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.
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.
Takamori
Hiroshi
H
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. h-takamori@fc.kuh.kumamoto-u.ac.jp
Ikeda
Osamu
O
Kanemitsu
Keiichiro
K
Tsuji
Tatsuya
T
Chikamoto
Akira
A
Kusano
Shuichi
S
Yamashita
Yasuyuki
Y
Hiraoka
Takehisa
T
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
D003287:Contrast Media; D007479:Iopamidol