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MDCT of Pancreatic Adenocarcinoma: Optimal Imaging Phases and Multiplanar Reformatted Imaging

Tomoaki Ichikawa1, Sukru Mehmet Erturk2,3, Hironobu Sou4, Hiroto Nakajima4, Tatsuaki Tsukamoto4, Utarou Motosugi4 and Tsutomu Araki4

1 Department of Radiology, University of Yamanashi, Nakakoma, Japan.
2 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120.
3 Present address: Department of Radiology, Sisli Etfal Training and Research Hospital, No: 10/1 Dogancilar, Uskudar Istanbul 81160, Turkey.
4 Department of Radiology, Yamanashi University, Shimokato, Japan.


Figure 1
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  		Fig. 1A —71-year-old woman with ductal adenocarcinoma of body of pancreas with surgically proven retroperitoneal extension. Axial MDCT image obtained during pancreatic parenchymal phase shows dilated main pancreatic duct and ill-defined hypoattenuating area (arrows). These findings are suspicious for but not diagnostic of pancreatic adenocarcinoma.

 

Figure 2
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  		Fig. 1B —71-year-old woman with ductal adenocarcinoma of body of pancreas with surgically proven retroperitoneal extension. Axial MDCT image obtained during portal venous phase shows suspicious lesion (arrows) that is isoattenuating with normal pancreatic parenchyma.

 

Figure 3
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  		Fig. 1C —71-year-old woman with ductal adenocarcinoma of body of pancreas with surgically proven retroperitoneal extension. Coronal multiplanar reformatted image reconstructed from axial MDCT images obtained during pancreatic parenchymal phase clearly shows hypoattenuated mass (arrows). Furthermore, there is evidence of disruption of inferior surface of pancreas and extension of hyperdense spicular structures into hypodense retroperitoneal fat (arrowheads). These findings indicate presence of retroperitoneal extension.

 

Figure 4
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  		Fig. 2A —69-year-old woman with ductal adenocarcinoma of body of pancreas with surgically proven superior mesenteric vein invasion and lymph node involvement. Axial CT image obtained during pancreatic parenchymal phase shows hypoattenuated mass in pancreatic body (arrows).

 

Figure 5
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  		Fig. 2B —69-year-old woman with ductal adenocarcinoma of body of pancreas with surgically proven superior mesenteric vein invasion and lymph node involvement. Coronal multiplanar reformatted (MPR) image reconstructed from axial MDCT images obtained during pancreatic parenchymal phase shows hypoattenauting mass that shows exophytic growth into retroperitoneal fat (black arrow). There is no evidence of intervening fat tissue between pancreas and superior mesenteric vein (white arrow); this finding is suggestive of venous invasion. Note presence of small lymph node caudad to mass (arrowhead).

 

Figure 6
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  		Fig. 2C —69-year-old woman with ductal adenocarcinoma of body of pancreas with surgically proven superior mesenteric vein invasion and lymph node involvement. Sagittal MPR image reconstructed from axial MDCT images obtained during pancreatic parenchymal phase shows two lymph nodes (arrowheads) just beneath mass (arrows).

 

Figure 7
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  		Fig. 3A —52-year-old man with ductal adenocarcinoma in pancreatic head. Axial CT image obtained during parenchymal phase does not clearly depict tumor. Note obliteration of fat planes between pancreas and stomach (arrow). Based on this finding, pancreatitis cannot be excluded from differential diagnosis.

 

Figure 8
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  		Fig. 3B —52-year-old man with ductal adenocarcinoma in pancreatic head. Coronal multiplanar reformatted image reconstructed from axial MDCT images obtained during pancreatic parenchymal phase reveals hypoattenuating tumor (white arrows) that shows peripheral enhancement more obviously. Furthermore, there is clear evidence of gastric wall invasion (black arrows).

 

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