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01-03-2007 | Hepatobiliary-Pancreas

Pancreatic adenocarcinoma

Authors: Wolfgang Schima, Ahmed Ba-Ssalamah, Claus Kölblinger, Christiane Kulinna-Cosentini, Andreas Puespoek, Peter Götzinger

Published in: European Radiology | Issue 3/2007

Abstract

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.

Parkin DM, Pisani P, Lopez AD, Masuyer E (1994) At least one in seven cases of cancer is caused by smoking. Global estimates for 1985. Int J Cancer 59:494–504PubMed

Lowenfels AB, Maisonneuve PM, Cavallini G et al (1993) Pancreatitis and the risk of pancreatic cancer. New Engl J Med 328:1435–1437CrossRef

Lowenfels AB, Maisonneuve P, DiMagno EP et al (1997) Hereditary pancreatitis and the risk of pancreatic cancer. International Hereditary Pancreatitis Study Group. J Natl Cancer Inst 89:442–446PubMedCrossRef

Alexakis N, Halloran C, Raraty M, Ghaneh P, Sutton R, Neoptolemos JP (2004) Current standards of surgery for pancreatic cancer. Br J Surg 91:1410–1427PubMedCrossRef

Trede M, Schwall G, Saeger H-D (1990) Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 211:447–458PubMedCrossRef

Warshaw AL, Gu Z, Wittenberg J, Waltman AC (1990) Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg 125:230–233PubMed

Warshaw AL, Fernandez-del Castillo C (1992) Pancreatic carcinoma. N Engl J Med 326:455–465PubMedCrossRef

Tsiotos GG, Farnell MB, Sarr MG (1999) Are the results of pancreatectomy for pancreatic cancer improving? World J Surg 23:913–919PubMedCrossRef

Tran KT, Smeenk HG, van Eijck CH et al (2004) Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 240:738–745PubMedCrossRef

10.

DelMaschio A, Vanzulli A, Sironi S et al (1991) Pancreatic cancer versus chronic pancreatitis: diagnosis with CA 19-9 assessment, US, CT, and CT-guided fine-needle biopsy. Radiology 178:95–99PubMed

11.

Richter GM, Wunsch C, Schneider B et al (1998) Hydro-CT in der detektion und im staging des pankreaskarzinoms. Radiologe 38:279–286PubMedCrossRef

12.

Prokesch RW, Chow LC, Beaulieu CF et al (2002) Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations-initial experience. Radiology 225:759–765PubMed

13.

Vargas R, Nino-Murcia M, Trueblood W, Jeffrey RBJ (2004) MDCT in pancreatic adenocarcinoma: prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations. AJR Am J Roentgenol 182:419–425PubMed

14.

Graf O, Boland GW, Warshaw AL, Fernandez-del Castillo C, Hahn PF, Mueller PR (1997) Arterial versus portal venous helical CT for revealing pancreatic adenocarcinoma: conspicuity of tumor and critical vascular anatomy. AJR Am J Roentgenol 169:119–123PubMed

15.

Keogan MT, McDermott VG, Paulson EK et al (1997) Pancreatic malignancy: effect of dual-phase helical CT in tumor detection and vascular opacification. Radiology 205:513–518PubMed

16.

Fletcher JG, Wiersma MJ, Farrell MA et al (2003) Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 229:81–90PubMed

17.

McNulty NJ, Francis IR, Platt JF, Cohan RH, Korobkin M, Gebramaniam A (2001) Multi-detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 220:97–102PubMed

18.

Lu DSK, Vedantham S, Krasny RM, Kadell B, Berger WL, Reber HA (1996) Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. Radiology 199:697–701PubMed

19.

Freeny PC (2005) CT diagnosis and staging of pancreatic carcinoma. Eur Radiol 15[Suppl 4]:D96–D99PubMed

20.

Schueller G, Schima W, Schueller-Weidekamm C et al (2006) Multi-detector row CT of the pancreas: effects of contrast material flow rates and individualized scan delay on enhancement of the pancreas and tumor contrast. Radiology (in press)

21.

Prokesch R, Chow LC, Beaulieu CF, Bammer R, Jeffrey RB (2002) Isoattenuating pancreatic carcinoma at multi-detector row CT: secondary signs. Radiology 224:764–768PubMed

22.

Bluemke DA, Cameron JL, Hruban RH et al (1995) Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation. Radiology 197:381–385PubMed

23.

Ichikawa T, Haradome H, Hachiya J et al (1997) Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging. Radiology 202:655–662PubMed

24.

