Skip to main content
Top
Published in: Abdominal Radiology 4/2010

Open Access 01-08-2010

Surgical resectability of pancreatic adenocarcinoma: CTA

Authors: Jimmie C. Wong, Steven Raman

Published in: Abdominal Radiology | Issue 4/2010

Login to get access

Abstract

Imaging studies play an important role in the diagnosis and management of patients with pancreatic adenocarcinoma. Computed tomography (CT) is the most widely available and best validated modality for imaging these patients. Meticulous technique following a well-designed pancreas protocol is essential for maximizing the diagnostic efficacy of CT. After the diagnosis of pancreatic adenocarcinoma is made, the key to management is staging to determine resectability. In practice, staging often entails predicting the presence or absence of vascular invasion by tumor, for which several radiologic grading systems exist. With advances in surgical techniques, the definition of resectability is in evolution, and it is crucial that radiologists have an understanding of the implications of findings that are relevant to the determination of resectability.
Literature
1.
go back to reference Bipat SB, Phoa SSKS, van Delden OM, et al. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma. J Comput Assist Tomogr 2005;29:438-445.CrossRefPubMed Bipat SB, Phoa SSKS, van Delden OM, et al. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma. J Comput Assist Tomogr 2005;29:438-445.CrossRefPubMed
2.
go back to reference Lu DSK, Vedantham S, Krasny RM, et al. Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. Radiology 1996;199:697-701.PubMed Lu DSK, Vedantham S, Krasny RM, et al. Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. Radiology 1996;199:697-701.PubMed
3.
go back to reference Fletcher JG, Wiersema MJ, Farrell MA, et al. Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 2003;229:81-90.CrossRefPubMed Fletcher JG, Wiersema MJ, Farrell MA, et al. Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 2003;229:81-90.CrossRefPubMed
4.
go back to reference Francis IR, Cohan RH, McNulty NJ. Multidetector CT of the liver and hepatic neoplasms: effect of multiphasic imaging on tumor conspicuity and vascular enhancement. AJR Am J Roentgenol 2003;180:1217-1224.PubMed Francis IR, Cohan RH, McNulty NJ. Multidetector CT of the liver and hepatic neoplasms: effect of multiphasic imaging on tumor conspicuity and vascular enhancement. AJR Am J Roentgenol 2003;180:1217-1224.PubMed
5.
go back to reference Ichikawa T, Erturk SM, Sou H, et al. MDCT of pancreatic adenocarcinoma: optimal imaging phases and multiplanar reformatted imaging. AJR Am J Roentgenol 2006;187:1513-1520.CrossRefPubMed Ichikawa T, Erturk SM, Sou H, et al. MDCT of pancreatic adenocarcinoma: optimal imaging phases and multiplanar reformatted imaging. AJR Am J Roentgenol 2006;187:1513-1520.CrossRefPubMed
6.
go back to reference McNulty NJ, Francis IR, Platt JR, et al. 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 2001;220:97-102.PubMed McNulty NJ, Francis IR, Platt JR, et al. 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 2001;220:97-102.PubMed
7.
go back to reference Zamboni GA, Kruskal JB, Vollmer CM, et al. Pancreatic adenocarcinoma: value of multidetector CT angiography in preoperative evaluation. Radiology 2007;245(3):770-778.CrossRefPubMed Zamboni GA, Kruskal JB, Vollmer CM, et al. Pancreatic adenocarcinoma: value of multidetector CT angiography in preoperative evaluation. Radiology 2007;245(3):770-778.CrossRefPubMed
8.
go back to reference Valls C, Andia E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. AJR Am J Roentgenol 2002;178:821-826.PubMed Valls C, Andia E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. AJR Am J Roentgenol 2002;178:821-826.PubMed
9.
go back to reference Legmann P, Vignaux O, Dousset B, et al. Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. AJR Am J Roentgenol 1998;170:1315-1322.PubMed Legmann P, Vignaux O, Dousset B, et al. Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. AJR Am J Roentgenol 1998;170:1315-1322.PubMed
10.
go back to reference Bronstein YL, Loyer EM, Kaur H, et al. Detection of small pancreatic tumors with multiphasic helical CT. AJR Am J Roentgenol 2004;182:619-623.PubMed Bronstein YL, Loyer EM, Kaur H, et al. Detection of small pancreatic tumors with multiphasic helical CT. AJR Am J Roentgenol 2004;182:619-623.PubMed
