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Koretsune Y, Sone M, Sugawara S, Wakatsuki Y, Ishihara T, Hattori C, Fujisawa Y, Kusumoto M. Validation of a convolutional neural network for the automated creation of curved planar reconstruction images along the main pancreatic duct. Jpn J Radiol 2023; 41:228-234. [PMID: 36121623 PMCID: PMC9889432 DOI: 10.1007/s11604-022-01339-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/09/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the accuracy and time-efficiency of newly developed software in automatically creating curved planar reconstruction (CPR) images along the main pancreatic duct (MPD), which was developed based on a 3-dimensional convolutional neural network, and compare them with those of conventional manually generated CPR ones. MATERIALS AND METHODS A total of 100 consecutive patients with MPD dilatation (≥ 3 mm) who underwent contrast-enhanced computed tomography between February 2021 and July 2021 were included in the study. Two radiologists independently performed blinded qualitative analysis of automated and manually created CPR images. They rated overall image quality based on a four-point scale and weighted κ analysis was employed to compare between manually created and automated CPR images. A quantitative analysis of the time required to create CPR images and the total length of the MPD measured from CPR images was performed. RESULTS The κ value was 0.796, and a good correlation was found between the manually created and automated CPR images. The average time to create automated and manually created CPR images was 61.7 s and 174.6 s, respectively (P < 0.001). The total MPD length of the automated and manually created CPR images was 110.5 and 115.6 mm, respectively (P = 0.059). CONCLUSION The automated CPR software significantly reduced reconstruction time without compromising image quality.
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Affiliation(s)
- Yuji Koretsune
- grid.136593.b0000 0004 0373 3971Department of Diagnostic and Interventional Radiology, Osaka University, 2-15 Yamadaoka, Suita, Osaka 565-0871 Japan
| | - Miyuki Sone
- grid.272242.30000 0001 2168 5385Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo City, Japan
| | - Shunsuke Sugawara
- grid.272242.30000 0001 2168 5385Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo City, Japan
| | - Yusuke Wakatsuki
- grid.272242.30000 0001 2168 5385Department of Diagnostic Technology, National Cancer Center Hospital, Chuo City, Japan
| | - Toshihiro Ishihara
- grid.272242.30000 0001 2168 5385Department of Diagnostic Technology, National Cancer Center Hospital, Chuo City, Japan
| | - Chihiro Hattori
- grid.471046.00000 0001 0671 5048Canon Medical Systems Corp., Otawara, Japan
| | - Yasuko Fujisawa
- grid.471046.00000 0001 0671 5048Canon Medical Systems Corp., Otawara, Japan
| | - Masahiko Kusumoto
- grid.272242.30000 0001 2168 5385Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo City, Japan
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Yu Y, Guo M, Han X. Comparison of multi-slice computed tomographic angiography and dual-source computed tomographic angiography in resectability evaluation of pancreatic carcinoma. Cell Biochem Biophys 2014; 70:1351-6. [PMID: 24908264 DOI: 10.1007/s12013-014-0063-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The assessment of pancreatic cancer resectability is based mainly on the extent of the peripancreatic vasculature involvement with tumor mass. The 16-slice computed tomography (MSCT) and dual-source computed tomography (DSCT) were used in non-invasive imaging of the pancreas and the regional vessels in 48 pancreatic carcinoma patients. Both of these techniques were combined with contrast-enhanced angiography and post-scanning reconstruction of 2D and 3D images. Based on the degree of involvement revealed by these images, the pre-operative tumor resectability was determined. The CTA-based resectability was then correlated with the surgical and pathological findings for the evaluation of their sensitivity, specificity, negative and positive predictive values, and diagnostic accuracy. The study suggests that resectability based on dual-source CTA showed higher sensitivity, specificity, and diagnostic accuracy than that obtained from MSCTA scanning.
