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MDCT in Pancreatic Adenocarcinoma: Prediction of Vascular Invasion and Resectability Using a Multiphasic Technique with Curved Planar Reformations

Rafael Vargas1,2, Matilde Nino-Murcia1,3, Ward Trueblood4 and R. Brooke Jeffrey, Jr.1

1 Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr., Room H1307, Stanford, CA 94305.
2 Present address:Department of Radiology, Southern Illinois University 1520 S Second St., #1103, Springfield, IL 62701.
3 Department of Radiology, Veterans Administration Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA 94304.
4 Department of General Surgery, Stanford University Medical Center, Stanford, CA 94305.



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  		Fig. 1A. —62-year-old man with normal pancreas. To obtain curved planar reformations, we placed cursors along course of pancreatic duct on axial (A) and coronal (B) MDCT scans. Two orthogonal curved planes were created through pancreatic duct. Arrows indicate planes of curved planar reformation.

 


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  		Fig. 1B. —62-year-old man with normal pancreas. To obtain curved planar reformations, we placed cursors along course of pancreatic duct on axial (A) and coronal (B) MDCT scans. Two orthogonal curved planes were created through pancreatic duct. Arrows indicate planes of curved planar reformation.

 


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  		Fig. 1C. —62-year-old man with normal pancreas. Resulting axial (C) and coronal (D) curved planar reformations (derived from A and B, respectively) display pancreas. Pancreatic duct (arrows) appears normal.

 


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  		Fig. 1D. —62-year-old man with normal pancreas. Resulting axial (C) and coronal (D) curved planar reformations (derived from A and B, respectively) display pancreas. Pancreatic duct (arrows) appears normal.

 


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  		Fig. 2A. —66-year-old man with pancreatic adenocarcinoma and normal peripancreatic vascular structures. M = tumor mass, A =aorta. Coronal (A) and sagittal (B) curved planar reformations obtained through superior mesenteric artery (SMA) show hypoattenuating tumor mass in pancreatic head that does not extend into superior mesenteric artery. In-place biliary stent (arrow, A) is also seen.

 


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  		Fig. 2B. —66-year-old man with pancreatic adenocarcinoma and normal peripancreatic vascular structures. M = tumor mass, A =aorta. Coronal (A) and sagittal (B) curved planar reformations obtained through superior mesenteric artery (SMA) show hypoattenuating tumor mass in pancreatic head that does not extend into superior mesenteric artery. In-place biliary stent (arrow, A) is also seen.

 


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  		Fig. 2C. —66-year-old man with pancreatic adenocarcinoma and normal peripancreatic vascular structures. M = tumor mass, A =aorta. Coronal (C) and sagittal (D) curved planar reformations obtained through superior mesenteric vein (SMV) show hypoattenuating tumor mass in pancreatic head with no involvement of superior mesenteric vein. PV = portal vein, SV = splenic vein.

 


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  		Fig. 2D. —66-year-old man with pancreatic adenocarcinoma and normal peripancreatic vascular structures. M = tumor mass, A =aorta. Coronal (C) and sagittal (D) curved planar reformations obtained through superior mesenteric vein (SMV) show hypoattenuating tumor mass in pancreatic head with no involvement of superior mesenteric vein. PV = portal vein, SV = splenic vein.

 


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  		Fig. 3A. —59-year-old woman with pancreatic adenocarcinoma invading superior mesenteric vein. M = tumor mass. Axial MDCT scan shows hypoattenuating tumor mass within pancreatic head distorting contour of superior mesenteric vein (arrowheads). In-place biliary stent (arrow) is visible.

 


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  		Fig. 3B. —59-year-old woman with pancreatic adenocarcinoma invading superior mesenteric vein. M = tumor mass. Coronal curved planar reformation obtained through confluence of superior mesenteric, portal (PV), and splenic (SV) veins shows narrowing and irregularity in contour of superior mesenteric vein (thick arrows) caused by hypoattenuating tumor mass. Thin arrow indicates in-place biliary stent.

 


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  		Fig. 4A. —58-year-old man with pancreatic adenocarcinoma. Apparent tumor invasion of superior mesenteric vein seen on MDCT was not confirmed at surgery. Axial MDCT scan shows isoattenuating tumor mass (M) distorting contour of superior mesenteric vein (solid arrow) and dilatation of pancreatic duct (open arrow).

 


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  		Fig. 4B. —58-year-old man with pancreatic adenocarcinoma. Apparent tumor invasion of superior mesenteric vein seen on MDCT was not confirmed at surgery. Coronal (B) and sagittal (C) curved planar reformations obtained through superior mesenteric vein (SMV) show isoattenuating tumor mass (M in B) that causes narrowing (solid arrows, B and C) of SMV near confluence with portal vein (PV). Dilatation of pancreatic duct (open arrow, C) is seen. SV = splenic vein.

 


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  		Fig. 4C. —58-year-old man with pancreatic adenocarcinoma. Apparent tumor invasion of superior mesenteric vein seen on MDCT was not confirmed at surgery. Coronal (B) and sagittal (C) curved planar reformations obtained through superior mesenteric vein (SMV) show isoattenuating tumor mass (M in B) that causes narrowing (solid arrows, B and C) of SMV near confluence with portal vein (PV). Dilatation of pancreatic duct (open arrow, C) is seen. SV = splenic vein.

 

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