11.
go back to reference Prokesch RW, Chow LC, Beaulieu CF, et al. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 2002;224:764-768.CrossRefPubMed Prokesch RW, Chow LC, Beaulieu CF, et al. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 2002;224:764-768.CrossRefPubMed
12.
go back to reference Lall CG, Howard TJ, Skandarajah A, et al. New concepts in staging and treatment of locally advanced pancreatic head cancer. AJR Am J Roentgenol 2007;189:1044-1050.CrossRefPubMed Lall CG, Howard TJ, Skandarajah A, et al. New concepts in staging and treatment of locally advanced pancreatic head cancer. AJR Am J Roentgenol 2007;189:1044-1050.CrossRefPubMed
13.
go back to reference Bilimoria KY, Bentrem DJ, Ko CY, et al. Validation of the 6th edition AJCC Pancreatic Cancer Staging System. Cancer 2007;110:738-744.CrossRefPubMed Bilimoria KY, Bentrem DJ, Ko CY, et al. Validation of the 6th edition AJCC Pancreatic Cancer Staging System. Cancer 2007;110:738-744.CrossRefPubMed
14.
go back to reference Katz MHG, Hwang R, Fleming JB. Tumor-node-metastasis staging of pancreatic adenocarcinoma. Cancer J Clin 2008;58:111-125.CrossRef Katz MHG, Hwang R, Fleming JB. Tumor-node-metastasis staging of pancreatic adenocarcinoma. Cancer J Clin 2008;58:111-125.CrossRef
15.
go back to reference Tseng JF, Tamm EP, Lee JE, et al. Venous resection in pancreatic cancer surgery. Best Pract Res Clin Gastroenterol 2006;20(2):349-364.CrossRefPubMed Tseng JF, Tamm EP, Lee JE, et al. Venous resection in pancreatic cancer surgery. Best Pract Res Clin Gastroenterol 2006;20(2):349-364.CrossRefPubMed
16.
go back to reference Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner MJ (eds) (2007) SEER survival monograph: cancer survival among adults: U.S. SEER Program, 1988–2001, patient and tumor characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner MJ (eds) (2007) SEER survival monograph: cancer survival among adults: U.S. SEER Program, 1988–2001, patient and tumor characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD
17.
go back to reference Lu DSK, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol 1997;168:1439-1443.PubMed Lu DSK, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol 1997;168:1439-1443.PubMed
18.
go back to reference Hough TJ, Raptopoulos V, Siewert B, et al. Teardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas. AJR Am J Roentgenol 1999;173:1509-1512.PubMed Hough TJ, Raptopoulos V, Siewert B, et al. Teardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas. AJR Am J Roentgenol 1999;173:1509-1512.PubMed
19.
go back to reference O’Malley ME, Boland GWL, Wood BJ, et al. Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT. AJRAm J Roentgenol 1999;173:1513-1518.PubMed O’Malley ME, Boland GWL, Wood BJ, et al. Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT. AJRAm J Roentgenol 1999;173:1513-1518.PubMed
20.
go back to reference Nakayama Y, Yamashita Y, Kadota M, et al. Vascular encasement by pancreatic cancer: correlation of CT findings with surgical and pathologic results. J Comput Assist Tomogr 2001;25(3):337-342.CrossRefPubMed Nakayama Y, Yamashita Y, Kadota M, et al. Vascular encasement by pancreatic cancer: correlation of CT findings with surgical and pathologic results. J Comput Assist Tomogr 2001;25(3):337-342.CrossRefPubMed
21.
go back to reference Li H, Zeng MS, Zhou KR, et al. Pancreatic adenocarcinoma—the different CT criteria for peripancreatic major arterial and venous invasion. J Comput Assist Tomogr 2005;29:170-175.CrossRefPubMed Li H, Zeng MS, Zhou KR, et al. Pancreatic adenocarcinoma—the different CT criteria for peripancreatic major arterial and venous invasion. J Comput Assist Tomogr 2005;29:170-175.CrossRefPubMed
22.
go back to reference Loyer EM, David CL, Dubrow RA, et al. Vascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT. Abdom Imaging 1996;21:202-206.CrossRefPubMed Loyer EM, David CL, Dubrow RA, et al. Vascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT. Abdom Imaging 1996;21:202-206.CrossRefPubMed
23.