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Affiliation(s)
- Yongmei Yu
- Department of CT, First People's Hospital, Jining, 272000, Shandong, China
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Hassanen O, Ghieda U, Eltomey MA. Assessment of vascular invasion in pancreatic carcinoma by MDCT. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Dawoud MA, Youssef MA, Elbarbary AA. Role of multi-detector computed tomography in the evaluation of pancreatic tumors. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Egorov VI, Petrov RV, Solodinina EN, Karmazanovsky GG, Starostina NS, Kuruschkina NA. Computed tomography-based diagnostics might be insufficient in the determination of pancreatic cancer unresectability. World J Gastrointest Surg 2013; 5:83-96. [PMID: 23717744 PMCID: PMC3664295 DOI: 10.4240/wjgs.v5.i4.83] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 02/09/2013] [Accepted: 02/28/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To inquire into a question of an overestimation of arterial involvement in patients with pancreatic cancer (PC). METHODS Radiology data were compared with the findings from 51 standard, 58 extended and 17 total pancreaticoduodenectomies; 9 distal resections with celiac artery (CA) excision; and 28 palliations for PC. The survival of 11 patients with controversial computed tomography (CT) and endoscopic ultrasound data with regard to arterial invasion, after R0/R1 procedures (false-positive CT results, Group A), was compared to survival after eight R2 resections (false-negative CT results, Group B) and after 12 bypass procedures for locally advanced cancer (true-positive CT results, Group C). RESULTS In all of the cases in group A, operative exploration revealed no arterial invasion, which was predicted by CT. The one-year survival in Group A was 88.9%, and the two-year survival was 26.7%, with a median follow-up of 22 mo. One-year survival was not attained in groups B and C, with a significant difference in survival (P a-b = 0.0029, P b-c = 0.003). CONCLUSION Arterial encasement on CT does not necessarily indicate arterial invasion. Whenever PC is considered unresectable, endoUS should be used. In patients with controversial CT an EUS data for peripancreatic arteries involvement radical resection might be possible, providing survival benefits as compared to R2- resections or palliative surgery.
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Falconi M, Bartsch DK, Eriksson B, Klöppel G, Lopes JM, O'Connor JM, Salazar R, Taal BG, Vullierme MP, O'Toole D. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology 2012; 95:120-34. [PMID: 22261872 DOI: 10.1159/000335587] [Citation(s) in RCA: 354] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Massimo Falconi
- Department of General Surgery, University of Verona, Verona, Italy.
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Buchs NC, Chilcott M, Poletti PA, Buhler LH, Morel P. Vascular invasion in pancreatic cancer: Imaging modalities, preoperative diagnosis and surgical management. World J Gastroenterol 2010; 16:818-31. [PMID: 20143460 PMCID: PMC2825328 DOI: 10.3748/wjg.v16.i7.818] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is associated with a poor prognosis, and surgical resection remains the only chance for curative therapy. In the absence of metastatic disease, which would preclude resection, assessment of vascular invasion is an important parameter for determining resectability of pancreatic cancer. A frequent error is to misdiagnose an involved major vessel. Obviously, surgical exploration with pathological examination remains the “gold standard” in terms of evaluation of resectability, especially from the point of view of vascular involvement. However, current imaging modalities have improved and allow detection of vascular invasion with more accuracy. A venous resection in pancreatic cancer is a feasible technique and relatively reliable. Nevertheless, a survival benefit is not achieved by curative resection in patients with pancreatic cancer and vascular invasion. Although the discovery of an arterial invasion during the operation might require an aggressive management, discovery before the operation should be considered as a contraindication. Detection of vascular invasion remains one of the most important challenges in pancreatic surgery. The aim of this article is to provide a complete review of the different imaging modalities in the detection of vascular invasion in pancreatic cancer.
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Liu FJ, Cheng YS. Advances in imaging diagnosis of pancreatic cancer. Shijie Huaren Xiaohua Zazhi 2010; 18:495. [DOI: 10.11569/wcjd.v18.i5.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
Recent technological advances in multidetector computed tomography (MDCT) have enabled 3D diagnostic imaging with superb spatial and temporal resolution. This often provides useful information on precise detail and relationships.
