Virtual pancreatoscopy of pancreatic cancer.
OBJECTIVE
Virtual endoscopy is a new method of diagnosis using computer processing of three-dimensional images data sets. However, there are few reports about the clinical application of virtual endoscopy for the pancreas. In this study, we evaluated the feasibility of surface-rendered magnetic resonance virtual endoscopy for pancreatic cancer.


METHODS
Twenty-six cases of pancreatic cancer were studied. Fifteen patients had pancreatic head cancer, 7 had pancreatic body cancer, and 4 had pancreatic tail cancer. Twelve patients underwent surgical resection of the pancreas. Magnetic resonance imaging data were acquired with a 1.5-T clinical imager (Signal.5; GE Medical Systems, USA). We used a multislab single-shot fast spin-echo sequence. Section thickness was between 2 and 3 mm in the coronal plane. Three-dimensional reconstructed images and virtual endoscopic images were generated with Advantage Windows by GE.


RESULTS
Virtual endoscopic images could be generated in 20 patients with pancreatic cancer (76.9%). In these cases, we were able to observe the inner surface of the pancreatic duct and the stricture from not only the pancreatic head but also the pancreatic tail. Clear virtual images could not be generated in 6 cases. We were able to divide the 20 cases in which images could be generated into groups according to the appearance of the stricture. The edge of the stricture appeared to be protruding in 4 cases (15.4%), and appeared to be polygonal in 13 cases (50.0%). In 3 cases, we recognized the existence of a stricture, but the detail of the stricture was unclear.


CONCLUSIONS
Virtual endoscopy caused minimal discomfort compared to real endoscopic examination, and it can access cystic lesions and the pancreatic duct behind the stricture. It is concluded that virtual endoscopy for pancreatic cancer has potential clinical utility.
Department of Surgery, National Cancer Center Hospital, East 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
Yutaka
Y
Tanizawa
Toshio
T
Nakagohri
Masaru
M
Konishi
Kazuto
K
Inoue
Tatsuya
T
Oda
Shin-ichiro
S
Takahashi
Hiroshi
H
Kawahira
Takayuki
T
Nakamura
Takanori
T
Nishimori
Michitaka
M
Nagase
Takanori
T
Ueda
Taira
T
Kinoshita
D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D003251:Constriction, Pathologic; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D014584:User-Computer Interface