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CT Assessment of the Inferior Peripancreatic Veins

Clinical Significance

Yasunari Yamada1, Hiromu Mori, Hiro Kiyosue, Shunro Matsumoto, Yuzo Hori and Tohru Maeda

1 All authors: Department of Radiology, Oita Medical University, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan.



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  		Fig. 1A. —Normal CT anatomy of inferior peripancreatic veins in 56-year-old man with ampullary carcinoma. A—D, Selective pancreatic arteriogram (A) and three consecutive helical CT images using selective pancreatic arteriography (B—D) reveal normal anatomy of inferior peripancreatic veins. Anteroinferior pancreaticoduodenal vein (AI) passes between inferior surface of pancreatic head and third portion of duodenum. Posteroinferior pancreaticoduodenal vein (PI) passes transversely above AI. AI and PI join together to form inferior pancreaticoduodenal vein (IP), which drains into first jejunal trunk (JT), which then drains into superior mesenteric vein (SMV) after passing posterior to superior mesenteric artery (SMA). Note catheters in B—D (arrowheads). 1stD = first duodenal vein, PS = posterosuperior pancreaticoduodenal vein, GT = gastrocolic trunk, AS = anterosuperior pancreaticoduodenal vein, Du = duodenum. (Reprinted with permission from [8]).

 


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  		Fig. 1B. —Normal CT anatomy of inferior peripancreatic veins in 56-year-old man with ampullary carcinoma. A—D, Selective pancreatic arteriogram (A) and three consecutive helical CT images using selective pancreatic arteriography (B—D) reveal normal anatomy of inferior peripancreatic veins. Anteroinferior pancreaticoduodenal vein (AI) passes between inferior surface of pancreatic head and third portion of duodenum. Posteroinferior pancreaticoduodenal vein (PI) passes transversely above AI. AI and PI join together to form inferior pancreaticoduodenal vein (IP), which drains into first jejunal trunk (JT), which then drains into superior mesenteric vein (SMV) after passing posterior to superior mesenteric artery (SMA). Note catheters in B—D (arrowheads). 1stD = first duodenal vein, PS = posterosuperior pancreaticoduodenal vein, GT = gastrocolic trunk, AS = anterosuperior pancreaticoduodenal vein, Du = duodenum. (Reprinted with permission from [8]).

 


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  		Fig. 1C. —Normal CT anatomy of inferior peripancreatic veins in 56-year-old man with ampullary carcinoma. A—D, Selective pancreatic arteriogram (A) and three consecutive helical CT images using selective pancreatic arteriography (B—D) reveal normal anatomy of inferior peripancreatic veins. Anteroinferior pancreaticoduodenal vein (AI) passes between inferior surface of pancreatic head and third portion of duodenum. Posteroinferior pancreaticoduodenal vein (PI) passes transversely above AI. AI and PI join together to form inferior pancreaticoduodenal vein (IP), which drains into first jejunal trunk (JT), which then drains into superior mesenteric vein (SMV) after passing posterior to superior mesenteric artery (SMA). Note catheters in B—D (arrowheads). 1stD = first duodenal vein, PS = posterosuperior pancreaticoduodenal vein, GT = gastrocolic trunk, AS = anterosuperior pancreaticoduodenal vein, Du = duodenum. (Reprinted with permission from [8]).

 


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  		Fig. 1D. —Normal CT anatomy of inferior peripancreatic veins in 56-year-old man with ampullary carcinoma. A—D, Selective pancreatic arteriogram (A) and three consecutive helical CT images using selective pancreatic arteriography (B—D) reveal normal anatomy of inferior peripancreatic veins. Anteroinferior pancreaticoduodenal vein (AI) passes between inferior surface of pancreatic head and third portion of duodenum. Posteroinferior pancreaticoduodenal vein (PI) passes transversely above AI. AI and PI join together to form inferior pancreaticoduodenal vein (IP), which drains into first jejunal trunk (JT), which then drains into superior mesenteric vein (SMV) after passing posterior to superior mesenteric artery (SMA). Note catheters in B—D (arrowheads). 1stD = first duodenal vein, PS = posterosuperior pancreaticoduodenal vein, GT = gastrocolic trunk, AS = anterosuperior pancreaticoduodenal vein, Du = duodenum. (Reprinted with permission from [8]).

 


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  		Fig. 2A. —Schematic drawings show angiogram (A) and corresponding CT images (B—D) of normal inferior peripancreatic veins. panc. = pancreas, Du = duodenum, IVC = inferior vena cava, Ao = aorta. Angiographic image shows relationship of normal peripancreatic veins, portosuperior mesenteric vein, and superior mesenteric artery. The horizontal lines are correlated to images B—E.

