Dual-Phase Helical CT of Pancreatic Adenocarcinoma
Assessment of Resectability Before Surgery
Carlos Valls1,
Eduard Andía1,
Anna Sanchez1,
Juan Fabregat2,
Oscar Pozuelo1,
Juan Carlos Quintero1,
Teresa Serrano3,
Francisco Garcia-Borobia2 and
Rosa Jorba2
1
Institut de Diagnòstic per la Imatge, Hospital Duran i Reynals, Ciutat
Sanitària i Universitària de Bellvitge, Autovia de Castelldefels
km 2, 7, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
2
Department of Surgery, Hospital Princeps d'Espanya Ciutat Sanitaria i
Universitaria de Bellvitge, C/Feixa Llarga s/n, L'Hospitalet de Llobregat,
08907 Barcelona, Spain.
3
Department of Pathology, Hospital Princeps d'Espanya, 08907 Barcelona,
Spain.
View larger version (150K):
[in a new window]
|
Fig. 1. —Arterial invasion in 65-year-old woman with obstructive
jaundice. Helical CT scan shows large hypodense mass (arrow) in
pancreatic head, abutting and encasing superior mesenteric artery. This sign
is clear indication of unresectability, and patient was excluded from
surgery.
|
|
View larger version (138K):
[in a new window]
|
Fig. 2. —Helical CT scan obtained during pancreatic phase in
52-year-old man reveals small hypoattenuating mass (arrow) in
pancreatic head. Tumor abuts superior mesenteric vein (arrowhead),
but tumor-to-vessel circumferential contiguity is less than 50%, indicating
absence of venous invasion. Surgical exploration confirmed absence of venous
invasion, and tumor was resected without venous resection.
|
|
View larger version (144K):
[in a new window]
|
Fig. 3A. —78-year-old woman with unresectable pancreatic cancer
understaged using helical CT. Note small hepatic cyst (arrowhead) in
both pancreatic and portal phases. Pancreatic-phase CT scan shows small
hypervascular hepatic lesion (arrow) in segment III that was missed
at prospective evaluation.
|
|
View larger version (133K):
[in a new window]
|
Fig. 3B. —78-year-old woman with unresectable pancreatic cancer
understaged using helical CT. Note small hepatic cyst (arrowhead) in
both pancreatic and portal phases. During portal phase, CT scan obtained at
same level as A shows lesion is isoattenuating and no longer
visible.
|
|
View larger version (176K):
[in a new window]
|
Fig. 4. —61-year-old man who had pancreatic adenocarcinoma with venous
invasion. Axial helical CT image obtained at level of uncinate process shows
large hypodense mass (arrow) with circumferential involvement of
superior mesenteric vein. Note that tumor-to-vein contiguity
(arrowheads) is greater than 50%, indicating venous invasion. Tumor
was successfully resected after en bloc venous resection and terminoterminal
anastomosis.
|
|
View larger version (145K):
[in a new window]
|
Fig. 5. —Axial CT scan in 69-year-old woman shows low-density tumor
(arrow) in pancreatic head. Tumor-to-vein contiguity is less than
50%, suggesting absence of venous invasion. However at surgical exploration,
venous invasion was found, and tumor was resected with partial vein
resection.
|
|
View larger version (154K):
[in a new window]
|
Fig. 6. —Periarterial streaks in resectable pancreatic adenocarcinoma
in 61-year-old woman with obstructive jaundice. Transverse contrast-enhanced
CT scan reveals low-density lesion (arrow) in pancreatic head. Note
periarterial streaks (arrowhead) arising from tumor and in contact
with lateral aspect of superior mesenteric artery.
|
|
View larger version (156K):
[in a new window]
|
Fig. 7. —Periarterial streaks in unresectable pancreatic
adenocarcinoma in 66-year-old man with obstructive jaundice. Helical CT scan
shows hypodense lesion (arrow) in uncinate process and linear
reticular opacities arising from tumor and abutting posterior aspect of
superior mesenteric artery (arrowhead). At surgical exploration,
invasion of mesenteric artery was found. Resection was not possible, leaving
grossly positive margin.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2002 by the American Roentgen Ray Society.
