Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery.
OBJECTIVE
The aim of our study was to prospectively evaluate the accuracy of dual-phase helical CT in the preoperative assessment of resectability in patients with suspected pancreatic cancer using surgical and histopathologic correlation.


METHODS
Between January 1999 and December 2000, 76 patients with suspected pancreatic cancer underwent preoperative evaluation and staging with dual-phase helical CT (3-mm collimation for pancreatic phase, 5-mm collimation for portal phase). Iodinated contrast material was injected IV (170 mL at a rate of 4 mL/sec); acquisition began at 40 sec during the pancreatic phase and at 70 sec during the portal phase. Three radiologists prospectively evaluated the imaging findings to determine the presence of pancreatic tumor and signs of unresectability (liver metastasis, vascular encasement, or regional lymph nodes metastasis). The degree of tumor-vessel contiguity was recorded for each patient (no contiguity with tumor, contiguity of < 50%, or contiguity of > or =50%).


RESULTS
Thirty-nine patients with pancreatic adenocarcinoma were surgically explored. Curative resections were attempted in 34 patients and were successful in 25. The positive predictive value for resectability was 73.5%. Nine patients considered resectable on the basis of CT findings were found to be unresectable at surgery because of liver metastasis (n = 5), vascular encasement (n = 2), or lymph node metastasis (n = 2). We found that the overall accuracy of helical CT as a tool for determining whether a pancreatic adenocarcinoma was resectable was 77% (30/39 patients).


CONCLUSIONS
Dual-phase helical CT is a useful technique for preoperative staging of pancreatic cancer. The main limitation of CT is that it may not reveal small hepatic metastases.
Valls
Carlos
C
Institut de Diagnòstic per la Imatge, Hospital Duran i Reynals, Ciutat Sanitària i Universitària de Bellvitge, Autovia de Castelldefels km 2, 7, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
Andía
Eduard
E
Sanchez
Anna
A
Fabregat
Juan
J
Pozuelo
Oscar
O
Quintero
Juan Carlos
JC
Serrano
Teresa
T
Garcia-Borobia
Francisco
F
Jorba
Rosa
R
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed