Time Interval Between Abnormalities Seen on CT and the Clinical Diagnosis of Pancreatic Cancer: Retrospective Review of CT Scans Obtained Before Diagnosis
Sumana Gangi1,
J. G. Fletcher2,
Mark A. Nathan2,
Jared A. Christensen3,
William S. Harmsen4,
Brian S. Crownhart4 and
Suresh T. Chari5
1 University of Medicine and Dentistry of New Jersey, Newark, NJ.
2 Department of Radiology, Mayo Clinic, 200 First St. SW, Mayo East-2B,
Rochester, MN 55905.
3 Mayo Medical School, Mayo Clinic, Rochester, MN 55905.
4 Division of Biostatistics, Mayo Clinic, Rochester, MN 55905.
5 Department of Internal Medicine, Division of Gastroenterology, Mayo Clinic,
Rochester, MN 55905.
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Fig. 1. —Bar graph shows specific radiologic findings identified by
both radiologists on CT scans of pancreatic cancer patients for each time
interval. White = pancreatic duct cutoff, black = pancreatic duct dilatation,
horizontal lines = attenuation difference, diagonal lines = loss of fatty
marbling, dark gray = mass present, light gray = vascular invasion.
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Fig. 2A. —63-year-old woman with pancreatic duct adenocarcinoma. Axial
contrast-enhanced CT image obtained with 10-mm slice thickness 26 months
before diagnosis of pancreatic cancer shows no pancreatic abnormalities.
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Fig. 2B. —63-year-old woman with pancreatic duct adenocarcinoma.
Contrast-enhanced CT image obtained with 7-mm slice thickness 13 months before
diagnosis shows mild dilatation of pancreatic duct (arrowheads) in
body of pancreas.
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Fig. 2C. —63-year-old woman with pancreatic duct adenocarcinoma. Axial
CT image obtained inferior to B shows abrupt cutoff of pancreatic duct
(arrow). Both observers identified pancreatic duct cutoff and
interpreted scan as showing findings suspicious for pancreatic cancer.
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Fig. 2D. —63-year-old woman with pancreatic duct adenocarcinoma.
Contrast-enhanced CT image obtained using 7-mm slice thickness 1 day before
histologic diagnosis shows progressive dilatation of pancreatic duct
(arrowhead) in pancreatic body compared with B.
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Fig. 2E. —63-year-old woman with pancreatic duct adenocarcinoma. Axial
CT image obtained inferior to D shows pancreatic duct cutoff
(arrow).
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Fig. 3A. —79-year-old man with pancreatic duct adenocarcinoma. Axial
contrast-enhanced CT image obtained 9 months before clinical diagnosis shows
absence of pancreatic duct dilatation or cutoff.
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Fig. 3B. —79-year-old man with pancreatic duct adenocarcinoma. Axial
contrast-enhanced CT image obtained inferior to A shows low-attenuation
mass (arrow) in pancreatic head. Patient deferred further workup at
that time because he was recovering from repair of abdominal aortic
aneurysm.
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Fig. 3C. —79-year-old man with pancreatic duct adenocarcinoma.
Contrast-enhanced CT image obtained at time of diagnosis shows interval
development of dilated pancreatic and intrahepatic bile ducts.
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Fig. 3D. —79-year-old man with pancreatic duct adenocarcinoma. Axial
contrast-enhanced CT image obtained inferior to C shows interval growth
of pancreatic mass (arrow) compared with B.
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Copyright © 2004 by the American Roentgen Ray Society.
