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Multidetector CT Angiography of Pancreatic Carcinoma

Part 2, Evaluation of Venous 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. —25-year-old healthy woman undergoing CT for renal donor evaluation. Coronal volume-rendered three-dimensional multidetector CT scan shows normal venous anatomy of portal vein (solid straight arrow), splenic vein (curved arrow), and superior mesenteric vein (open arrow).

 


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  		Fig. 2. —56-year-old man with pancreatic cancer. Coronal volume-rendered three-dimensional multidetector CT scan shows tumor encasement (arrow) of portal vein. Patient would not be candidate for curative resection.

 


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  		Fig. 3. —73-year-old woman with pancreatic cancer. Coronal volume-rendered three-dimensional multidetector CT scan shows tumor infiltration (arrows) and encasement of portal confluence.

 


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  		Fig. 4. —48-year-old man with pancreatic cancer. Coronal volume rendered three-dimensional multidetector CT scan shows large mass (arrow) in head of pancreas. Mass is compressing and invading portal vein. Note bile ductal dilatation.

 


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  		Fig. 5. —67-year-old woman with extensive pancreatic cancer involving the entire gland. Coronal volume-rendered three-dimensional multidetector CT scan shows thrombosis of portal vein, splenic vein, and superior mesenteric veins (arrowheads). Note tumor infiltration (arrow) of body.

 


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  		Fig. 6A. —48-year-old woman with pancreatic cancer. Coronal volume-rendered three-dimensional (3D) multidetector CT scan shows tumor encasement (arrows) of portal confluence. Splenic vein is not opacified; this finding is compatible with occlusion.

 


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  		Fig. 6B. —48-year-old woman with pancreatic cancer. Coronal volume-rendered 3D multidetector CT scan obtained at more anterior level than A shows multiple venous collaterals (arrows).

 


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  		Fig. 7A. —65-year-old woman with pancreatic cancer. Coronal volume-rendered three-dimensional multidetector CT scan shows large tumor in pancreatic body (arrow) and tail. Portal vein and superior mesenteric veins are patent, but splenic vein is not visualized. The latter finding is compatible with occlusion.

 


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  		Fig. 7B. —65-year-old woman with pancreatic cancer. Coronal maximum-intensity-projection CT scan shows venous collaterals resulting from splenic vein occlusion.

 


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  		Fig. 8. —54-year-old woman with pancreatic cancer. Coronal volume-rendered three-dimensional multidetector CT scan shows mass arising from head of pancreas encasing proximal portion of superior mesenteric vein (arrow).

 


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  		Fig. 9. —45-year-old man with pancreatic cancer. Coronal volume-rendered three-dimensional multidetector CT scan shows small tumor in head of pancreas with minimal local invasion (arrow) of superior mesenteric vein.

 

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