Performance of Multidetector Computed Tomographic Angiography in Determining Surgical Resectability of Pancreatic Head Adenocarcinoma

Kaneko, Osamu; Lee, Deborah M.; Wong, Jeffrey; Kadell, Barbara; Reber, Howard A.; Lu, David; Raman, Steven S.

doi:10.1097/rct.0b013e3181e5d6f7

Cited by 43 publications

(25 citation statements)

References 23 publications

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“…Studies showed that multidetector computed tomography (MDCT) has a higher accuracy than endoscopic ultrasonography (US), conventional angiography, and magnetic resonance imaging (MRI) in the detection of primary tumors, vascular invasion, and distant metastases, and currently, MDCT is the most important and reliable imaging method for preoperative staging of patients with pancreas adenocarcinoma (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Studies have reported high sensitivity rates, such as 100%, in determining the resectability of pancreas adenocarcinomas with MDCT, but highly variable ranges may be seen for more important parameters, like positive predictive value (PPV) and accuracy rates.…”

Section: Introductionmentioning

confidence: 99%

Assessment of surgical resectability of pancreatic adenocarcinomas with multidetector computed tomography: What are the possibilities and problems?

Işcanlı

Türkvatan²,

Bostancı³

et al. 2014

Turk J Gastroenterol

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Background/Aims: To investigate the accuracy of multidetector computed tomography (MDCT) in preoperatively determining the surgical resectability of pancreatic adenocarcinomas. Materials and Methods: Multidetector computed tomography, surgery, and pathological results of 274 patients with pancreatic adenocarcinoma were evaluated retrospectively. MDCT findings were compared with surgical and pathological findings to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MDCT in determining surgical resectability. Results: A total of 124 of 274 (56%) patients (83 males, mean age: 60 years) underwent laparoscopy and/or laparotomy. The sensitivity, specificity, PPV, NPV, and accuracy of MDCT in determining the surgical resectability of pancreatic adenocarcinomas were 100%, 72%, 78%, 100%, and 86%, respectively. Liver metastases in 9 cases, peritoneal metastases in 3 cases, and vascular invasion in 5 cases, which were determined during surgery, were not reported by MDCT. On re-review of the MDCT images of these 17 patients, no metastatic lesions could be seen in 9 patients with liver metastases and in 2 of 3 patients with peritoneal metastases. In 1 patient, a peritoneal implant of a diameter of 8 mm was missed on MDCT. There was no vascular invasion according to Lu criteria on the MDCT images in the 5 cases that had vascular invasion in the surgical exploration. Conclusion: The accuracy of MDCT is high in the preoperative determination of surgical resectability of pancreatic adenocarcinomas, but the detection of small liver and peritoneal metastases and accurate determination of vascular invasion are still major problems. Surgeons should be aware of the limitations of preoperative MDCT.

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Section: Introductionmentioning

confidence: 99%

Assessment of surgical resectability of pancreatic adenocarcinomas with multidetector computed tomography: What are the possibilities and problems?

Işcanlı

Türkvatan²,

Bostancı³

et al. 2014

Turk J Gastroenterol

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“…In a recent study evaluating the involvement of the SMA, the CHA, and the celiac trunk with multidetector CT using the traditional criteria of circumferential tumor contact and vessel constriction in 70 pancreatic cancer patients, the sensitivity and specificity were increased from 88 % and 94 % for axial images to 100 % and 93 % for additional multiplanar reconstructions [20]. Other recent studies showed similar results with high accuracy for the assessment of arterial invasion for CT and even for MRI using latest generation devices [10,25,26]. These improvements help to increase the rate of correct indications for and successful completions of open surgery with curative intent in pancreatic cancer patients [27].…”

Section: Arteriesmentioning

confidence: 70%

“…Variants of hepatic arteries are common and can be relevant because tumor contact can occur at important arteries, which are not where the radiologist and the surgeon expect them to be [26]. Conditions which may lead to impaired arterial blood supply of the liver after pancreatic head resection are, e. g. preexisting severe stenosis of the celiac axis which becomes relevant after cutting off the collateral flow from the gastroduodenal artery (GDA) or accidental injury of an aberrant hepatic artery arising from the SMA behind or -rarely -inside the pancreatic head ( • " Fig.…”

Section: Arterial Variantsmentioning

confidence: 99%

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Radiologic Resectability Assessment in Pancreatic Cancer

Denecke

Grieser

Bahra

2013

Fortschr Röntgenstr

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Complete tumor resection is still the only potentially curative therapy option for patients with ductal adenocarcinoma of the pancreas. Surgical exploration is the gold standard for the determination of tumor resectability. Radiological resectability assessment is of great importance because many clearly unresectable cases can be identified preoperatively and it became essential for surgical planning. The evolving surgical and radiological techniques demand a continuous reappraisal of radiological criteria in resectability assessment. In the following, the criteria for resection planning are described along with surgical management and the role of radiology in some innovative surgical concepts is explained. Citation Format:

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“…Kaneko et al 47 retrospectively compared MDCTA done preoperatively in cases of pancreatic head cancers to the surgical outcomes. In this study, MDCTA was found to have a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 100%, 71%, 85%, 100%, and 89%, respectively, which was similar to the results reported by Fusari et al 26 and Zamboni et al 48 Results vary according to the various generations of MDCT scanners used.…”

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confidence: 99%

Value of multidetector computed tomographic angiography in marginally resectable pancreatic cancer

Fagkrezos¹,

Dervenis²,

Triantopoulou³

2015

RMI

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Background: Pancreatic carcinoma is a common gastrointestinal malignancy. Accurate preoperative imaging helps to avoid unnecessary or unsuccessful surgical procedures and reduce the number of aborted pancreatic resections. The purpose of this review is to determine the role of multidetector computed tomographic angiography (MDCTA), which allows rapid anatomic evaluation, in accurate local and distant staging of marginally resectable pancreatic adenocarcinomas. Methods: Our methodology was based on the systematic search of published papers using PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for the years 2009-2014, reporting on the reliability and diagnostic accuracy of MDCTA in the evaluation of pancreatic cancer resectability. Results: Based on 33 articles analyzed in the review, MDCTA is the most widely available imaging modality for diagnosing and staging patients with pancreatic cancer, and it can be used for the surgical planning, specifically in locally advanced marginally resectable tumors. Conclusion: Accurate pretreatment assessment of resectability is crucial to design appropriate preoperative protocols of the operating team. It is possible to achieve a complete resection at the first instance in some patients who have borderline resectable tumors as predicted on preoperative imaging. Preoperative MDCTA-based grading systems can help identify such patients. This would help to avoid delayed curative resections in such patients and minimize the risk of aborted open-close operations.

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Performance of Multidetector Computed Tomographic Angiography in Determining Surgical Resectability of Pancreatic Head Adenocarcinoma

Abstract: Multidetector CT angiography offers accurate and valuable preoperative assessment of surgical resectability of pancreatic ductal adenocarcinoma. Liver and peritoneal metastases and vascular invasion still remain important pitfalls in preoperative evaluation.

Cited by 43 publications

References 23 publications

Assessment of surgical resectability of pancreatic adenocarcinomas with multidetector computed tomography: What are the possibilities and problems?

Assessment of surgical resectability of pancreatic adenocarcinomas with multidetector computed tomography: What are the possibilities and problems?

Radiologic Resectability Assessment in Pancreatic Cancer

Value of multidetector computed tomographic angiography in marginally resectable pancreatic cancer

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