Pancreatic carcinoma: the role of high-resolution multislice spiral CT in the diagnosis and assessment of resectability

Abstract

The purpose of our study was to evaluate multislice computed tomography (MSCT) in the assessment of patients with clinical, laboratory, and US suspicion of pancreatic neoplasm, and to evaluate resectability status. Forty-six patients with a suspected pancreatic tumor underwent MSCT. After a preliminary precontrast survey, a postcontrast scan was performed in the arterial and portal venous phase with the following protocol: 4×1-mm collimation; 1.25-and 5-mm slice thickness width, respectively, and 1-and 5-mm reconstruction interval. In all patients pathological correlation was obtained. The evaluation of all images provided a diagnosis in 44 patients, with a sensitivity, specificity, and accuracy of 97, 80, and 96%, respectively. The MSCT correctly provided a diagnosis of unresectability with sensitivity of 96%, specificity of 86%, and accuracy of 93%. Evaluation of 1-mm slices demonstrated 83 of the 91 liver metastases found at surgery; conversely, the 5-mm slices detected only 76 of these lesions. Infiltration of peripancreatic major vessels was demonstrated, and was confirmed at surgery in 18 patients. High-resolution MSCT improves prediction of resectability in patients with suspected pancreatic carcinoma. Parenchymal and vascular information can be achieved with a single MSCT examination.

Comparison of multislice computed tomography and endoscopic ultrasonography with operative and histological findings in suspected pancreatic and periampullary malignancy

“…The two imaging modalities demonstrated a high degree of accuracy for both diagnosis and staging. The sensitivities for the diagnosis of malignancy for MSCT and EUS were 97 and 95 per cent respectively, which compare favourably with published data 3,10,11,20,21,34 . A comparison of the two modalities demonstrated minimal differences in diagnosis or staging, except that MSCT was superior to EUS in the assessment of portal vein/SMV invasion.…”

Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for the evaluation of curability and resectability in patients with pancreatic adenocarcinoma

“…Therefore, the accuracy of preoperative assessment of unresectability, distant metastases, and lymph node metastases of pancreatic cancer has improved signifi cantly. [22][23][24][25][26] Nevertheless, the preoperative detection of small metastatic lesions in the liver or the peritoneum, and the preoperative detection of lymph node metastasis, remain diffi cult. Because oncologically noncurative resection (R1/2) usually fails to achieve long-term survival, 4,10,27 we investigated the usefulness of preoperative serum levels of known tumor markers, i.e., CEA and CA 19-9, for the prediction of curability.…”

Comparison of preoperative imaging and pathological findings for pancreatic head adenocarcinoma

“…[21,22] Many series that contain cases of “false-positive” patients have also been described. [23,24] These studies showed an overestimation of arterial invasion by CT, especially in cases of degenerated IPMN. In our series, the presence of IPMN was not associated with an overestimation of tumor extension.…”