American Journal of Roentgenology, Vol 173, 1513-1518, Copyright © 1999 by American Roentgen Ray Society

ARTICLES

Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT

ME O'Malley, GW Boland, BJ Wood, C Fernandez-del Castillo, AL Warshaw and PR Mueller
Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.

OBJECTIVE: This study was conducted to evaluate newly introduced criteria for unresectability of pancreatic cancer with thin-section pancreatic-phase helical CT. MATERIALS AND METHODS: Twenty-five patients with adenocarcinoma in the head of the pancreas underwent thin- section pancreatic-phase helical CT. The major peripancreatic vessels were categorized on a scale of 1-4, according to the degree of circumferential involvement by tumor. The maximum diameters of the small peripancreatic veins--gastrocolic trunk, anterosuperior pancreaticoduodenal vein, and posterosuperior pancreaticoduodenal vein-- were recorded. Findings on CT were compared with the results of surgery in each patient. RESULTS: Sixteen patients had surgically resectable tumors, and nine patients had surgically unresectable tumors. CT and surgical correlation was available for 98 major peripancreatic vessels; 85 were resectable and 13 were unresectable. Of category 1 vessels, 72 (97%) of 74 were resectable at surgery. Of category 2 vessels, 12 (71%) of 17 were resectable. One (50%) of two category 3 vessels and none (0%) of five category 4 vessels were resectable at surgery. CT showed a dilated gastrocolic trunk in two patients; one of these patients had a surgically resectable tumor, but the other patient had a surgically unresectable tumor. CONCLUSION: In patients with adenocarcinoma in the head of the pancreas, the degree of circumferential vessel involvement by tumor as shown by CT is useful in predicting which patients will have surgically unresectable tumors. A dilated gastrocolic trunk should not be used as an independent sign of surgical unresectability.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				H. Y. Lee, S. H. Kim, J. M. Lee, S.-W. Kim, J.-Y. Jang, J. K. Han, and B. I. Choi Preoperative Assessment of Resectability of Hepatic Hilar Cholangiocarcinoma: Combined CT and Cholangiography with Revised Criteria Radiology, April 1, 2006; 239(1): 113 - 121. [Abstract] [Full Text] [PDF]

				J. M. Pipas, R. J. Barth Jr., B. Zaki, M. J. Tsapakos, A. A. Suriawinata, M. A. Bettmann, J. M. Cates, G. H. Ripple, J. E. Sutton, S. R. Gordon, et al. Docetaxel/Gemcitabine Followed by Gemcitabine and External Beam Radiotherapy in Patients With Pancreatic Adenocarcinoma Ann. Surg. Oncol., December 1, 2005; 12(12): 995 - 1004. [Abstract] [Full Text] [PDF]

				M. Imbriaco, A. J. Megibow, A. Ragozzino, R. Liuzzi, P. Mainenti, S. Bortone, L. Camera, and M. Salvatore Value of the Single-Phase Technique in MDCT Assessment of Pancreatic Tumors Am. J. Roentgenol., April 1, 2005; 184(4): 1111 - 1117. [Abstract] [Full Text] [PDF]

				J. DeWitt, B. Devereaux, M. Chriswell, K. McGreevy, T. Howard, T. F. Imperiale, D. Ciaccia, K. A. Lane, D. Maglinte, K. Kopecky, et al. Comparison of Endoscopic Ultrasonography and Multidetector Computed Tomography for Detecting and Staging Pancreatic Cancer Ann Intern Med, November 16, 2004; 141(10): 753 - 763. [Abstract] [Full Text] [PDF]

				P Manoharan and M B Sheridan Neoplasms of the pancreas Imaging, September 1, 2004; 16(4): 323 - 337. [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]

				M. K. Kalra, M. M. Maher, G. W. Boland, S. Saini, and A. J. Fischman Correlation of Positron Emission Tomography and CT in Evaluating Pancreatic Tumors: Technical and Clinical Implications Am. J. Roentgenol., August 1, 2003; 181(2): 387 - 393. [Full Text] [PDF]

				C. J. Roche, M. L. Hughes, C. J. Garvey, F. Campbell, D. A. White, L. Jones, and J. P. Neoptolemos CT and Pathologic Assessment of Prospective Nodal Staging in Patients with Ductal Adenocarcinoma of the Head of the Pancreas Am. J. Roentgenol., February 1, 2003; 180(2): 475 - 480. [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]

				W. Schima, R. Fugger, E. Schober, C. Oettl, P. Wamser, F. Grabenwoger, J. M. Ryan, and G. Novacek Diagnosis and Staging of Pancreatic Cancer: Comparison of Mangafodipir Trisodium--Enhanced MR Imaging and Contrast-Enhanced Helical Hydro-CT Am. J. Roentgenol., September 1, 2002; 179(3): 717 - 724. [Abstract] [Full Text] [PDF]

				R. W. Prokesch, L. C. Chow, C. F. Beaulieu, R. Bammer, and R. B. Jeffrey Jr Isoattenuating Pancreatic Adenocarcinoma at Multi-Detector Row CT: Secondary Signs Radiology, September 1, 2002; 224(3): 764 - 768. [Abstract] [Full Text] [PDF]

				M. Imbriaco, A. J. Megibow, L. Camera, L. Pace, P. P. Mainenti, M. Romano, G. Selva, and M. Salvatore Dual-Phase Versus Single-Phase Helical CT to Detect and Assess Resectability of Pancreatic Carcinoma Am. J. Roentgenol., June 1, 2002; 178(6): 1473 - 1479. [Abstract] [Full Text] [PDF]

				K. M. Horton and E. K. Fishman Multidetector CT Angiography of Pancreatic Carcinoma: Part 2, Evaluation of Venous Involvement Am. J. Roentgenol., April 1, 2002; 178(4): 833 - 836. [Full Text] [PDF]

				C. D. Johnson Pancreatic Carcinoma: Developing a Protocol for Multi-Detector Row CT Radiology, July 1, 2001; 220(1): 3 - 4. [Full Text] [PDF]

				M. Nino-Murcia, R. B. Jeffrey Jr., C. F. Beaulieu, K. C. P. Li, and G. D. Rubin Multidetector CT of the Pancreas and Bile Duct System: Value of Curved Planar Reformations Am. J. Roentgenol., March 1, 2001; 176(3): 689 - 693. [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]