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Manak E, Merkel S, Klein P, Papadopoulos T, Bautz WA, Baum U. Resectability of pancreatic adenocarcinoma: assessment using multidetector-row computed tomography with multiplanar reformations. ACTA ACUST UNITED AC 2009; 34:75-80. [PMID: 17934772 DOI: 10.1007/s00261-007-9285-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The purpose was to assess capabilities of the multidetector-row computed tomography (MDCT) with multiplanar reformations (MPR) for predicting of pancreatic adenocarcinoma resectability. Forty-eight patients deemed to have resectable pancreatic adenocarcinoma after assessment using biphasic MDCT with MPRs underwent surgery for potential tumor resection. Imaging findings were retrospectively evaluated for tumor resectability and correlated with surgical and pathological results. Curative resection was successful in 44 of 48 patients. The positive predictive value for tumor resectability made up 91% with four false-negative results. The reasons for unresectability were venous involvement (1), small liver metastases (2) and peritoneal involvement associated with small metastases to lymph nodes (1). MDCT yielded a negative predictive value of 99% (286 of 288 vessels) for detection of vascular invasion. Our results indicate the tendency towards improved prediction of resectability using MDCT compared to single-detector CT.
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Affiliation(s)
- Elena Manak
- Institute for Diagnostic Radiology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
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Tamm EP, Balachandran A, Bhosale P, Szklaruk J. Update on 3D and multiplanar MDCT in the assessment of biliary and pancreatic pathology. ACTA ACUST UNITED AC 2009; 34:64-74. [PMID: 18483805 DOI: 10.1007/s00261-008-9416-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The development of multidetector row computed tomography (MDCT) has led to the acquisition of true isotropic voxels that can be postprocessed to yield images in any plane of the same resolution as the original axially acquired images. This, coupled with rapid MDCT imaging during peak target organ enhancement has led to a variety of means to review imaging information beyond that of the axial perspective. Postprocessing can be utilized to identify variant biliary anatomy to guide preoperative planning of biliary-related surgery, determine the level and cause of biliary obstruction and assist in staging of biliary cancer. Postprocessing can also be used to identify pancreatic ductal variants, visualize diagnostic features of pancreatic cystic lesions, diagnose and stage pancreatic cancer, and differentiate pancreatic from peripancreatic disease.
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Affiliation(s)
- Eric P Tamm
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Usefulness of multidetector computed tomography for detecting protruding lesions in intraductal papillary mucinous neoplasm of the pancreas in comparison with single-detector computed tomography and endoscopic ultrasonography. Pancreas 2009; 38:131-6. [PMID: 18981954 DOI: 10.1097/mpa.0b013e31818b0040] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To retrospectively evaluate the usefulness of multidetector computed tomography (MDCT) with multiplanar reformations (MPRs) and curved planar reformations (CPRs) for detecting protruding lesions in intraductal papillary mucinous neoplasms of the pancreas (IPMNs) as compared with single-detector CT (SDCT) and endoscopic ultrasonography (EUS). METHODS Eighty-six patients with IPMNs were imaged either with SDCT (n = 52) or MDCT with MPRs/CPRs and EUS (n = 34). The diagnostic accuracy of each imaging modality for identifying protruding lesions was compared with histological samples. RESULTS Among the patients in whom protruding lesions were histopathologically identified, the lesions were detected in 9 of the 33 patients subjected to SDCT (51.9% accuracy), in 17 of the 25 patients subjected to MDCT with MPRs and CPRs (76.5% accuracy), and in 21 of the 25 patients subjected to EUS (70.6% accuracy). Thus, significant difference was observed between MDCT and SDCT regarding accuracy (P < 0.05); however, no significant difference was seen between MDCT and EUS. Protruding lesions of less than 10 mm in height were better visualized with MDCT (53.3%) than with SDCT (13.0%; P < 0.05). CONCLUSIONS Multidetector computed tomography proved more useful than SDCT and equivalent to EUS in detecting protruding lesions in IPMNs.
