Multidetector CT Angiography of Pancreatic Carcinoma: Part I, Evaluation of Arterial Involvement

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Multidetector CT Angiography of Pancreatic Carcinoma

Part I, Evaluation of Arterial Involvement

Karen M. Horton¹ and Elliot K. Fishman

^¹ Both authors: Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, 601 N. Caroline St., Rm. 3253, Baltimore, MD 21287.

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Fig. 1. —45-year-old man with pancreatic cancer. Sagittal three-dimensional volume-rendered multidetector CT scan shows encasement (solid arrow) and invasion (open arrow) of proximal superior mesenteric artery.

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Fig. 2. —64-year-old woman with pancreatic cancer. Sagittal three-dimensional volume-rendered multidetector CT scan shows mass (arrow) between celiac axis and superior mesenteric artery. Cancer is causing mass effect on superior mesenteric artery. Note vessel is not narrowed. This tumor was successfully resected.

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Fig. 3A. —45-year-old man with pancreatic cancer. Volume-rendered three-dimensional (3D) multidetector CT scan obtained in coronal projection shows normal anatomy of celiac axis and vessel branches in orientation similar to that on classic angiography. Note gastroduodenal artery (arrowhead), splenic artery (curved arrow), left gastric artery (open arrow), and hepatic artery (solid straight arrow).

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Fig. 3B. —45-year-old man with pancreatic cancer. Slightly oblique 3D axial image shows main branches of celiac axis: common hepatic artery (straight arrow) and splenic artery (curved arrow).

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Fig. 4A. —63-year-old woman with pancreatic cancer. Slightly oblique axial three-dimensional (3D) volume-rendered multidetector CT scan reveals mass (arrows) arising from body and tail of pancreas and extending posteriorly to involve left renal hilum. Mass caused delayed renal function seen as decreased cortical enhancement in left kidney.

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Fig. 4B. —63-year-old woman with pancreatic cancer. Coronal 3D volume-rendered multidetector CT scan shows mass (arrows) seen in A. In this orientation, mass is seen encasing splenic artery (arrowhead).

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Fig. 5. —62-year-old woman with small periampullary mass. Coronal maximum-intensity-projection CT scan shows normal gastroduodenal artery (arrow). Vessel is much easier to appreciate on coronal three-dimensional images than on axial CT images. No evidence of arterial encasement is seen.

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Fig. 6A. —73-year-old man with pancreatic cancer. Coronal three-dimensional (3D) volume-rendered multidetector CT scan shows mass (arrow) encasing gastroduodenal artery (arrowhead). This alone would not make patient ineligible for curative resection.

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Fig. 6B. —73-year-old man with pancreatic cancer. Coronal oblique 3D volume-rendered multidetector CT scan obtained during portal venous phase shows mass (arrows) encasing superior mesenteric artery and portal confluence (arrowhead). Venous involvement would make patient ineligible for curative resection.

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Fig. 7. —63-year-old man with pancreatic cancer. Axial oblique three-dimensional volume-rendered multidetector CT scan imaged from above shows calcified atherosclerotic plaque narrowing origin of celiac axis (arrow). No evidence of vascular invasion by tumor was present. Vascular bypass was performed at time of pancreatic resection.

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Fig. 8A. —62-year-old man with pancreatic cancer. Sagittal three-dimensional (3D) volume-rendered multidetector CT scan shows normal appearance of superior mesenteric artery (straight arrow) and celiac axis (curved arrow).

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Fig. 8B. —62-year-old man with pancreatic cancer. Coronal 3D volume-rendered multidetector CT scan shows normal branching pattern of superior mesenteric artery. These small vessels are almost impossible to confidently identify on axial scans.

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Fig. 9. —73-year-old woman with pancreatic cancer. Coronal three-dimensional volume-rendered multidetector CT scan shows pancreatic mass (arrows) encasing mid portion of superior mesenteric artery (arrowhead). Narrowed vessel is compatible with tumor invasion. This patient was not eligible for curative resection.

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Fig. 10A. —53-year-old man with pancreatic cancer. Axial three-dimensional (3D) volume-rendered multidetector CT scan shows tumor invasion (straight solid arrows) of superior mesenteric artery (curved arrow) and hepatic artery (open arrow).

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Fig. 10B. —53-year-old man with pancreatic cancer. Axial oblique 3D volume-rendered multidetector CT scan shows tumor encasing common hepatic artery (arrowhead) arising off celiac axis. Note encasement of replaced right hepatic artery (arrow) off superior mesenteric artery.

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Fig. 11A. —52-year-old woman with abdominal pain. Three-dimensional (3D) volume-rendered multidetector CT scan shows that aorta and spine have not been removed. Superior mesenteric artery can be identified even though it is overlying aorta.

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Fig. 11B. —52-year-old woman with abdominal pain. Maximum-intensity-projection CT scan is in same orientation as A. Because maximum-intensity-projection is 3D technique that displays brightest pixel along array, aorta and spine will obscure mesenteric vessels, unless extensive editing is performed.

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