The changing role of pancreatic arteriography in the era of computed tomography.

Abstract

Computed tomography (CT) in the assessment of suspected pancreatic disease, although an excellent screening procedure, has certain shortcomings, such as a significant percentage of inaccurate studies, a low predictive value of the finding of a pancreatic mass, failure to detect small lesions, and inability to differentiate localized masses caused by pancreatitis from those caused by adenocarcinoma. Arteriography provides important additional information in patients with clinically suspected pancreatic lesions and positive findings on CT or other noninvasive screening studies in whom surgical resection is contemplated. This procedure helps determine the presence and resectability of adenocarcinoma and can also demonstrate lesions which may resemble pancreatic adenocarcinoma on CT but which, in reality, are nonmalignant or nonpancreatic or both. Arteriography should no longer be used as a screening procedure but should be performed whenever a potentially resectable pancreatic mass, either cystic or solid is suggested by CT.

Preoperative and operative diagnosis of pancreatic cancer

“…As CT can also serve as a guide at fine-needle puncture and at splanchnic nerve block, it has found advocates for use as a first-option procedure [19]. However, infiltrating or small tumors, especially of the head of the pancreas, are easily missed at CT [2,20]. It is, therefore, not helpful for the early diagnosis of pancreatic cancer, but rather for tumors deforming the gland contour and for those having spread outside the gland.…”