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Singh AK, Sahani DV, Blake MA, Joshi MC, Wargo JA, Fernandez-del Castillo C. Assessment of pancreatic tumor resectability with multidetector computed tomography: semiautomated console-generated images versus dedicated workstation-generated images. Acad Radiol 2008; 15:1058-68. [PMID: 18620126 DOI: 10.1016/j.acra.2008.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 01/28/2008] [Accepted: 03/11/2008] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this retrospective study was to compare the maximum intensity projection (MIP) images generated at a multidetector computed tomography (MDCT) scanner console using advanced tools at a three-dimensional (3D) workstation for assessment of pancreatic tumor resectability. MATERIALS AND METHODS Institutional review board approval and informed consent wavier were obtained for this retrospective study. The intraoperative findings were used as reference standard. Two radiologists assessed console MIPs that were created using computed tomographic (CT) data sets of 30 patients (17 men and 13 women; age range, 35-79 years; mean age, 58 years) operated for pancreatic tumors. Semi-automated MIP images were created on a separate MDCT console. Two blinded radiologist (R1, R2) and surgeons (S1, S2) evaluated the image data independently for vascular involvement and tumor resectability. The image quality and diagnostic confidence for MIPs were graded on a 5-point scale (1 = poor, 2 = suboptimal, 3 = intermediate, 4 = good; 5 = excellent) and comparison was made with 3D workstation image scores. RESULTS The findings revealed greater than 90% sensitivity, specificity, and accuracy for detecting involvement of peripancreatic vessels by pancreatic tumor with an excellent interobserver agreement (kappa = 0.87-1.00). The findings of console-generated MIPs were same as the findings of 3D workstation images. The mean of image quality and diagnostic confidence grading for console MIPs by assessors were 4.4 and 4.2, respectively. The average time to generate simple MIPs at the console was 3.4 minutes (range, 2.3-4.4) compared to 26 minutes (range, 18-33) to create images at the 3D workstation. CONCLUSION Semi-automated MIPs generated from an MDCT scanner console is an excellent alternative to 3D workstation images for assessing resectability of pancreatic tumor based on vascular involvement. Console MIPs can be quickly generated during the time of scan and thus can improve CT workflow.
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Abstract
OBJECTIVE The purpose of this pictorial essay is to showcase the use of minimum intensity projection in the imaging of low attenuation structures such as the pancreatic duct. CONCLUSION Minimum intensity projection is a valuable adjunct to other processing techniques for the diagnosis and staging of pancreatic adenocarcinoma and cystic tumors of the pancreas.
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Affiliation(s)
- Arghavan Salles
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive Room H1307, Stanford, California 94305-5105, USA
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Morley NP, Pyrros AT, Yaghmai V, Miller FH, Nikolaidis P. Biliary dilatation and duodenal intussusception secondary to enteric duplication cyst: MDCT diagnosis. Emerg Radiol 2008; 16:243-5. [DOI: 10.1007/s10140-008-0720-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2007] [Accepted: 03/11/2008] [Indexed: 11/24/2022]
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Mazzeo S, Cappelli C, Caramella D, Del Chiaro M, Campani D, Pollina L, Caproni G, Battaglia V, Belcari A, Funel N, Di Candio G, Forasassi F, Boggi U, Bevilacqua G, Mosca F, Bartolozzi C. Evaluation of vascular infiltration in resected patients for pancreatic cancer: comparison among multidetector CT, intraoperative findings and histopathology. ABDOMINAL IMAGING 2007; 32:737-742. [PMID: 17387543 DOI: 10.1007/s00261-006-9172-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND To assess vascular infiltration is crucial in surgical planning of pancreatic cancer. Our aim was to assess the capability of multidetector CT in detecting vascular infiltration. METHODS We evaluated 37 patients with pancreatic tumors. The relation between tumor and vessels was classified: grade 0: no contact between lesion and vessel; grade I: focal contiguity without modification of the vessel caliber; grade II: lesion surrounding the vessel, without reduction of its lumen; grade III: cancer surrounding the vessel with reduction or obstruction of its lumen. CT grades were compared to intraoperative findings and histopathology. RESULTS We evaluated 52 critical vessels with the following CT grades: grade 0 (4 cases), grade I (13 cases), grade II (17 cases), grade III (18 cases). Vascular resection was performed in 26 patients, with a total of 31 resected vessels (3 of grade 0, 5 of grade I, 8 of grade II, 15 of grade III). Histopathology excluded vascular infiltration in 4/4 cases with grade 0 and in 10/13 cases with grade I and confirmed it in 14/17 cases with grade II and 14/18 cases with grade III. CONCLUSIONS Multidetector CT is accurate in detecting vascular involvement and provides pre-operative information to effectively plan resection.
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Affiliation(s)
- Salvatore Mazzeo
- Diagnostic and Interventional Radiology, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy.
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Kim HC, Yang DM, Jin W, Ryu CW, Ryu JK, Park SI, Park SJ, Shin HC, Kim IY. Multiplanar reformations and minimum intensity projections using multi-detector row CT for assessing anomalies and disorders of the pancreaticobiliary tree. World J Gastroenterol 2007; 13:4177-84. [PMID: 17696245 PMCID: PMC4250615 DOI: 10.3748/wjg.v13.i31.4177] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
CT scan is regarded as the imaging modality of choice in patients with pancreaticobiliary ductal abnormalities. However, the axial orientation of the CT images provides only limited anatomical view of pancreaticobiliary ductal abnormalities. The technological advances of multi-detector row CT and three-dimensional image processing in workstations allows rapid image acquisition and a short postprocessing time. In particular, multiplanar reformations (MPR) and minimum intensity projections (MinIP) offer rapid and accurate images of the anatomy and abnormalities of the pancreaticobiliary tree. Moreover, MPR and MinIP help determine the relationship between the pancreaticobiliary ductal anatomy and the surrounding structures. This pictorial review illustrates the wide spectrum of images obtained by the MPR and MinIP of the anomalies and disorders of the pancreaticobiliary tree.
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Affiliation(s)
- Hyun Cheol Kim
- Department of Radiology, East-West Neo Medical Center, Kyung-Hee University, 149 Sangil-dong, Gangdong-gu, Seoul 134-727, Republic of Korea.
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Balachandran A, Darden DL, Tamm EP, Faria SC, Evans DB, Charnsangavej C. Arterial variants in pancreatic adenocarcinoma. ACTA ACUST UNITED AC 2007; 33:214-21. [PMID: 17435979 DOI: 10.1007/s00261-007-9235-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Surgery remains the only curative option for the treatment of pancreatic adenocarcinoma. Local tumor resectability depends on a number of factors, but most importantly, the relationship of the tumor to adjacent arterial structures. For example, surgery is rarely performed when the tumor involves the celiac axis or the superior mesenteric artery. Unexpected variant arterial anatomy or tumor involvement of aberrant arteries may complicate pancreatic surgery. The classic visceral arterial anatomy occurs in only 55%-60% of the population, with one or more variant vessels occurring in the remaining population. Knowledge of both variant and normal anatomy is essential for accurate preoperative planning. We describe here the arterial variant anatomy of the pancreas and its identification by multidetector CT imaging, with and without the aid of post-processed volume-rendered images.
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Affiliation(s)
- Aparna Balachandran
- Diagnostic Radiology, UT MD Anderson Cancer Center, 1515 Holcombe Boulevard Box 0057, Houston, TX 77030, USA.
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Kakihara D, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Hirakawa M, Ishigami K, Yamaguchi K, Taketomi A, Nishihara Y, Honda H. Usefulness of the long-axis and short-axis reformatted images of multidetector-row CT in evaluating T-factor of the surgically resected pancreaticobiliary malignancies. Eur J Radiol 2007; 63:96-104. [PMID: 17368790 DOI: 10.1016/j.ejrad.2007.01.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 01/19/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the diagnostic efficacy of curved planar reformations along the duct (long-axis CPR) and series of reformations perpendicular to the duct (short-axis MPR) in evaluating T-factors of pancreaticobiliary malignancy. MATERIALS AND METHODS Twenty-five patients with surgically proven pancreaticobiliary malignancy (12 bile duct cancers and 13 pancreas cancers) were evaluated. A dynamic study was performed with multidetector-row CT with four detectors, and reconstructed with 1mm thickness and intervals. Tracing the center of the duct system on axial images, long-axis CPR images and serial short-axis MPR images were obtained. Two radiologists interpreted the T factor of the diseases three times: session (1), axial images only; session (2), axial, coronal and sagittal multiplanar reformation images; and session (3), axial, long-axis CPR, and short-axis MPR images. Receiver operating characteristic curves were analyzed. RESULTS In evaluations of bile duct cancer, Az values of (3) (0.95, 0.92) were higher than those of (1) (0.89, 0.88) and (2) (0.92, 0.89), with some significant differences. In evaluations of pancreas cancer, Az values of all interpretations were almost equal. CONCLUSION Long-axis CPR and short-axis MPR images were suggested to be useful as additional images to the original axial images in evaluating the local extension of bile duct carcinomas.
