Imaging pancreatic cancer: The role of multidetector CT with three-dimensional CT angiography

Fishman, Elliot K.; Horton, Karen M.

doi:10.1159/000055871

Cited by 53 publications

(20 citation statements)

References 27 publications

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“…Extent of tumor growth along the superior mesenteric artery is better seen at the coronal maximum intensity projection images (h) enhanced dynamic (nonhelical) CT for staging and resectability was 73%, with a positive predictive value for nonresectability of 90% [52]; however, more recent studies on helical and MDCT have reported accuracies of 85-95%, likely related to improvements in CT technology [12,13,25,50]. Whereas helical CT angiography was inferior to diagnostic angiography for detecting minor arterial invasion [53], MDCT angiography with its superb depiction of anatomy has replaced catheter angiography for vascular assessment [54]. Unfortunately, due to diagnostic difficulties, the reported negative predictive value for resectability (i.e, to rule out unresectability) is not more than 80% because CT may miss small liver metastases, peritoneal carcinomatosis, and subtle vascular involvement [12,41].…”

Section: Radiologic Stagingmentioning

confidence: 99%

Pancreatic adenocarcinoma

et al. 2006

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Adenocarcinoma is the most common malignant pancreatic tumor, affecting the head of the pancreas in 60-70% of cases. By the time of diagnosis, at least 80% of tumors are unresectable. Helical computed tomography (CT) is very effective in detecting and staging adenocarcinoma, with a sensitivity of up to 90% for detection and an accuracy of 80-90% for staging, but it has limitations in detecting small cancers. Moreover, it is not very accurate for determining nonresectability because small liver metastases, peritoneal carcinomatosis, and subtle signs of vascular infiltration may be missed. Multidetector-row CT (MDCT) has brought substantial improvements with its inherent ability to visualize vascular involvement in three dimensions. MDCT has been found to be at least equivalent to contrast-enhanced magnetic resonance imaging (MRI) for detecting adenocarcinoma. MRI can be used as a problem-solving tool in equivocal CT: MRI may help rule out pitfalls, such as inflammatory pseudotumor, focal lipomatosis, abscess, or cystic tumors. Mangafodipir-enhanced MRI reveals a very high tumor-pancreas contrast, which helps in diagnosing small cancers. Endosonography is, if available, also a very accurate tool for detecting small cancers, with a sensitivity of up to 98%. It is the technique of choice for image-guided biopsy if a histologic diagnosis is required for further therapy.

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Section: Radiologic Stagingmentioning

confidence: 99%

Pancreatic adenocarcinoma

et al. 2006

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“…In recent years the technical and diagnostic performance of computed tomography (CT) has improved significantly [1]. Today, multislice spiral CT with 4-16 detector rows of simultaneous acquisition is state of the art.…”

Section: Introductionmentioning

confidence: 99%

CT in the Differentiation of Pancreatic Neoplasms – Progress Report

Gritzmann

Macheiner²,

Hollerweger³

et al. 2004

Dig Dis

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Today, computed tomography (CT) is the most commonly used imaging method in the assessment of pancreatic tumors. The sensitivity of CT in detection of pancreatic tumors is more than 90% when direct and indirect signs are used for diagnosis. However, the potential to differentiate exocrine (non-endocrine) tumors of the pancreas is limited. CT is used in these lesions to perform an adequate staging, especially for surgical purposes. The operative resectability, primarily in regard to vessels, lymph node metastasis and hepatic metastasis, has to be assessed. Keeping in mind the limitations of this macromorphological imaging procedure, CT has the best reproducibility and overall accuracy of all imaging methods. Using multislice CT it is possible to perform non-axial reconstructions with high resolution. In functional endocrine tumors, multislice spiral CT will enhance the diagnostic capabilities, since the whole organ can be examined in thin slices, with high resolution during the rather short arterial phase of the contrast medium. Since some endocrine tumors are hypovascular, a scan during the portovenous phase is recommended too. The diagnosis of benign pancreatic tumors, like serous cystadenoma and pancreatic lipomas, is addressed. The most important pseudotumors of the pancreas are discussed.

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“…Over the past a few decades, multi-detector row CT (MDCT) has been the driving technology and it enabled faster volumetric scan times, thinner slices, and reduced motion artifacts [1][2][3]. While these technical developments enable innovative clinical applications such as CT angiography, perfusion imaging, and cardiac imaging, increased detector size and cone angle produced more scatter radiation, cone-beam artifacts, heel effect, wasted dose and detector cost.…”

Section: Introductionmentioning

confidence: 99%

Initial results with a multisource inverse-geometry CT system

et al. 2012

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The multi-source inverse-geometry CT(MS-IGCT) system is composed of multiple sources and a small 2D detector array. An experimental MS-IGCT system was built and we report initial results with 2×4 x-ray sources, a 75 mm inplane field-of-view (FOV) and 160 mm z-coverage in a single gantry rotation. To evaluate the system performance, experimental data were acquired from several phantoms and a post-mortem rat. Before image reconstruction, geometric calibration, data normalization, beam hardening correction and detector spectral calibration were performed. For reconstruction, the projection data were rebinned into two full cone beam data sets, and the FDK algorithm was used. The reconstructed volumes from the upper and lower source rows shared an overlap volume which was combined in image space. The reconstructed images of the uniform cylinder phantom showed good uniformity of the reconstructed values without any artifacts. The rat data were also reconstructed reliably. The initial experimental results from this rotating-gantry MS-IGCT system demonstrated its ability to image a complex anatomical object without any significant image artifacts and to ultimately achieve large volumetric coverage in a single gantry rotation.

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Imaging pancreatic cancer: The role of multidetector CT with three-dimensional CT angiography

Cited by 53 publications

References 27 publications

Pancreatic adenocarcinoma

Pancreatic adenocarcinoma

CT in the Differentiation of Pancreatic Neoplasms – Progress Report

Initial results with a multisource inverse-geometry CT system

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