Assessment of vascular invasion in pancreatic carcinoma by MDCT

Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT

“… 36 Adenocarcinoma: 30 Other malignancies: 3 Benign lesions: 4 1 patient had both adenocarcinoma and other malignancy Median: 71 Range: 32–84 24:12 UNCLEAR Cieslak [ 44 ] Suspected Inclusion: Patient who underwent exploratory laparotomy for a suspected pancreatic or periampullary malignancy; Patients who underwent both preoperative contrast enhanced CT and endoscopic ultrasonography. 86 Adenocarcinoma: 37† Other malignancy: 30† Benign lesions: 9† Mean ± SD: 65 ± 10.5 49:37 YES Hassanen [ 45 ] Suspected Inclusion: patients with suspected pancreatic carcinoma underwent biphasic MDCT for pancreatic examination. 47 (study group) Adenocarcinoma: 47 Mean: 63.5 Range: 45-82 32:15 YES Iscanli [ 46 ] Known Inclusion: Patients with pancreatic adenocarcinoma confirmed by surgery-pathology or clinical follow-up.…”

“… Pancreatic parenchymal: 25 –s post-threshold, slice thickness 3 mm Portal venous phase: 23-s after pancreatic phase, section thickness 3 mm YES Fang [ 41 ] 64 slice Not available 80-100 mL Iopamiron Bolus tracking : 100 HU in the diaphragmatic section of the abdominal aorta Arterial-phase: 8-s post-threshold slice thickness 0.67 mm Portal venous phase: 60-s post-threshold; slice thickness 0.67 mm YES Khattab [ 42 ] 64-slice 1000 mL of mixed water and contrast orally 100 mL Omnipaque 350 Bolus triggering : 110 HU in the aorta at corresponding level of superior mesenteric artery. Pancreatic arterial phase: 20-s post-threshold delay; section width of 1.5 mm Delayed venous phase: 50-s post-threshold delay; section width of 1.5 mm YES Yao [ 43 ] Not available Not available Not available Not available NO Cieslak [ 44 ] Range: 16–64-slice Oral contrast 100-150 mL Portal OR Arterial and portal; 5.0-mm slice thickness NO Hassanen [ 45 ] 16-slice 600–800 mL water or water soluble contrast agent orally 100 mL Ultravist 370 (Iopromide) Bolus triggering : 110 HU in the abdominal aorta at the level of the celiac axis Late arterial phase: 10- s post-threshold delay; 3.0 mm Portal venous phase: 35-s post-threshold delay; 3.0 mm YES Iscanli [ 46 ] 16- or 64- slice 1000 mL water orally 90-110 mL Visipaque 320 (Iodixanol) or Ultravist 370 (Iopromide) Bolus tracking : 180-HU enhancement on the proximal abdominal aorta Arterial phase: start automatically when maximum contrast reached Pancreatic phase: 45-s post-contrast delay: slice thickness: 1-1.25 mm, Portal phase: 65-s post-contrast delay: slice thickness: 1-1.25 mm YES * The execution of the CT was described in sufficient detail if type of scanner, the type, amount, and concentration of iv contrast and the different phases with scan delay were described …”

“…Methods of reconstruction and the experience of observers were poorly described. However, the criteria used for unresectability was described in most of the papers, except in three studies [ 30 , 35 , 45 ]. In three studies [ 24 , 25 , 41 ], only vascular invasion was used as criteria for unresectability; in other studies all criteria were used.…”

“…Vascular invasion: when exceeding 270 o of the circumference of the portal vein/superior mesenteric vein or exceeding 90 o of the circumference of the superior mesentery artery, celiac trunk, or hepatic artery; 2. Distant metastases NO YES YES Hassanen [ 45 ] Not available 2 radiologist Not available NO UNCLEAR NO Iscanli [ 46 ] MPR and curved MPR MIP and VR By one of two radiologists (5 and 12 years of experience in reading pancreatic imaging) Criteria for unresectability: 1. Distant metastases to the liver, peritoneum, or omentum; 2.…”

The Role of Multi-Detector Computed Tomography in The Evaluation of Pancreatic Lesions

“…Omar Hassanen et al (2014), in their study (112 patients involved) found SMA to be the most invaded artery and SMV was the most invaded vein. (28) According to predicting resectability by using the MDCT on the studied 18 patients, 6 patients (33.3%%) were considered suitable for tumor resection and 12 patients (66.7%) were considered inoperable with unresectable tumor, and the causes of unresectability were hepatic metastasis, distant lymph nodes involvement, vascular invasion and ascites. Li et al stated that about (15-20%) of patients have resectable disease at the time of presentation (29) Enass M.Khattab et al (2012) in their study (39 patients), found 21 patients (53.8%) were considered inoperable with unresected tumor; the remaining 18 patients (46.2%) were considered suitable for tumor resection.…”