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Selective Intraarterial Contrast-Enhanced CT of Pancreaticoduodenal Tumors

Early Clinical Experience in Evaluating Blood Supply and Detectability

Hiroyoshi Furukawa1, Ryoko Iwata1, Noriyuki Moriyama1 and Tomoo Kosuge2

1 Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104, Japan.
2 Department of Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, 104, Japan.



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  		Fig. 1A. —Pancreatic adenocarcinoma in 52-year-old woman. IV contrast-enhanced CT scan shows hypoattenuating area in pancreatic head (arrowheads). Note superior tumor conspicuity from surrounding pancreatic tissue.

 


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  		Fig. 1B. —Pancreatic adenocarcinoma in 52-year-old woman. CT during common hepatic arteriography at same level as A shows marked enhancement on right side of pancreas and duodenum. Note faint enhancement on right side of tumor (arrow). Volume and injection rate of contrast material were 50 ml and 2 ml/sec, respectively.

 


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  		Fig. 1C. —Pancreatic adenocarcinoma in 52-year-old woman. CT scan obtained during superior mesenteric arteriography at same level as A and B shows faint enhancement on left side of tumor (arrow) and marked enhancement of jejunum. Volume and injection rate of contrast material were 50 ml and 1.5 ml/sec, respectively. Both enhanced areas in B and C are complementary to each other in whole pancreaticoduodenal region including tumor.

 


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  		Fig. 2A. —Ampullary carcinoma in 58-year-old man. IV contrast-enhanced CT scan shows tumor as enhanced mass protruding into duodenal lumen (arrow).

 


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  		Fig. 2B. —Ampullary carcinoma in 58-year-old man. CT scan obtained during gastroduodenal arteriography at same level as A shows enhancement in right superior side of tumor and in duodenum. Volume and injection rate of contrast material were 30 ml and 1.5 ml/sec, respectively.

 


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  		Fig. 2C. —Ampullary carcinoma in 58-year-old man. CT scan obtained during superior mesenteric arteriography at same level as A and B shows enhancement in left inferior side of tumor and in jejunum. Volume and injection rate of contrast material were 60 ml and 3 ml/sec, respectively. Both enhanced areas in B and C are complementary to each other in whole pancreaticoduodenal region including tumor.

 


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  		Fig. 3A. —Pancreatic adenocarcinoma in 74-year-old man. On arteriography, common hepatic artery arises from superior hepatic artery. Volume and injection rate of contrast material were 30 ml and 4 ml/sec, respectively.

 


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  		Fig. 3B. —Pancreatic adenocarcinoma in 74-year-old man. IV contrast-enhanced CT scan shows tumor as hypoattenuated area in pancreatic head (arrow). Note superior tumor conspicuity from surrounding pancreatic tissue.

 


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  		Fig. 3C. —Pancreatic adenocarcinoma in 74-year-old man. CT scan obtained during hepatomesenteric arteriography at same level as A shows marked enhancement in whole pancreatic head, in which tumor appears as hypoattenuated area (arrow). Volume and injection rate of contrast material were 60 ml and 3 ml/sec, respectively.

 


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  		Fig. 4A. —Islet cell tumor of the pancreas in 45-year-old man. Superior mesenteric arteriogram shows marked tumor stain (arrows). Volume and injection rate of contrast material were 25 ml and 3 ml/sec, respectively.

 


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  		Fig. 4B. —Islet cell tumor of the pancreas in 45-year-old man. Celiac arteriogram also shows faint tumor stain (arrow). Volume and injection rate of contrast material were 20 ml and 4 ml/sec, respectively.

 


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  		Fig. 4C. —Islet cell tumor of the pancreas in 45-year-old man. IV contrast-enhanced CT scan shows two tumors protruding behind pancreas (arrows).

 


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  		Fig. 4D. —Islet cell tumor of the pancreas in 45-year-old man. CT scan obtained during superior mesenteric arteriography shows enhancement in large left-sided pancreatic tumor (arrow) and pancreatic body. Volume and injection rate of contrast material were 40 ml and 2 ml/sec, respectively.

 


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  		Fig. 4E. —Islet cell tumor of the pancreas in 45-year-old man. CT scan obtained during celiac arteriography shows enhancement in small right-sided pancreatic tumor (arrow) and pancreatic head and tail. Volume and injection rate of contrast material were 40 ml and 2 ml/sec, respectively.

 


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  		Fig. 5A. —Intraductal papillary adenoma in 69-year-old man. Celiac arteriogram shows no remarkable or abnormal findings. Volume and injection rate of contrast material were 20 ml and 4 ml/sec, respectively. GD = gastroduodenal artery, DP = dorsal pancreatic artery.

 


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  		Fig. 5B. —Intraductal papillary adenoma in 69-year-old man. IV contrast-enhanced CT scan shows cystic tumor in uncinate process of pancreas (arrows).

 


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  		Fig. 5C. —Intraductal papillary adenoma in 69-year-old man. CT scan obtained during celiac arteriography at same level as B shows marked enhancement in whole pancreatic head. Volume and injection rate of contrast material were 50 ml and 2.5 ml/sec, respectively.

 


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  		Fig. 5D. —Intraductal papillary adenoma in 69-year-old man. CT scan obtained during gastroduodenal arteriography at same level as B shows enhanced area in right side of pancreas and duodenum. Volume and injection rate of contrast material were 20 ml and 1 ml/sec, respectively. Cystic tumor is not enhanced.

 


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  		Fig. 5E. —Intraductal papillary adenoma in 69-year-old man. CT scan obtained during dorsal pancreatic arteriography shows marked enhancement in cystic tumor. Volume and injection rate of contrast material were 10 ml and 0.5 ml/sec, respectively. Note conspicuity of wall and septa of tumor.

 

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