 


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  		Fig. 2B. —Schematic drawings show angiogram (A) and corresponding CT images (B—D) of normal inferior peripancreatic veins. panc. = pancreas, Du = duodenum, IVC = inferior vena cava, Ao = aorta. Posterosuperior pancreaticoduodenal vein (PS) accompanies common bile duct (CBD). Gastrocolic trunk (GT) drains into right anterolateral aspect of superior mesenteric vein (SMV).

 


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  		Fig. 2C. —Schematic drawings show angiogram (A) and corresponding CT images (B—D) of normal inferior peripancreatic veins. panc. = pancreas, Du = duodenum, IVC = inferior vena cava, Ao = aorta. Anterosuperior pancreaticoduodenal vein (AS) is joined by right gastroepiploic vein (RGE) and right superior colic vein (RCV) to form GT.

 


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  		Fig. 2D. —Schematic drawings show angiogram (A) and corresponding CT images (B—D) of normal inferior peripancreatic veins. panc. = pancreas, Du = duodenum, IVC = inferior vena cava, Ao = aorta.

Anteroinferior pancreaticoduodenal vein (AI) is contiguous to AS at anterosulcus of pancreas. Posteroinferior pancreaticoduodenal vein (PI) originates below CBD and passes transversely above AI. AI and PI join together to form inferior pancreaticoduodenal vein (IP), which drains into first jejunal trunk (JT), which then drains into SMV after passing posterior to superior mesenteric artery (SMA).

 


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  		Fig. 2E. —Schematic drawings show angiogram (A) and corresponding CT images (B—D) of normal inferior peripancreatic veins. panc. = pancreas, Du = duodenum, IVC = inferior vena cava, Ao = aorta.

Anteroinferior pancreaticoduodenal vein (AI) is contiguous to AS at anterosulcus of pancreas. Posteroinferior pancreaticoduodenal vein (PI) originates below CBD and passes transversely above AI. AI and PI join together to form inferior pancreaticoduodenal vein (IP), which drains into first jejunal trunk (JT), which then drains into SMV after passing posterior to superior mesenteric artery (SMA).

 


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  		Fig. 3A. —74-year-old woman with ampullary cancer and normal peripancreatic veins.

A—D, Second phase of contrast-enhanced helical CT. Scans show inferior peripancreatic veins—anteroinferior pancreaticoduodenal vein (AI), posteroinferior pancreaticoduodenal vein (PI), inferior pancreaticoduodenal vein (IP), and first jejunal trunk (JT)—and gastrocolic trunk (GT) as mostly enhanced. Note drainage tube (arrowheads). SMV = superior mesenteric vein, SMA = superior mesenteric artery.

 


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  		Fig. 3B. —74-year-old woman with ampullary cancer and normal peripancreatic veins.

A—D, Second phase of contrast-enhanced helical CT. Scans show inferior peripancreatic veins—anteroinferior pancreaticoduodenal vein (AI), posteroinferior pancreaticoduodenal vein (PI), inferior pancreaticoduodenal vein (IP), and first jejunal trunk (JT)—and gastrocolic trunk (GT) as mostly enhanced. Note drainage tube (arrowheads). SMV = superior mesenteric vein, SMA = superior mesenteric artery.

 


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  		Fig. 3C. —74-year-old woman with ampullary cancer and normal peripancreatic veins.

A—D, Second phase of contrast-enhanced helical CT. Scans show inferior peripancreatic veins—anteroinferior pancreaticoduodenal vein (AI), posteroinferior pancreaticoduodenal vein (PI), inferior pancreaticoduodenal vein (IP), and first jejunal trunk (JT)—and gastrocolic trunk (GT) as mostly enhanced. Note drainage tube (arrowheads). SMV = superior mesenteric vein, SMA = superior mesenteric artery.

 


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  		Fig. 3D. —74-year-old woman with ampullary cancer and normal peripancreatic veins.

A—D, Second phase of contrast-enhanced helical CT. Scans show inferior peripancreatic veins—anteroinferior pancreaticoduodenal vein (AI), posteroinferior pancreaticoduodenal vein (PI), inferior pancreaticoduodenal vein (IP), and first jejunal trunk (JT)—and gastrocolic trunk (GT) as mostly enhanced. Note drainage tube (arrowheads). SMV = superior mesenteric vein, SMA = superior mesenteric artery.

 


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  		Fig. 4A. —67-year-old man with carcinoma of pancreatic head.

A—D, Helical CT scans show dilatation of gastrocolic trunk (GT) (6 mm) and posterosuperior pancreaticoduodenal vein (PS) (5 mm) that resulted from tumor invasion of anteroinferior pancreaticoduodenal vein (AI), posteroinferior pancreaticoduodenal vein (PI), and inferior pancreaticoduodenal vein (IP). Portosuperior mesenteric vein is normal. Note drainage tube (arrowhead) in A and B. AS = anterosuperior pancreaticoduodenal vein, SMV = superior mesenteric vein, SMA = superior mesenteric artery, JT = first jejunal trunk, Ca = carcinoma.

