CT arterial portography vs pancreatic arteriography in the assessment of vascular involvement in pancreatic and periampullary tumors.
OBJECTIVE
Preoperative staging of pancreatic tumors is frequently accomplished through a combined effort of CT and arteriography. For tumor detection and delineation of disease extent CT is utilized routinely, with CT arterial portography (CTAP) being the single most accurate study for the detection liver metastases. Arteriography has remained the "gold" standard for assessing vascular involvement. The purpose of this study was to determine whether CTAP could become the single study of choice for assessing resectability in patients with pancreatic and periampullary tumors with particular emphasis on its accuracy in determining vascular involvement.


METHODS
Radiologic studies and medical records were reviewed in 20 patients who had received both CTAP and arteriographic examinations for preoperative assessment of pancreatic and periampullary tumors. These findings were correlated with results from either surgery (12 cases) or percutaneous biopsy and follow-up (8 cases) in 12 nonresectable and 8 resectable tumors.


RESULTS
Arteriography and CTAP correctly concurred in 75% of cases (15 of 20); CTAP correctly demonstrated vascular involvement not appreciated on arteriography in 15% (3 of 20) with an overall sensitivity and specificity of 90 and 100%, respectively. Arteriography was superior to CTAP in one patient (5%) with an overall sensitivity and specificity of 70 and 90%, respectively, for predicting vascular involvement by tumor.


CONCLUSIONS
Our experience suggests that CTAP is more accurate than arteriography for demonstrating tumor involvement of major peripancreatic vessels. Because CTAP, additionally, has a high sensitivity for detecting liver metastases, no further studies may be necessary to determine operability of these patients.
Savader
B L
BL
Russell H. Morgan Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD.
Fishman
E K
EK
Savader
S J
SJ
Cameron
J L
JL
D000230:Adenocarcinoma / Q000098:blood supply / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000000981:diagnostic imaging* / Q000473:pathology; D000792:Angiography; D002445:Celiac Artery / Q000000981:diagnostic imaging; D003138:Common Bile Duct Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging*; D003974:Diatrizoate Meglumine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply*; D010190:Pancreatic Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging*; D011169:Portal Vein / Q000000981:diagnostic imaging; D011172:Portography; D014057:Tomography, X-Ray Computed / Q000379:methods
D003974:Diatrizoate Meglumine