Multidetector CT evaluation of the course of nonresectable pancreatic carcinomas with neoadjuvant therapy.
OBJECTIVE
A prospective study to determine the value of multidetector CT (MD-CT) in assessing the course of nonresectable pancreatic carcinoma during therapy.


METHODS
26 patients with nonresectable pancreatic carcinoma underwent MD-CT before and after therapy. The examinations were evaluated with regard to tumor size and vascular invasion using an invasion score (IS) by 2 radiologists independently (kappa analysis). Diagnosis was confirmed surgically, by biopsy or clinical course.


RESULTS
Sensitivity for the assessment of irresectability was 100%. Following therapy, 54% of all the tumors were smaller (14/26), 42% had increased in volume (11/26), and one tumor remained stable (1/26). The IS (veins) during follow-up changed in 26 patients (portal vein: 5 higher (mean score 10.4/16.2), 4 lower (mean score 17.5/11.5); superior mesenteric vein: 12 higher (11/14.4), 5 lower (16.2/14.6); p = 0.026). The IS (arteries) changed in 13 patients (celiac trunk: 3 higher (3.3/10); hepatic artery: 4 higher (5.7/10.2), 3 lower (11.6/10.3); superior mesenteric artery: 2 higher (4.5/9.5), 1 lower (12/11)). The kappa values were calculated between 0.56 and 0.87.


CONCLUSIONS
MD-CT is suitable for evaluating tumor spread during therapy for nonresectable pancreatic carcinoma. The IS is useful for assessing the degree of change in vessel invasion.
Klauss
M
M
Department of Diagnostic Radiology, University of Heidelberg, Heidelberg, Germany. miriam.klauss@med.uni-heidelberg.de
Alt
C D
CD
Welzel
T
T
Werner
J
J
Buchler
M W
MW
Richter
G M
GM
Kauffmann
G W
GW
Kauczor
H U
HU
Grenacher
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002445:Celiac Artery / Q000000981:diagnostic imaging; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D011169:Portal Vein / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed