Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion.
OBJECTIVE
To establish preliminarily the different diagnostic criteria for peripancreatic arterial and venous invasion in pancreatic carcinoma by comparing their multidetector-row computed tomography (MDCT) appearances with surgical exploration.


METHODS
Among 101 patients with pancreatic carcinoma examined by MDCT, 54 candidates accepting surgery were preoperatively evaluated for vascular invasion based on CT signs (A-E): arterial embedment in tumor or venous obliteration; tumor involvement exceeding one-half of the circumference of the vessel; vessel wall irregularity; vessel caliber stenosis; teardrop superior mesenteric vein (SMV). The peripancreatic major vessels (n = 224) were examined carefully by surgeons during the operation.


RESULTS
During surgical exploration, 78 vessels were found to be invaded. With sign A (B, C, or D) as the CT criterion for peripancreatic vascular invasion, the sensitivity of arterial and venous invasion was 66% (97%, 45%, or 41%) and 14% (49%, 63%, or 55%), respectively; the specificity of absence of arterial and venous invasion was 100% (91%, 99%, or 100%) and 100% (all 100%). In this study, there were 3 SMVs appearing teardrop (sign E), which were all confirmed to be invaded.


CONCLUSIONS
It is recommended that the CT diagnostic criteria for arterial and venous invasion should be dealt with differently. The criteria of arterial invasion are the presence of sign A or the combination of sign B with one of signs C and D. The criteria of venous invasion are the presence of one of the following signs: sign A, sign B, sign C, sign D, and sign E.
Li
Hui
H
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China. l_h@zshospital.net
Zeng
Meng Su
MS
Zhou
Kang Rong
KR
Jin
Da Yong
DY
Lou
Wen Hui
WH
D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004322:Drainage; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D007565:Jaundice / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010166:Palliative Care; D010179:Pancreas / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D011859:Radiography; D019043:Vascular Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery