Assessment of vascular invasion in pancreatic head cancer with multislice spiral CT: value of multiplanar reconstructions

Abstract

The use of multiplanar reconstructions (MPRs) generated from multislice spiral CT (MSCT) data sets in the preoperative assessment of vascular invasion in pancreatic cancer was evaluated. Forty patients underwent biphasic high-resolution MSCT prior to surgery for pancreatic head cancer. Image reconstruction included thin-slice axial, sagittal and coronal MPRs as well as an MPR perpendicular to the course of a major peripancreatic vessel in proximity to the tumor. CT criteria for vascular invasion were: (1) circumferential involvement >180 degrees and (2) vessel narrowing. Imaging findings of 52 vessels were correlated with surgical and histopathological reports. Regarding the CT criterion circumferential involvement, vascular invasion was demonstrated on axial MPRs with a sensitivity and specificity of 58 and 97%. For the assessment with coronal and sagittal MPRs sensitivity was only 47%. Vascular invasion was recognized best on perpendicular MPRs with a sensitivity, specificity and accuracy of 74, 97 and 88%, respectively. Vessel narrowing was a less reliable CT criterion for vascular invasion, mainly due to the lower specificity of 91% obtained with each available MPR. Thin-slice MPRs oriented perpendicularly to a possibly invaded vessel exactly depict the grade of circumferential involvement and thus have the capability to improve the assessment of vascular invasion in pancreatic cancer.

A New Invasion Score for Determining the Resectability of Pancreatic Carcinomas with Contrast-Enhanced Multidetector Computed Tomography

“…At most centers, spiral CT is considered the state of the art for diagnosing pancreatic carcinomas and evaluating resectability [6] . The benefits of using 16-row spiral CT with the ability to generate an MPR with a high image quality and high resolution in assessing vascular invasion in pancreatic cancer have been reported recently [14,15,17] .…”

“…The latter, for example, is important for the detection of small lesions and the evaluation of vascular invasion [11][12][13] . Probably the most valuable advantage of multislice CT with 16 or more rows is that the multiplanar reconstruction (MPR) images achieve high image quality at high resolution but without slice misregistration, since the row data are generated with an isotropic voxel size [14] . Therefore, MPR images can be generated in any plane, which can be used to obtain additional information ( fig.…”

Value of multidetector computed tomographic angiography in marginally resectable pancreatic cancer

“…MDCTA seems to be the technique of choice, permitting detailed evaluation of peripancreatic arteries and veins before therapeutic selection and design, specifically in borderline cases. 5,[11][12][13]16,17,19,21,23,[25][26][27]29,33,[36][37][38][39][40][41]44,45,[48][49][50]52,53,56,57,[63][64][65][66] …”

“…MDCT axial source data combined with VR and curved MPR images represent the optimal method for the evaluation of pancreatic cancer resectability. 56,57 As described in the previous section, there …”

“…Many reports have shown the added value of high-quality MPR images in the accurate evaluation of vascular invasion and resectability of pancreatic cancer. 55,56 For the preoperative evaluation of pancreatic tumors, it is necessary to evaluate axial images; coronal, sagittal, and curved MPR images; and vascular, MIP, or VR reformatted images from data obtained during both the pancreatic parenchymal and portal venous phases. Reconstructions of curved MPR-MIP images of the hepatobiliary system are occasionally needed for pancreatic head cancer.…”