 


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  		Fig. 4B. —67-year-old man with carcinoma of pancreatic head.

A—D, Helical CT scans show dilatation of gastrocolic trunk (GT) (6 mm) and posterosuperior pancreaticoduodenal vein (PS) (5 mm) that resulted from tumor invasion of anteroinferior pancreaticoduodenal vein (AI), posteroinferior pancreaticoduodenal vein (PI), and inferior pancreaticoduodenal vein (IP). Portosuperior mesenteric vein is normal. Note drainage tube (arrowhead) in A and B. AS = anterosuperior pancreaticoduodenal vein, SMV = superior mesenteric vein, SMA = superior mesenteric artery, JT = first jejunal trunk, Ca = carcinoma.

 


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  		Fig. 4C. —67-year-old man with carcinoma of pancreatic head.

A—D, Helical CT scans show dilatation of gastrocolic trunk (GT) (6 mm) and posterosuperior pancreaticoduodenal vein (PS) (5 mm) that resulted from tumor invasion of anteroinferior pancreaticoduodenal vein (AI), posteroinferior pancreaticoduodenal vein (PI), and inferior pancreaticoduodenal vein (IP). Portosuperior mesenteric vein is normal. Note drainage tube (arrowhead) in A and B. AS = anterosuperior pancreaticoduodenal vein, SMV = superior mesenteric vein, SMA = superior mesenteric artery, JT = first jejunal trunk, Ca = carcinoma.

 


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  		Fig. 4D. —67-year-old man with carcinoma of pancreatic head.

A—D, Helical CT scans show dilatation of gastrocolic trunk (GT) (6 mm) and posterosuperior pancreaticoduodenal vein (PS) (5 mm) that resulted from tumor invasion of anteroinferior pancreaticoduodenal vein (AI), posteroinferior pancreaticoduodenal vein (PI), and inferior pancreaticoduodenal vein (IP). Portosuperior mesenteric vein is normal. Note drainage tube (arrowhead) in A and B. AS = anterosuperior pancreaticoduodenal vein, SMV = superior mesenteric vein, SMA = superior mesenteric artery, JT = first jejunal trunk, Ca = carcinoma.

 


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  		Fig. 4E. —67-year-old man with carcinoma of pancreatic head.

Photomicrograph shows tumor extension (arrow) to third portion of duodenum (Du). Ca = carcinoma (H and E, x1)

 


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  		Fig. 4F. —67-year-old man with carcinoma of pancreatic head.

High-power photomicrograph shows neural invasion to second portion of extrapancreatic nerve plexus. Note cancer cells (arrows) in perineural space. N = nerve. (H and E, x100)

 


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  		Fig. 5A. —Illustrations show CT findings of normal anatomy of peripancreatic veins and features in tumor invasion of peripancreatic tissues.

Drawing shows CT findings of normal anatomy of peripancreatic veins and second portion of extrapancreatic nerve plexus. Paired pancreaticoduodenal venous arcades, anterior arcade—anterosuperior pancreaticoduodenal vein (AS) and anteroinferior pancreaticoduodenal vein (AI)—and posterior arcade—posterosuperior pancreaticoduodenal vein (PS) and posteroinferior pancreaticoduodenal vein (PI)—lie directly on surface of pancreatic head. Inferior pancreaticoduodenal vein (IP) and first jejunal trunk (JT) run behind superior mesenteric artery (SMA). Note area of small circles representing extrapancreatic nerve plexus. RCV = right superior colic vein, RGE = right gastroepiploic vein, GT = gastrocolic trunk, SMV = superior mesenteric vein, Panc. = pancreas.

 


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  		Fig. 5B. —Illustrations show CT findings of normal anatomy of peripancreatic veins and features in tumor invasion of peripancreatic tissues.

Drawing shows changes of peripancreatic veins in carcinomatous tumor involvement (Ca) of portosuperior mesenteric vein. When tumor involved portosuperior mesenteric vein, most inferior peripancreatic veins (AI, PI, and IP) were visualized and some were abnormally dilated.

 


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  		Fig. 5C. —Illustrations show CT findings of normal anatomy of peripancreatic veins and features in tumor invasion of peripancreatic tissues.

Drawing shows changes of peripancreatic veins in carcinomatous tumor involvement (Ca) of second portion of extrapancreatic nerve plexus. Tumor involvement of any inferior peripancreatic veins (AI, PI, and IP) may have caused dilatation of other peripancreatic veins. Nonvisualization of IP, JT, or both with dilatation of other peripancreatic veins indicates tumor invasion of second portion of extrapancreatic nerve plexus and mesenteric root. Note directions of venous blood flow (arrows).

 

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