title: Color Doppler imaging predicts portal invasion by pancreatic adenocarcinoma.
abstract: 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.
authors: 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
authors: Alexander
authors: A
authors: Kern
authors: Frank
authors: F
authors: Dobrowolski
authors: Stephan
authors: S
authors: Kersting
authors: Dag-Daniel
authors: DD
authors: Dittert
authors: Hans Detlev
authors: HD
authors: Saeger
authors: Eberhard
authors: E
authors: Kuhlisch
authors: Alfred
authors: A
authors: Bunk
mesh_terms: 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