the facts. World J Surg 27:1075–1084

    Article  PubMed  Google Scholar 

  9. Fuhrman GM, Charnsangavej C, Abbruzzese JL, Cleary KR, Martin RG, Fenoglio CJ, Evans DB (1994) Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms. Am J Surg 167:104–113

    CAS  PubMed  Google Scholar 

  10. Megibow AJ, Zhou XH, Rotterdam H, Francis IR, Zerhouni EA, Balfe DM, Weinreb JC, Aisen A, Kuhlman J, Heiken JP, Gatsonis C, McNeil BJ (1995) Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability—report of the radiology diagnostic oncology group. Radiology 195:327–332

    CAS  PubMed  Google Scholar 

  11. Bluemke DA, Cameron JL, Hruban RH, Pitt HA, Siegelman SS, Soyer P, Fishman EK (1995) Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation. Radiology 197:381–385

    PubMed  Google Scholar 

  12. Diehl SJ, Lehmann KJ, Sadick M, Lachmann R, Georgi M (1998) Pancreatic cancer: value of dual-phase helical CT in assessing resectability. Radiology 206:373–378

    CAS  PubMed  Google Scholar 

  13. Fishman EK, Horton KM, Urban BA (2000) Multidetector CT angiography in the evaluation of pancreatic carcinoma: preliminary observations. JCAT 24:849–853

    CAS  Google Scholar 

  14. Horton KM, Fishman EK (2002) Multidetector CT angiography of pancreatic carcinoma. Part 1. Evaluation of arterial involvement. Am J Roentgenol 178:827–831

    Google Scholar 

  15. Raptopoulos V, Steer ML, Sheiman RG, Vrachliotis TG, Gougoutas CA, Movson JS (1997) The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery. Am J Roentgenol 168:971–977

    CAS  Google Scholar 

  16. Prokesch RW, Chow LC, 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—inital experience. Radiology 225:759–765

    PubMed  Google Scholar 

  17. Catalano C, Laghi A, Fraioli F, Pediconi F, Napoli A, Danti M, Reitano I, Passariello R (2003) Pancreatic carcinoma: the role of high-resolution multislice spiral CT in the diagnosis and assessment of resectability. Eur Radiol 13:149–156

    PubMed  Google Scholar 

  18. O’Malley ME, Boland GWL, 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 173:1513–1518

    CAS  Google Scholar 

  19. Hommeyer SC, Freeney 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 196:133–238

    Google Scholar 

  20. 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 170:377–383

    CAS  Google Scholar 

  21. Hough TJ, Raptopoulos V, Siewert B, Matthews JB (1999) Teardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas. Am J Roentgenol 173:1509–1512

    CAS  Google Scholar 

  22. Warshaw AL, Gu ZY, Wittenberg J, Waltman AC (1990) Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg 125:230–233

    CAS  PubMed  Google Scholar 

  23. Talamini MA, Moesinger RC, Pitt HA, Sohn TA, Hruban RH, Lillemoe KD, Yeo CJ, Cameron JL (1997) Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg 225:590–600

    Article  CAS  PubMed  Google Scholar 

  24. 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 168:1439–1443

    CAS  Google Scholar 

  25. Nakayama Y, Yamashita Y, Kadota M, Takahashi M, Kanemitsu K, Hiraoka T, Hirota M, Ogawa M, Takeya M (2001) Vascular encasement by pancreatic cancer: correlation of CT findings with surgical and pathologic results. JCAT 25:337–342

    CAS  Google Scholar 

  26. Arslan A, Buanes T, Geitung JT (2001) Pancreatic carcinoma: MR, MR angiography and dynamic helical CT in the evaluation of vascular invasion. Eur J Radiol 38:151–159

    CAS  PubMed  Google Scholar 

  27. Phoa SSKS, Reeders JWAJ, Rauws EAJ, de Wit L, Gouma DJ, Laméris JS (1999) Spiral computed tomography for preoperative staging of potentially resectable carcinoma of the pancreatic head. Br J Surg 86:789–794

    Article  CAS  PubMed  Google Scholar 

  28. McFarland EG, Kaufman JA, Saini S, Halpern EF, Lu DS, Waltman AC, Warshaw AL (1996) Preoperative staging of cancer of the pancreas: value of MR angiography versus conventional angiography in detecting portal venous invasion. Am J Roentgenol 166:37–43

    CAS  Google Scholar 

  29. Fletcher JG, Wiersema MJ, Farrell MA, Fidler JL, Burgart LJ, Koyama T, Johnson CD, Stephens DH, Ward EM, Harmsen WS (2003) Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 229:81–90

    PubMed  Google Scholar 

  30. Harrison LE, Brennan MF (1998) Portal vein resection for pancreatic adenocarcinoma. Surg Oncol Clin N Am 7:165–181

    CAS  PubMed  Google Scholar 

  31. Roder JD, Stein HJ, Siewert JR (1996) Carcinoma of the periampullary region: who benefits from portal vein resection. Am J Surg 171:170–175

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany

    Melanie Brügel, Thomas M. Link, Ernst J. Rummeny, Peter Lange & Martin Dobritz

  2. Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany

    Jörg Theisen

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  1. Melanie Brügel
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  2. Thomas M. Link
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  3. Ernst J. Rummeny
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  4. Peter Lange
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  5. Jörg Theisen
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  6. Martin Dobritz
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Correspondence to Melanie Brügel.

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Brügel, M., Link, T.M., Rummeny, E.J. et al. Assessment of vascular invasion in pancreatic head cancer with multislice spiral CT: value of multiplanar reconstructions. Eur Radiol 14, 1188–1195 (2004). https://doi.org/10.1007/s00330-004-2326-0

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  • DOI: https://doi.org/10.1007/s00330-004-2326-0

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