Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography.
We assessed the accuracy of dynamic contrast-enhanced computed tomography (CT) in the diagnosis and staging of 213 patients with pancreatic carcinoma and compared it with the accuracy of angiography and surgery. A correct CT diagnosis of pancreatic carcinoma was made in 207 of 213 (97%) patients. Tumors were located in the pancreatic head in 64%, the body in 22%, and the tail in 10%, and enlarged the pancreas diffusely in 4%. CT staged 25 (12%) patients as having potentially resectable tumors and 188 (88%) as having unresectable tumors on the basis of local extension (72%), contiguous organ invasion (43%), vascular invasion (82%), and distant metastases (50%). Compared with angiography in 60 patients, CT detected vascular invasion missed on angiography in 20%, and angiography detected invasion missed by CT in 5%. In these latter cases, other CT criteria of unresectability were present, and angiography provided no significant staging information. Compared with surgery in 71 patients, CT accurately predicted unresectable tumors in 100% of patients and resectable tumors in 72% of patients. Eleven of the patients with CT-resectable tumors underwent resection. Median survival was 22.7 months, with four patients alive at a median of 15.5 months postoperatively. Palliative resections were performed in six patients, and median survival was 14.4 months.
Freeny
P C
PC
Department of Radiology, University of Washington School of Medicine, Virginia Mason Medical Center, Seattle 98195.
Traverso
L W
LW
Ryan
J A
JA
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D000792:Angiography; D006801:Humans; D007813:Laparotomy; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed