title: Detection of liver metastases secondary to pancreatic cancer: utility of combined helical computed tomography during arterial portography with biphasic computed tomography-assisted hepatic arteriography.
abstract: BACKGROUND
  This study was designed to define the diagnostic advantage of computed tomography during arterial portography (CTAP) combined with computed tomography-assisted hepatic arteriography (CTHA) for the preoperative detection of liver metastases secondary to pancreatic cancer compared with that of multidetector computed tomography (MDCT).
  
  
  METHODS
  From January 2002 to December 2007, we retrospectively studied 197 consecutive patients with pancreatic cancer. MDCT was performed on 192 patients prior to preoperative visceral angiography; 153 patients underwent CTAP + CTHA at the time of preoperative angiography.
  
  
  RESULTS
  Liver metastases were identified in 39 patients by means of MDCT. Of the 153 patients who had no evidence of liver metastases on MDCT, 129 patients underwent CTAP + CTHA, and 53 of these 129 patients (41.1%) were diagnosed as having liver metastases that could not be detected by MDCT. These tumors missed by MDCT ranged from 3 to 15 mm in size. On CTAP + CTHA, a solitary nodule in the liver was detected in 11 patients, 2 nodules were detected in 6 patients, 3 lesions were detected in 2 patients, and ≧4 lesions were detected in 34 patients. The sensitivity and specificity of CTAP + CTHA versus MDCT were 94.2 versus 48.4% and 82.7 versus 97.9%, respectively.
  
  
  CONCLUSIONS
  The combination of CTAP and CTHA is useful to confirm liver metastases and can potentially offer more accurate staging of pancreatic cancer compared with MDCT.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ikuta
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takamori
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hashimoto
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ozaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Nakahara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Furuhashi
authors.forename: Shinya
authors.initials: S
authors.lastname: Abe
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Shinya
authors.initials: S
authors.lastname: Shimada
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D011172:Portography / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*