American Journal of Roentgenology, Vol 173, 1509-1512, Copyright © 1999 by American Roentgen Ray Society

ARTICLES

Teardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas

TJ Hough, V Raptopoulos, B Siewert and JB Matthews
Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.

OBJECTIVE: Our objective was to investigate whether a tethered, teardrop-shaped superior mesenteric vein (SMV) is a reliable CT indicator of unresectable adenocarcinoma of the head of the pancreas. MATERIALS AND METHODS: CT scans of 92 patients with high suspicion for pancreatic head adenocarcinoma were retrospectively reviewed by two radiologists who were unfamiliar with the patients' outcomes. The reviewers were asked to assess whether the teardrop SMV sign was present or not; agreement was reached by consensus. Teardrop SMV was considered absent in patients with an obstructed vessel. RESULTS: Of 92 patients, 30 had a normal pancreas without a teardrop SMV. A mass in the head of the pancreas was seen in all 62 patients with cancer. Of these 62 patients, 30 (seven with teardrop SMV) were deemed to have inoperable disease by standard CT or clinical criteria. The remaining 32 patients underwent surgery; only 15 of these 32 had successful pancreatoduodenectomies. No patient with resectable tumor had an unequivocal teardrop SMV sign. In 17 patients (13 with teardrop SMV), resection of the tumor could not be accomplished because of vascular encasement (n = 12) or metastasis (n = 5). Added to conventional signs, teardrop SMV significantly increased CT's sensitivity (from 60% to 91%) and accuracy (from 79% to 95%) without significantly changing its specificity (from 100% to 98%) for resectability of pancreatic head cancer. CONCLUSION: The teardrop SMV is a reliable sign for predicting unresectability of adenocarcinoma of the head of the pancreas and can significantly contribute to preoperative planning.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				G. A. Zamboni, J. B. Kruskal, C. M. Vollmer, J. Baptista, M. P. Callery, and V. D. Raptopoulos Pancreatic Adenocarcinoma: Value of Multidetector CT Angiography in Preoperative Evaluation Radiology, December 1, 2007; 245(3): 770 - 778. [Abstract] [Full Text] [PDF]

				M.-P. Vullierme, M. Giraud-Cohen, P. Hammel, A. Sauvanet, A. Couvelard, D. O'Toole, P. Levy, P. Ruszniewski, and V. Vilgrain Malignant Intraductal Papillary Mucinous Neoplasm of the Pancreas: In Situ versus Invasive Carcinoma Surgical Resectability Radiology, November 1, 2007; 245(2): 483 - 490. [Abstract] [Full Text] [PDF]

				D. D. D. Brennan, G. A. Zamboni, V. D. Raptopoulos, and J. B. Kruskal Comprehensive Preoperative Assessment of Pancreatic Adenocarcinoma with 64-Section Volumetric CT RadioGraphics, November 1, 2007; 27(6): 1653 - 1666. [Abstract] [Full Text] [PDF]

				D. D. Brennan, G. Zamboni, J. Sosna, M. P. Callery, C. M.V. Vollmer, V. D. Raptopoulos, and J. B. Kruskal Virtual Whipple: Preoperative Surgical Planning with Volume-Rendered MDCT Images to Identify Arterial Variants Relevant to the Whipple Procedure Am. J. Roentgenol., May 1, 2007; 188(5): W451 - W455. [Abstract] [Full Text] [PDF]

				H Li, M S Zeng, K R Zhou, D Y Jin, and W H Lou Pancreatic adenocarcinoma: signs of vascular invasion determined by multi-detector row CT Br. J. Radiol., November 1, 2006; 79(947): 880 - 887. [Abstract] [Full Text] [PDF]

				T. M. Cardillo, H. Karacay, D. M. Goldenberg, D. Yeldell, C.-H. Chang, D. E. Modrak, R. M. Sharkey, and D. V. Gold Improved Targeting of Pancreatic Cancer: Experimental Studies of a New Bispecific Antibody, Pretargeting Enhancement System for Immunoscintigraphy Clin. Cancer Res., May 15, 2004; 10(10): 3552 - 3561. [Abstract] [Full Text] [PDF]

				R. Vargas, M. Nino-Murcia, W. Trueblood, and R. B. Jeffrey Jr. MDCT in Pancreatic Adenocarcinoma: Prediction of Vascular Invasion and Resectability Using a Multiphasic Technique with Curved Planar Reformations Am. J. Roentgenol., February 1, 2004; 182(2): 419 - 425. [Abstract] [Full Text] [PDF]

				J. G. Fletcher, M. J. Wiersema, M. A. Farrell, J. L. Fidler, L. J. Burgart, T. Koyama, C. D. Johnson, D. H. Stephens, E. M. Ward, and W. S. Harmsen Pancreatic Malignancy: Value of Arterial, Pancreatic, and Hepatic Phase Imaging with Multi-Detector Row CT Radiology, October 1, 2003; 229(1): 81 - 90. [Abstract] [Full Text] [PDF]

				R. W. Prokesch, L. C. Chow, C. F. Beaulieu, M. Nino-Murcia, R. E. Mindelzun, R. Bammer, J. Huang, and R. B. Jeffrey Jr Local Staging of Pancreatic Carcinoma with Multi-Detector Row CT: Use of Curved Planar Reformations—Initial Experience Radiology, December 1, 2002; 225(3): 759 - 765. [Abstract] [Full Text] [PDF]

				E. Lopez Hanninen, H. Amthauer, N. Hosten, J. Ricke, M. Bohmig, J. Langrehr, R. Hintze, P. Neuhaus, B. Wiedenmann, S. Rosewicz, et al. Prospective Evaluation of Pancreatic Tumors: Accuracy of MR Imaging with MR Cholangiopancreatography and MR Angiography Radiology, July 1, 2002; 224(1): 34 - 41. [Abstract] [Full Text] [PDF]

				P. Prassopoulos, I. Tritou, N. Papanikolaou, N. Gourtsoyiannis, and V. Raptopoulos Deformity of the Superior Mesenteric Vein: MR Sign of Pancreatic Cancer Unresectability Am. J. Roentgenol., June 1, 2001; 176 (6): 1600 - 1601. [Full Text] [PDF]

				L. Lepanto, Y. Arzoumanian, D. Gianfelice, P. Perreault, M. Dagenais, R. Lapointe, R. Letourneau, and A. Roy Helical CT with CT Angiography in Assessing Periampullary Neoplasms: Identification of Vascular Invasion Radiology, February 1, 2002; 222(2): 347 - 352. [Abstract] [Full Text] [PDF]