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Affiliation(s)
- Daisuke Kakihara
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Falconi M, Plockinger U, Kwekkeboom DJ, Manfredi R, Korner M, Kvols L, Pape UF, Ricke J, Goretzki PE, Wildi S, Steinmuller T, Oberg K, Scoazec JY. Well-differentiated pancreatic nonfunctioning tumors/carcinoma. Neuroendocrinology 2007; 84:196-211. [PMID: 17312380 DOI: 10.1159/000098012] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Amin Z, Theis B, Russell RCG, House C, Novelli M, Lees WR. Diagnosing pancreatic cancer: the role of percutaneous biopsy and CT. Clin Radiol 2007; 61:996-1002. [PMID: 17097419 DOI: 10.1016/j.crad.2006.07.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 06/29/2006] [Accepted: 07/07/2006] [Indexed: 01/12/2023]
Abstract
AIMS To determine the sensitivity and complications of percutaneous biopsy of pancreatic masses, and whether typical computed tomography (CT) features of adenocarcinoma can reliably predict this diagnosis. MATERIALS AND METHODS A 5 year retrospective analysis of percutaneous core biopsies of pancreatic masses and their CT features was undertaken. Data were retrieved from surgical/pathology databases; medical records and CT reports and images. RESULTS Three hundred and three patients underwent 372 biopsies; 56 of 87 patients had repeat biopsies. Malignancy was diagnosed in 276 patients, with ductal adenocarcinoma in 259 (85%). Final sensitivity of percutaneous biopsy for diagnosing pancreatic neoplasms was 90%; for repeat biopsy it was 87%. Complications occurred in 17 (4.6%) patients, in three of whom the complications were major (1%): one abscess, one duodenal perforation, one large retroperitoneal bleed. CT features typical of ductal adenocarcinoma were: hypovascular pancreatic mass with bile and/or pancreatic duct dilatation. Atypical CT features were: isodense or hypervascular mass, calcification, non-dilated ducts, cystic change, and extensive lymphadenopathy. Defining typical CT features of adenocarcinoma as true-positives, CT had a sensitivity of 68%, specificity of 95%, positive predictive value (PPV) of 98%, and negative predictive value of 41% for diagnosing pancreatic adenocarcinoma. CONCLUSION Final sensitivity of percutaneous biopsy for establishing the diagnosis was 90%. CT features typical of pancreatic adenocarcinoma had high specificity and PPV. On some occasions, especially in frail patients with co-morbidity, it might be reasonable to assume a diagnosis of pancreatic cancer if CT features are typical, and biopsy only if CT shows atypical features.
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Affiliation(s)
- Z Amin
- Department of Imaging, University College Hospital, London, UK.
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Ichikawa T, Erturk SM, Sou H, Nakajima H, Tsukamoto T, Motosugi U, Araki T. MDCT of pancreatic adenocarcinoma: optimal imaging phases and multiplanar reformatted imaging. AJR Am J Roentgenol 2006; 187:1513-20. [PMID: 17114545 DOI: 10.2214/ajr.05.1031] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the individual contributions of arterial, pancreatic parenchymal, and portal venous phase (PVP) images and the utility of coronal and sagittal multiplanar reformatted (MPR) images in the assessment of pancreatic adenocarcinoma using triple-phase MDCT. MATERIALS AND METHODS Thirty-one patients with and 35 patients without pancreatic adenocarcinoma underwent triple-phase MDCT. Three radiologists independently attempted to detect pancreatic adenocarcinoma and assess local extension using the MDCT images in five sessions. The first three sessions involved sets of images obtained in arterial phase, pancreatic parenchymal phase, and PVP separately and respectively. In the fourth session, a combination of axial images from all phases was evaluated. During the fifth session, radiologists had access to coronal and sagittal MPR images together with the axial images obtained in all phases. Results were compared with surgical findings using receiver operating characteristic (ROC) analysis and kappa statistics. RESULTS Regarding tumor detection, the image set composed of coronal and sagittal MPR images and of axial images obtained in all phases had a significantly higher value for the area under the ROC curve (A(Z), 0.98 +/- 0.01) than the other image sets and yielded the highest sensitivity (93.5%). The sensitivity of the arterial phase image set (80.6%) was significantly lower than that of all other image sets. Whereas the image set composed of coronal and sagittal MPR images and axial images obtained in all phases yielded the highest kappa values for all local extension factors evaluated, the image set composed of only arterial phase images yielded the lowest kappa values for almost all of the factors. CONCLUSION A combination of pancreatic parenchymal phase and PVP imaging is necessary and efficient for the assessment of pancreatic adenocarcinoma. The addition of coronal and sagittal MPR images increased the performance of MDCT, especially in the evaluation of local extension.
