Sonography versus helical CT in identification and staging of pancreatic ductal adenocarcinoma.
OBJECTIVE
The aim of this prospective study was to compare sonography with helical CT in the identification and staging of ductal adenocarcinoma of the pancreas.


METHODS
Sixty-four patients with histopathologically proven pancreatic ductal adenocarcinoma underwent both sonography and helical CT at our hospital between November 1, 2000, and October 31, 2001. These diagnostic imaging examinations were performed by 2 independent radiologists who were unaware of the findings of any other imaging or histopathologic examination and who assessed each case for the presence of tumor, involvement of peripancreatic vessels, the presence of metastases in the liver, and the resectability of the tumor. In the patients who underwent subsequent laparotomy, imaging-based diagnoses of overall resectability and vascular involvement were compared with surgical findings, which were considered the gold standard. Imaging-based diagnoses for the presence of hepatic metastases were compared with the findings of intraoperative sonography in patients who underwent radical resection and with the surgical findings in the patients who underwent palliative surgery; the operative findings were considered the gold standard.


RESULTS
In the identification of pancreatic adenocarcinoma, sonography was more accurate (61 of 64 tumors, 95.3%) than helical CT was (57 of 64 tumors, 89.1%). In the overall prediction of resectability among the 43 patients who underwent laparotomy, sonography (81.4%) was less accurate than CT was (86.0%). In diagnosing involvement of the superior mesenteric artery, sonography (95.3%) was more accurate than CT (88.4%). The 2 methods were equally accurate in diagnosing hepatic metastases (86.0%) and involvement of the celiac trunk (100%) and the superior mesenteric vein (88.4%), but sonography was less accurate than CT for diagnosing involvement of the common hepatic artery (90.7% versus 95.3%, respectively) and portal vein (88.4% versus 93.0%, respectively).


CONCLUSIONS
Sonography is more reliable than CT in identifying pancreatic adenocarcinoma, and its accuracy in staging is similar to that of CT.
Minniti
Salvatore
S
Department of Radiology, University of Verona, Piazzale L. A. Scuro 1, 37134 Verona, Italy.
Bruno
Costanza
C
Biasiutti
Carlo
C
Tonel
Davide
D
Falzone
Andrea
A
Falconi
Massimo
M
Procacci
Carlo
C
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D014463:Ultrasonography