title: Identification and staging of pancreatic tumours using computed tomography, endoscopic ultrasound and mangafodipir trisodium-enhanced magnetic resonance imaging.
abstract: Pancreatic malignancy can be staged by a number of different investigations, either alone or in combination. The purpose of the present study was to compare the use of endoscopic ultrasound, CT and mangafodipir trisodium-enhanced MRI for the staging of pancreatic malignancy, particularly with respect to determining resectability prior to surgery. Twenty-seven patients referred for the investigation of a suspected pancreatic malignancy were entered into the trial. All patients had contrast-enhanced CT, gadolinium and mangafodipir trisodium-enhanced MRI, and endoscopic ultrasound (EUS). Images were assessed for nodal staging, tumour staging and resectability for each investigation, and the results compared with findings at surgery. The results for the accuracy of MRI, CT and EUS, in detecting T4 disease versus T3 or lower was 78, 79 and 68%, respectively; nodal involvement was 56, 63 and 69%, respectively; and overall resectability (including the T stage, presence of involved nodes and metastases) was 83, 76 and 63%, respectively. There was no significant difference demonstrated between the three tests. The present study suggests that for patients referred for investigation and staging of pancreatic malignancy, EUS and MRI scanning convey little advantage over contrast-enhanced CT. Furthermore, although mangafodipir trisodium improved the conspicuity of pancreatic tumours, it has little influence on T staging.
authors.affiliation: Department of Radiology, The Royal Perth Hospital, Perth, Western Australia, Australia. Duncan.Ramsay@health.was.gov.au
authors.forename: Duncan
authors.initials: D
authors.lastname: Ramsay
authors.forename: Martin
authors.initials: M
authors.lastname: Marshall
authors.forename: Swithin
authors.initials: S
authors.lastname: Song
authors.forename: Mathew
authors.initials: M
authors.lastname: Zimmerman
authors.forename: Simon
authors.initials: S
authors.lastname: Edmunds
authors.forename: Ian
authors.initials: I
authors.lastname: Yusoff
authors.forename: Graham
authors.initials: G
authors.lastname: Cullingford
authors.forename: David
authors.initials: D
authors.lastname: Fletcher
authors.forename: Richard
authors.initials: R
authors.lastname: Mendelson
mesh_terms: D003287:Contrast Media; D004492:Edetic Acid / Q000031:analogs & derivatives*; D019160:Endosonography; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011732:Pyridoxal Phosphate / Q000031:analogs & derivatives*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D011732:Pyridoxal Phosphate; D004492:Edetic Acid; C060076:N,N'-bis(pyridoxal-5-phosphate)ethylenediamine-N,N'-diacetic acid