Value of three-dimensional reconstructions in pancreaticcarcinoma using multidetector CT: Initial results

Abstract

AIM:To evaluate the use of three-dimensional imaging of pancreatic carcinoma using multidetector computed tomography (CT) in a prospective study. METHODS:Ten patients with suspected pancreatic tumors were examined prospectively using multidetector CT (Somatom Sensation 16, Siemens, Erlangen, Germany). The images were evaluated for the presence of a pancreatic carcinoma and invasion of the peripancreatic vessels and surrounding organs. Using the isotropic CT data sets, a three-dimensional image was created with automatic vascular analysis and semiautomatic segmentation of the organs and pancreatic tumor by a radiologist. The CT examinations and the three-dimensional images were presented to the surgeon directly before and during the patient's operation using the Medical Imaging Interaction Toolkit-based software "ReLiver". Immediately after surgery, the value of the two images was judged by the surgeon. The operation and the histological results served as the gold standard. RESULTS:Nine patients had a pancreatic carcinoma (all pT3), and one patient had a serous cystadenoma. One tumor infiltrated the superior mesenteric vein. The infiltration was correctly evaluated. All carcinomas were resectable. In comparison to the CT image with axial and coronal reconstructions, the three-dimensional image was judged by the surgeons as better for operation planning and consistently described as useful. CONCLUSION:A 3D-image of the pancreas represents an invaluable aid to the surgeon. However, the 3D-software must be further developed in order to be integrated into daily clinical routine.

Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

“…Gemcitabine + erlotinib c, 8 Gemcitabine + capecitabine 9 Gemcitabine + cisplatin 10 (especially for patients with BRCA1/BRCA2 or other DNA repair mutations) Gemcitabine Capecitabine (category 2B) CI 5-FU (category 2B) Fixed-dose-rate gemcitabine, docetaxel, capecitabine (GTX regimen) 11 (category 2B) Fluoropyrimidine + oxaliplatin (category 2B) (eg, 5-FU/leucovorin/oxaliplatin 12 or CapeOx 13 ) Induction chemotherapy with any of the chemotherapy options above (≥4-6 cycles) followed by chemoradiation* ,d or SBRT 14 (in selected patients, locally advanced disease without systemic metastases) 15 Chemoradiation* ,e or SBRT e (in select patients who are not candidates for combination therapy)…”

“…Studies have shown that 70% to 85% of patients determined by CT imaging to have resectable tumors were able to undergo resection. 11,[13][14][15][16] Pancreas protocol MRI with contrast can be a helpful adjunct to CT in the staging of pancreatic cancer, particularly for characterization of CT-indeterminate liver lesions and when suspected tumors are not visible on CT or in cases of contrast allergy. 17,18 The difference in contrast enhancement between the parenchyma and adenocarcinoma is highest during the pancreatic phase, thereby providing a clear distinction between a hypodense lesion in the pancreas and the rest of the organ.…”

“…Criteria for Resection: The NCCN Panel recommends that pancreatic resections be performed at institutions that perform a large number (at least [15][16][17][18][19][20] of pancreatic resections annually. It is again emphasized that institutions performing pancreatic resections should have a multidisciplinary team with focus in pancreatic cancer that actively participates in the decision-making process regarding which patients should undergo surgery.…”

Enhanced primary tumor delineation in pancreatic adenocarcinoma using ultrasmall super paramagnetic iron oxide nanoparticle-ferumoxytol: an initial experience with histopathologic correlation

“…12 A well-performed pancreatic protocol CT is a popular approach in staging pancreatic cancer and has been validated well in the literature. [13][14][15] MRI has also been proved equally efficacious in predicting vascular and nodal involvement. 16,17 CT, however, has limited capacity to characterize the nature of post-radiation soft tissue attenuation.…”

Diagnostic Value of Three-Dimensional Reconstructions of Ct Images in Patients With Ductal Pancreas Adenocarcinoma

“…Опухоль обладает агрессив-ным ростом, выявляется на далеко зашедших стадиях, а пятилетняя выживаемость составля-ет всего 5%. Адъювантная химиотерапия явля-ется единственным способом, позволяющим увеличить выживаемость пациентов с R0 ре-зекцией [3,4].…”