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Affiliation(s)
- Tomoaki Ichikawa
- Department of Radiology, University of Yamanashi, Nakakoma, Japan
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Ayuso C, Sánchez M, Ayuso JR, de Caralt TM, de Juan C. Diagnóstico y estadificación del carcinoma de páncreas (I). RADIOLOGIA 2006; 48:273-82. [PMID: 17168236 DOI: 10.1016/s0033-8338(06)75136-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Carcinoma of the pancreas is a neoplasm with a poor prognosis that is diagnosed in the advanced stages in most patients. Given that surgical resection is the only potentially curative treatment for this disease, it is of the utmost importance to appropriately select the group of patients with initial stage pancreatic tumors that have not extended and can therefore be resected. Several different imaging techniques can be used for this purpose: ultrasonography (US), computed tomography (CT), magnetic resonance (MR), as well as the recent additions of endoscopic ultrasonography (EUS) and positron emission tomography (PET). Other techniques, such as laparoscopy and laparoscopic ultrasonography, also play a role in the diagnosis and staging of these patients. Continual technological developments in each of the above-mentioned techniques have led to reiterated updates in the scientific literature throughout the last two decades. This review aims to evaluate each of these techniques and present diagnostic algorithms reflected in the literature in order to achieve the greatest diagnostic accuracy in determining the extent of the disease so that unnecessary surgery can be avoided in cases not susceptible to resection.
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Affiliation(s)
- C Ayuso
- Servicio de Radiodiagnóstico, Hospital Clínic, Barcelona, España.
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Ishigaki S, Itoh S, Satake H, Ota T, Ishigaki T. CT depiction of small arteries in the pancreatic head: assessment using coronal reformatted images with 16-channel multislice CT. ACTA ACUST UNITED AC 2006; 32:215-23. [PMID: 16967252 DOI: 10.1007/s00261-006-9042-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 07/11/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND To assess the capabilities of 16-channel multislice CT in acquiring almost exclusively arterial-phase images of the pancreas and depicting small pancreatic arteries in coronal reformatted images. MATERIALS AND METHODS In 45 consecutive patients, arterial-phase contrast enhancement was measured in the aorta and its branches, portal venous system, and pancreas. Coronal reformatted images of 1.2- or 1.3-mm slice thickness at 0.8- or 0.9-mm intervals were generated from axial images acquired with 0.5-mm collimation. Two radiologists evaluated the quality of imaging in the arterial phase and the visibility of the pancreatic arteries in coronal reformatted images. RESULTS Mean enhancement in the aorta and its branches was greater than 300 HU, while that in the portal venous system and pancreas was less than 100 HU. The images were judged to be suitable for delineating the pancreatic arteries in all patients. The following arteries were visualized: anterior superior pancreaticoduodenal (39 patients), posterior superior pancreaticoduodenal (41), anterior inferior pancreaticoduodenal (39), posterior inferior pancreaticoduodenal (33), dorsal pancreatic (42), its right branch (34), and transverse pancreatic (37). CONCLUSION Multislice CT can depict small pancreatic arteries using coronal reformatted images generated from almost exclusively arterial-phase axial images acquired with 0.5-mm collimation.
