title: Prediction of Vascular Invasion Using a 3-Point Scale Computed Tomography Grading System in Pancreatic Ductal Adenocarcinoma: Correlation With Surgery.
abstract: OBJECTIVE
  The aim of this study was to evaluate the correlation between a 3-point scale multidetector computed tomography (MDCT) grading system and surgical exploration in predicting vascular invasion and resectability in patients with pancreatic ductal adenocarcinoma (PDA).
  
  
  METHODS
  Fifty-five patients with surgical and pathologic confirmation of PDA were retrospectively analyzed by 3 radiologists independently. All patients had MDCT examination with multiplanar reformatted images, computed tomography (CT) angiography, and negative-contrast CT cholangiopancreatography (nCTCP). A 3-point scale CT grading system and criteria for unresectability adopting the latest guidelines were used in predicting the correlation between the invasion and resectability of 5 peripancreatic vessels and surgical grade and pathology.
  
  
  RESULTS
  Tumor location was correctly identified in all patients including 2 isodense lesions by means of nCTCP. The mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT were 92%, 83%, 95%, 78%, and 90%, respectively, in predicting tumor resectability compared with surgery and pathology and with good agreement (κ = 0.72-0.77). A correlation was observed between CT and surgical grade in predicting vascular invasion on a per-vessel basis, and the agreement presented as good to excellent (κ = 0.66-1.00).
  
  
  CONCLUSIONS
  A 3-point scale CT grading system is a simple and practical method in predicting peripancreatic vessel invasion and, importantly, correlates with surgical grade and pathology. Axial images combined with multiplanar reformation, nCTCP, and CT angiography can strengthen the comprehensive evaluation of PDA for resectability.
authors: From the *Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou; and †Department of Radiology, Wuxi Second People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, P.R. China.
authors: Lei
authors: L
authors: Zhang
authors: Zhui-Yang
authors: ZY
authors: Zhang
authors: Jian-Ming
authors: JM
authors: Ni
authors: Bin
authors: B
authors: Li
authors: Fang-Ming
authors: FM
authors: Chen
authors: Chun-Juan
authors: CJ
authors: Jiang
authors: Chun-Hong
authors: CH
authors: Hu
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity