Imaging Pearls ❯ Pancreas ❯ 3D Imaging in Staging
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"The technique is also valuable in providing a time-efficient method to review pertinent findings with clinicians."
Evaluation of Periampullary Pathology With CT Volumetric Oblique Coronal Reformations
Pham DT et al.
DOI:10.2214/AJR.08.2069"Volumetric oblique coronal reformations are a useful noninvasive method to provide diagnostic information about periampullary abnormalities as well as show secondary features important for local staging and management. The technique is also valuable in providing a time-efficient method to review pertinent findings with clinicians."
Evaluation of Periampullary Pathology With CT Volumetric Oblique Coronal Reformations
Pham DT et al.
DOI:10.2214/AJR.08.2069- "A combination of pancreatic parenchymal phase and PVP imaging is necessary and efficient for the assessment of pancreatic adenocarcinoma. The addition of coronal and sagittal MPR images increased the performance of MDCT, especially in the evaluation of local extension."
MDCT of Pancreatic Adenocarcinoma: Optimal Imaging Phases and Multiplanar Reformatted Imaging
Ichikawa T et al.
AJR 2006; 187:1513-1520
- "The addition of coronal and sagittal MPR images to the MDCT protocol increases the sensitivity of MDCT and improves its agreement with surgical findings regarding local staging factors."
MDCT of Pancreatic Adenocarcinoma: Optimal Imaging Phases and Multiplanar Reformatted Imaging
Ichikawa T et al.
AJR 2006; 187:1513-1520
- "Pancreas protocol CT imaging appears to be a better predictor of resectability compared with EUS. EUS accuracy is affected by the presence of biliary stents."
Endoscopic Ultrasound and Computed Tomography Predictors of Pancreatic Cancer Resectability
Bao PQ et al
J Gastrointest Surg (2008) 12:10-16
- "Venous involvement >180° and arterial involvement >90° by CT had a 100% positive predictive value for failure to achieve R0 resection."
Endoscopic Ultrasound and Computed Tomography Predictors of Pancreatic Cancer Resectability
Bao PQ et al
J Gastrointest Surg (2008) 12:10-16
(R0 is margin negative)
- "Several reports concluded that local extension of pancreatic cancer and invasion of adjacent vascular structures could be well depicted with helical CT, with the main limitations of this technique for preoperative staging being a difficulty in revealing unsuspected liver metastases and a low rate of revealing lymph node metastases."
Diagnosis of pancreatic cancer
Miura F et al.
HPB 2006; 8:337-342
- Role of 3D Imaging in the Evaluation of Pancreatic Cancer
- House et al Gastrointestinal Surg 2004;8:280-288.
- Among patients with periampullary cancer, the extent of tumor burden involving the pancreas and peripancreatic tissues was accurately depicted by 3D CT in 93% of patients
- 3D CT was 95% accurate in determining cancer invasion of the superior mesenteric vessels
- Resectability rate/margin negative rate - Periampullary 98%/ 85%
- Role of 3D Imaging in the Evaluation of Pancreatic Cancer
- Raptolpoulos AJR 1997;168:971-977
- SDCT
- Found that 3D imaging of the peripancreatic vasculature was more accurate than axial images alone in revealing resectable disease
- By adding 3D imaging of the vessels, the negative predictive value of a resectable tumor was 96% compared to 70% for axial images alone.
- Role of 3D Imaging in the Evaluation of Pancreatic Cancer
- Raptolpoulos AJR 1997;168:971-977
- SDCT
- Found that 3D imaging of the peripancreatic vasculature was more accurate than axial images alone in revealing resectable disease
- By adding 3D imaging of the vessels, the negative predictive value of a resectable tumor was 96% compared to 70% for axial images alone.
- Role of 3D Imaging in the Evaluation of Pancreatic Cancer
- House et al Gastrointestinal Surg 2004;8:280-288.
- Among patients with periampullary cancer, the extent of tumor burden involving the pancreas and peripancreatic tissues was accurately depicted by 3D CT in 93% of patients
- 3D CT was 95% accurate in determining cancer invasion of the superior mesenteric vessels
- Resectability rate/margin negative rate
- Periampullary 98%/ 85%
- "Multidetector row CT with 3-dimensional volume rendering allows for accurate delineation of the portal venous system and collaterals that develop in cases of portal hypertension.Whereas the direction of blood flow cannot be determined on axial images the pattern of collateral circulation that develops can predict the flow direction to bypass a point of obstruction along the portal venous system."
Patterns of Collateral Pathways in Extrahepatic Portal Hypertension as Demonstrated by Multidetector Row Computed Tomography and Advanced Image Processing
Kamel IR, Lawler LP, Corl FM, Fishman EK J Comput Assist Tomogr 2004;28:469-477
- "Multidetector row CT with 3-dimensional volume rendering allows for accurate delineation of the portal venous system and collaterals that develop in cases of portal hypertension."
Patterns of Collateral Pathways in Extrahepatic Portal Hypertension as Demonstrated by Multidetector Row Computed Tomography and Advanced Image Processing
Kamel IR, Lawler LP, Corl FM, Fishman EK
J Comput Assist Tomogr 2004;28:469-477
- "Among the patients with periampullary cancer, the extent of local tumor burden involving the pancreas and peripancreatic tissues was accurately depicted by 3D-CT in 93% of the patients. 3D-CT was 95% accurate in determining cancer invasion of the superior mesenteric vessels. Preoperative 3D-CT accurately predicted periampullary cancer resectability and a margin-negative resection in 98% and 86% of patients, respectively."
Predicting resectability of periampullary cancer with three-dimensional computed tomography
House MG et al
J Gastrointest Surg. 2004 Mar-Apr;8(3):280-8.
- What post processing tools are helpful for evaluation of the pancreas?
- Multiplanar reconstruction
- Curved planar reformations
- 3D volume rendering
- Maximum intensity projection (MIP)
- "Curved planar reformations are equivalent to transverse images in the detection of pancreatic tumors and determination of surgical resectability."
Local Staging of Pancreatic Carcinoma with Multidetector Row CT: Use of Curved Planar Reformations-Initial Experience
Prokesch RW et al.
Radiology 2002; 225:759-765