Legmann P, Vignaux O, Dousset B et al (1998) Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. AJR Am J Roentgenol 170:1315–1322PubMed

25.

Schima W, Függer R, Schober E et al (2002) Diagnosis and staging of pancreatic cancer: comparison of mangafodipir-enhanced MRI and contrast-enhanced helical hydro-CT. AJR Am J Roentgenol 179:717–724PubMed

26.

Irie H, Honda H, Kaneko K, Kuroiwa T, Yoshimitsu K, Masuda K (1997) Comparison of helical CT and MR imaging in detecting and staging small pancreatic adenocarcinoma. Abdom Imaging 22:429–433PubMedCrossRef

27.

Bronstein YL, Loyer EM, Kaur H et al (2004) Detection of small pancreatic tumors with multiphasic helical CT. AJR Am J Roentgenol 182:619–623PubMed

28.

Fukushima H, Itoh S, Takada A et al (2006) Diagnostic value of curved multiplanar reformatted images in multislice CT for the detection of resectable pancreatic ductal adenocarcinoma. Eur Radiol 16(8):1709–1718PubMedCrossRef

29.

Grenacher L, Klauss M, Dukic L et al (2004) Hochauflösende Bildgebung beim Pankreaskarzinom: prospektiver Vergleich von MRT und 4-Zeilen-Spiral-CT. Fortschr Röntgenstr 176:1624–1633CrossRef

30.

DeWitt J, Deveraux B, Chriswell M et al (2004) Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 141:753–763PubMed

31.

Klapman JB, Chang KJ, Lee JG, Nguyen P (2005) Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastronterol 100:2658–2661CrossRef

32.

Akahoshi K, Chijiwa Y, Nakano I, Nawara H, Ogawa Y (1998) Diagnosis and staging of pancreatic cancer by endoscopic ultrasound. Br J Radiol 492–496

33.

Romijn MG, Stoker J, van Eijck CHJ, van Muiswinkel JM, Torres CG, Lameris JS (2000) MRI with mangafodipir trisodium in the detection and staging of pancreatic cancer. J Magn Reson Imaging 12:261–268PubMedCrossRef

34.

Schima W, Ba-Ssalamah A, Plank C et al (2006) Das Pankreas: Teil 2 Tumore. Radiologe 46:421–438PubMedCrossRef

35.

Birchard KR, Semelka RC, Hyslop WB et al (2005) Suspected pancreatic cancer: evaluation by dynamic gadolinium-enhanced 3D gradient-echo MRI. AJR Am J Roentgenol 185:700–703PubMed

36.

Gehl H-B, Vorwerk D, Klose K-C, Günther R-W (1991) Pancreatic enhancement after low-dose infusion of Mn-DPDP. Radiology 180:337–339PubMed

37.

Gehl H-B, Urhahn R, Bohndorf K et al (1993) Mn-DPDP in MR imaging of pancreatic adenocarcinoma: initial clinical experience. Radiology 186:795–798PubMed

38.

Mayo-Smith W, Schima W, Saini S, Slater GJ, McFarland EG (1998) Pancreatic enhancement and pulse sequence analysis using low-dose mangafodipir trisodium. AJR Am J Roentgenol 170:649–652PubMed

39.

Kettritz U, Warshauer DM, Brown ED, Schlund JF, Eisenberg LB, Semelka RC (1996) Enhancement of the normal pancreas: comparison of manganese-DPDP and gadolinium chelate. Eur Radiol 6:14–18PubMedCrossRef

40.

Diehl SJ, Lehmann KJ, Gaa J, McGill S, Hoffmann V, Georgi M (1999) MR imaging of pancreatic lesions. Comparison of manganese-DPDP and gadolinium chelate. Invest Radiol 34:589–595PubMedCrossRef

41.

Schima W, Függer R (2002) Evaluation of focal pancreatic masses: comparison of mangafodipir-enhanced MR imaging and contrast-enhanced helical CT. Eur Radiol 12:2998–3008PubMed

42.

Heinrich S, Goerres GW, Schäfer M et al (2005) Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg 242:235–243PubMedCrossRef

43.

Bipat S, Phoa SSKS, van Delden OM et al (2005) Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic carcinoma. J Comput Assist Tomogr 29:438–445PubMedCrossRef

44.

Park DI, Lee JK, Kim J-E et al (2001) The analysis of resectability and survival in pancreatic cancer patients with vascular invasion. J Clin Gastroenterol 32:231–234PubMedCrossRef

45.

