Color Doppler imaging predicts portal invasion by pancreatic adenocarcinoma.
BACKGROUND
Tumor infiltration of the intima of the portal vein (PV) and superior mesenteric vein (SMV) by pancreatic adenocarcinoma is classically considered a criterion for unsuitability for resection and poor prognosis. This study was performed to evaluate modern color duplex imaging (CDI) for the assessment of PV/SMV infiltration by pancreatic adenocarcinomas.


METHODS
From 1994 to 2005, Whipple's procedure or pylorus-preserving pancreato-duodenectomy (PPPD) was performed in 303 patients with pancreatic adenocarcinoma; 35 of these underwent partial PV/SMV resection. Applying a previously reported CDI score, we evaluated the integrity of the echogenic border layer between the vein and tumor (mural demarcation) and maximum blood flow velocity (V (max)) in the PV segment in contact with the tumor. The results were compared to the final histological findings in the resected venous walls.


RESULTS
CDI findings correlated well with the histological invasion grades. By measuring V (max )and evaluating mural demarcation, we observed a sensitivity of 66.7% and 100% and a specificity of 98.3% and 93.9%, respectively, in predicting full thickness vein invasion, including the intima. V (max) above 80 cm/s and lack of mural demarcation were predictors of PV/SMV invasion. The postoperative survival rates depended on the depth of tumor infiltration into the PV/SMV.


CONCLUSIONS
Modern CDI is a reliable and valid technique for evaluation of morphological and hemodynamic parameters in the portal vein segment adjacent to pancreatic adenocarcinoma. Maximal blood-flow velocity in the portal segment in contact with the tumor and absence of the echogenic vessel-parenchymal sonographic interface are parameters predictive of tumor infiltration of the portal intima.
Kern
Alexander
A
Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. alexander.kern@uniklinikum-dresden.de
Dobrowolski
Frank
F
Kersting
Stephan
S
Dittert
Dag-Daniel
DD
Saeger
Hans Detlev
HD
Kuhlisch
Eberhard
E
Bunk
Alfred
A
D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000556:secondary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D018615:Ultrasonography, Doppler, Color; D019043:Vascular Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary