title: Three-dimensional volume-rendered multidetector CT imaging of the posterior inferior pancreaticoduodenal artery: its anatomy and role in diagnosing extrapancreatic perineural invasion.
abstract: Extrapancreatic perineural spread in pancreatic adenocarcinoma contributes to poor outcomes, as it is known to be a major contributor to positive surgical margins and disease recurrence. However, current staging classifications have not yet taken extrapancreatic perineural spread into account. Four pathways of extrapancreatic perineural spread have been described that conveniently follow small defined arterial pathways. Small field of view three-dimensional (3D) volume-rendered multidetector computed tomography (MDCT) images allow visualization of small peripancreatic vessels and thus perineural invasion that may be associated with them. One such vessel, the posterior inferior pancreaticoduodenal artery (PIPDA), serves as a surrogate for extrapancreatic perineural spread by pancreatic adenocarcinoma arising in the uncinate process. This pictorial review presents the normal and variant anatomy of the PIPDA with 3D volume-rendered MDCT imaging, and emphasizes its role as a vascular landmark for the diagnosis of extrapancreatic perineural invasion from uncinate adenocarcinomas. Familiarity with the anatomy of PIPDA will allow accurate detection of extrapancreatic perineural spread by pancreatic adenocarcinoma involving the uncinate process, and may potentially have important staging implications as neoadjuvant therapy improves.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Bhavik N
authors.initials: BN
authors.lastname: Patel
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Giacomini
authors.affiliation: Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: R Brooke
authors.initials: RB
authors.lastname: Jeffrey
authors.affiliation: Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: Juergen K
authors.initials: JK
authors.lastname: Willmann
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Health Care System, Palo Alto, CA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Olcott
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D001158:Arteries; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D061330:Multidetector Computed Tomography / Q000379:methods*; D009361:Neoplasm Invasiveness; D009389:Neovascularization, Pathologic; D010179:Pancreas / Q000098:blood supply*; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000473:pathology*