go back to reference Raptopoulos V, Steer ML, Sheiman RG, et al. The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery. AJR Am J Roentgenol 1997;168:971-977.PubMed Raptopoulos V, Steer ML, Sheiman RG, et al. The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery. AJR Am J Roentgenol 1997;168:971-977.PubMed
24.
go back to reference Brennan DDD, Zamboni GA, Raptopoulos VD, et al. Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT. Radiographics 2007;27:1653-1666.CrossRefPubMed Brennan DDD, Zamboni GA, Raptopoulos VD, et al. Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT. Radiographics 2007;27:1653-1666.CrossRefPubMed
25.
go back to reference Roche CJ, Hughes ML, Garvey CJ, et al. CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas. AJR Am J Roentgenol 2003;180:475-480.PubMed Roche CJ, Hughes ML, Garvey CJ, et al. CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas. AJR Am J Roentgenol 2003;180:475-480.PubMed
26.
go back to reference DeWitt J, Devereaux B, Chriswell M, et al. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 2004;141:753-763.PubMed DeWitt J, Devereaux B, Chriswell M, et al. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med 2004;141:753-763.PubMed
27.
go back to reference Maki DD, Birnbaum BA, Chakraborty DP, et al. Renal cyst pseudoenhancement: beam-hardening effects on CT numbers. Radiology 1999;213:468-472.PubMed Maki DD, Birnbaum BA, Chakraborty DP, et al. Renal cyst pseudoenhancement: beam-hardening effects on CT numbers. Radiology 1999;213:468-472.PubMed
28.
go back to reference Schwartz LH, Gandras EJ, Colangelo SM, et al. Prevalence and importance of small hepatic lesions found at CT in patients with cancer. Radiology 1999;210:71-74.PubMed Schwartz LH, Gandras EJ, Colangelo SM, et al. Prevalence and importance of small hepatic lesions found at CT in patients with cancer. Radiology 1999;210:71-74.PubMed
29.
go back to reference Diehl SJ, Lehmann KJ, Sadick M, et al. Pancreatic cancer: value of dual-phase helical CT in assessing resectability. Radiology 1998;206:373-378.PubMed Diehl SJ, Lehmann KJ, Sadick M, et al. Pancreatic cancer: value of dual-phase helical CT in assessing resectability. Radiology 1998;206:373-378.PubMed
30.
go back to reference Bluemke DA, Cameron JL, Hruban RH, et al. Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation. Radiology 1998;197:381-385. Bluemke DA, Cameron JL, Hruban RH, et al. Potentially resectable pancreatic adenocarcinoma: spiral CT assessment with surgical and pathologic correlation. Radiology 1998;197:381-385.
31.
go back to reference Walkey MM, Friedman AC, Sohotra P, et al. CT manifestations of peritoneal carcinomatosis. AJR Am J Roentgenol 1988;150:1035-1041.PubMed Walkey MM, Friedman AC, Sohotra P, et al. CT manifestations of peritoneal carcinomatosis. AJR Am J Roentgenol 1988;150:1035-1041.PubMed
32.
go back to reference White RR, Paulson EK, Freed KS. Staging of pancreatic cancer before and after neoadjuvant chemoradiation. J Gastrointest Surg 2001;5:626-633.CrossRefPubMed White RR, Paulson EK, Freed KS. Staging of pancreatic cancer before and after neoadjuvant chemoradiation. J Gastrointest Surg 2001;5:626-633.CrossRefPubMed
33.
go back to reference Tamm EP, Loyer EM, Faria S. Staging of pancreatic cancer with multidetector CT in the setting of preoperative chemoradiation therapy. Abdom Imaging 2006;31:566-574.CrossRef Tamm EP, Loyer EM, Faria S. Staging of pancreatic cancer with multidetector CT in the setting of preoperative chemoradiation therapy. Abdom Imaging 2006;31:566-574.CrossRef
34.
go back to reference Kim YE, Park MS, Hong HS. Effects of neoadjuvant combined chemotherapy and radiation therapy on the CT evaluation of resectability and staging in patients with pancreatic cancer. Radiology 2009;250(3):758-765.CrossRefPubMed Kim YE, Park MS, Hong HS. Effects of neoadjuvant combined chemotherapy and radiation therapy on the CT evaluation of resectability and staging in patients with pancreatic cancer. Radiology 2009;250(3):758-765.CrossRefPubMed
Metadata
Title
Surgical resectability of pancreatic adenocarcinoma: CTA
Authors
Jimmie C. Wong
Steven Raman
Publication date
01-08-2010
Publisher
Springer-Verlag
Published in
Abdominal Radiology / Issue 4/2010
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-009-9539-2

Other articles of this Issue 4/2010

Abdominal Radiology 4/2010 Go to the issue