title: Preoperative detection of liver metastases secondary to pancreatic cancer: utility of combined helical computed tomography during arterial portography with biphasic computed tomography-assisted hepatic arteriography.
abstract: OBJECTIVE
  This study was designed to define the diagnostic advantage of computed tomography during arterial portography combined with computed tomography-assisted hepatic arteriography ( CTAP + CTHA) for preoperative detection of liver metastases secondary to pancreatic cancer compared with that of multidetector computed tomography (MDCT).
  
  
  METHODS
  From January 2002 to February 2003, we retrospectively studied 19 consecutive patients with pancreatic cancer. MDCT was performed on all patients prior to preoperative visceral angiography. Fourteen patients underwent CTAP + CTHA at the time of preoperative angiography.
  
  
  RESULTS
  Liver metastases were identified in 3 patients by means of MDCT. Of 14 patients who underwent CTAP + CTHA, 8 patients (57.1%) were diagnosed as having liver metastases, which could not be detected by MDCT. These tumors missed by MDCT ranged from 5 to 15 mm in size. On CTAP + CTHA, a single nodule in the liver was detected in 2 patients, 2 nodules in 2 patients, 3 lesions in 1 patient, and > or =4 lesions in 3 patients. The sensitivity and specificity of CTAP + CTHA versus MDCT were 75.0% versus 23.1% and 66.7% versus 100%, respectively.
  
  
  CONCLUSIONS
  In conclusion, the combination of CTAP and CTHA is useful to confirm liver metastases before operation for resectable pancreatic cancer because it has higher sensitivity to detect of liver metastases compared with MDCT.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. h-takamori@fc.kuh.kumamoto-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takamori
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Kanemitsu
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Tsuji
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kusano
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Takehisa
authors.initials: T
authors.lastname: Hiraoka
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D007269:Injections, Intra-Arterial; D007479:Iopamidol / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D011172:Portography / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed
chemical_list: D003287:Contrast Media; D007479:Iopamidol