Lu DSK, Reber HA, Krasny RM, Kadell BM, Sayre J (1997) Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase thin section helical CT. AJR Am J Roentgenol 168:1439–1443PubMed

46.

O’Malley ME, Boland GWL, Wood BJ, Fernandez-del Castillo C, Warshaw AL, Mueller PR (1999) Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT. AJR Am J Roentgenol 173:1513–1518PubMed

47.

Li H, Zeng MS, Zhou KR, Jin DY, Lou WH (2005) Pancreatic adenocarcinoma. The different CT criteria for peripancreatic major arterial and venous invasion. J Comput Assist Tomogr 29:170–175PubMedCrossRef

48.

Yamada Y, Mori H, Kiyosue H, Matsumoto S, Hori Y, Maeda T (2000) CT assessment of the inferior peripancreatic veins: clinical significance. AJR Am J Roentgenol 174:677–684PubMed

49.

Trede M, Rumstadt B, Wendl K et al (1997) Ultrafast magnetic resonance imaging improves the staging of pancreatic tumors. Ann Surg 226:393–407PubMedCrossRef

50.

Diehl SJ, Lehmann KJ, Sadlick M, Lachmann R, Georgi M (1998) Pancreatic cancer: value of dual-phase helical CT in assessing resectability. Radiology 206:373–378PubMed

51.

Bartolozzi C, Donati F, Cioni D et al (2004) Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT. Eur Radiol 14:14–20PubMedCrossRef

52.

Megibow AJ, Zhou XH, Rotterdam H et al (1995) Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability. Report of the Radiology Diagnostic Oncology Study Group. Radiology 195:327–332PubMed

53.

Kaneko K, Honda H, Hayashi T et al (1997) Helical CT evaluation of arterial invasion in pancreatic tumors: comparison with angiography. Abdom Imaging 22:204–207PubMedCrossRef

54.

Fishman EK (2001) Imaging pancreatic cancer: the role of multidetector CT with three-dimensional CT angiography. Pancreatology 1:610–624PubMedCrossRef

55.

To’o KJ, Raman SS, Yu NC et al (2005) Pancreatic and peripancreatic diseases mimicking primary pancreatic neoplasia. Radiographics 25:949–965PubMed

56.

Boll DT, Merkle EM (2003) Differentiating a chronic hyperplastic mass from pancreatic cancer: a challenge remaining in multidetector CT of the pancreas. Eur Radiol 13:M42–M49PubMed

57.

Ichikawa T, Sou H, Araki T et al (2001) Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 221:107–116PubMed

58.

Manfredi R, Costamagna G, Brizi MG et al (2000) Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulation. Radiology 214:849–855PubMed

59.

Eloubeidi MA, Jhala D, Chhieng DC et al (2003) Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer 99:285–292PubMedCrossRef

60.

Raut CP, Grau AM, Staerkel GA et al (2003) Diagnostic accuracy of endoscopic fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg 7:118–128PubMedCrossRef

61.

Mallery JS, Centeno BA, Hahn PF, Chang Y, Warshaw AL, Brugge WR (2002) Pancreatic tissue sampling guided by EUS, CT/US, and surgery: a comparison of sensitivity and specificity. Gastrointest Endoscopy 56:218–224CrossRef

62.

Zech CJ, Helmberger T, Wichmann MW, Holzknecht N, Diebold J, Reiser MF (2002) Large core biopsy of the pancreas under CT fluoroscopy control: results and complications. J Compout Assist Tomogr 26:743–749CrossRef

63.

Kariniemi J, Blanco Sequeiros R, Ojala R, Tervonen O (2005) MRI-guided abdominal biopsy in a 0.23-T open-configuration MRI system. Eur Radiol 15:1256–1262PubMedCrossRef

64.

Cameron JL, Crist DW, Sitzmann JV et al (1991) Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer. Am J Surg 161:120–125PubMedCrossRef

65.

Rieber A, Tomczak R, Nüssle K, Klaus H, Brambs H-J (2000) MRI with mangafodipir trisodium in the detection of pancreatic tumours: comparison with helical CT. Br J Radiol 73:1165–1169PubMed

Title: Pancreatic adenocarcinoma
Authors: Wolfgang Schima
Ahmed Ba-Ssalamah
Claus Kölblinger
Christiane Kulinna-Cosentini
Andreas Puespoek
Peter Götzinger
Publication date: 01-03-2007
Publisher: Springer-Verlag
Published in: European Radiology / Issue 3/2007
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-006-0435-7

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Springer Medicine

Pancreatic adenocarcinoma

Abstract

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Abstract

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