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Affiliation(s)
- Satoko Ishigaki
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
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Itoh S, Fukushima H, Takada A, Suzuki K, Satake H, Ishigaki T. Assessment of Anomalous Pancreaticobiliary Ductal Junction with High-Resolution Multiplanar Reformatted Images in MDCT. AJR Am J Roentgenol 2006; 187:668-75. [PMID: 16928928 DOI: 10.2214/ajr.05.0824] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of our study was to assess the capabilities of MDCT for the diagnosis of an anomalous pancreaticobiliary ductal junction using high-resolution multiplanar reformatted (multiplanar reconstruction) images. MATERIALS AND METHODS This study included nine patients with and 54 without an anomalous pancreaticobiliary ductal junction confirmed on direct cholangiopancreatography. Multiplanar reconstruction images with 0.5-mm continuous slices were generated from isotropic or nearly isotropic pancreatic phase images. By mainly interpreting the multiplanar reconstruction images using the Scrolling mode, two blinded reviewers independently determined whether the confluence of the pancreatic and biliary ducts joined in the pancreatic parenchyma (in other words, outside the duodenal wall). The results were correlated with the findings of direct cholangiopancreatography. The diagnostic capabilities of CT for revealing associated pancreatobiliary diseases were assessed in patients with this anomaly. RESULTS Interobserver agreement in the classification of the duct confluence was high (kappa = 0.804). The duct confluence was identified in all patients except four without an anomalous pancreaticobiliary ductal junction. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT for diagnosing an anomalous pancreaticobiliary ductal junction were 100% (9 of 9 patients), 87% (47 of 54 patients), 89% (56 of 63 patients), 75% (9 of 12 patients), and 100% (47 of 47 patients) in the final decisions, respectively. CT showed all associated pancreatobiliary diseases except bile duct stones in two patients. CONCLUSION MDCT enabled the diagnosis of an anomalous pancreaticobiliary ductal junction by showing whether the pancreatic and biliary ducts join within the pancreatic parenchyma on high-resolution multiplanar reconstruction images.
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Affiliation(s)
- Shigeki Itoh
- Department of Technical Radiology, Nagoya University School of Health Sciences, Nagoya, Aichi 461-8673, Japan.
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27
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Kirkpatrick IDC, Desser TS, Nino-Murcia M, Jeffrey RB. Small cystic lesions of the pancreas: clinical significance and findings at follow-up. ACTA ACUST UNITED AC 2006; 32:119-25. [PMID: 16944031 DOI: 10.1007/s00261-006-9080-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2005] [Accepted: 08/25/2005] [Indexed: 01/01/2023]
Abstract
BACKGROUND Our purpose was to correlate the imaging findings of small cystic pancreatic lesions to the incidence of growth on follow-up imaging and their pathologic diagnoses. METHODS CT images for 159 patients with cystic pancreatic lesions were retrospectively evaluated and lesions were assessed for size, number, connection to the main pancreatic duct (MPD), MPD dilatation, and any presence of loculation, wall irregularity, thick septations, or solid components. A total of 86 patients had follow-up imaging with time periods of less than 6 months (n = 21), 6-12 months (n = 22), 1-2 years (n = 14), and greater than 2 years (n = 29). Lesion histology was available in 20 patients. RESULTS Lesions with pathologic correlation proved to be: side branch intraductal papillary mucinous neoplasm or tumor (IPMT) (n = 5), combined type IPMT (n = 4), nonmucinous cyst (n = 4), chronic pancreatitis (n = 2), and reactive atypia with nonmucinous fluid (n = 1), combined type IMPT with foci of adenocarcinoma (n = 1), mucinous adenocarcinoma (n = 2), and nonmucinous adenocarcinoma (n = 1). Lesions with solid components were significantly more likely to grow and be malignant (P < 0.05). The presence of MPD dilatation was more common in patients with combined type IPMTs or malignancies. No other factors were predictive of malignancy. CONCLUSIONS Solid components are predictive of malignancy, and MPD dilatation should prompt consideration of surgery. Other cystic lesions can be followed.
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Itoh S, Ikeda M, Satake H, Ota T, Ishigaki T. The Effect of Patient Age on Contrast Enhancement During CT of the Pancreatobiliary Region. AJR Am J Roentgenol 2006; 187:505-10. [PMID: 16861556 DOI: 10.2214/ajr.05.0541] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to assess whether it is possible to reduce the dose and rate of contrast material injection in elderly patients in triple-phase contrast-enhanced CT of the pancreatobiliary region with an MDCT scanner. SUBJECTS AND METHODS One hundred twelve patients were divided into three groups: contrast injection at 0.08 mL/kg body weight/s (an upper limit of 5 mL/s) over 30 seconds in patients 60 years old or younger (group 1, n = 49), the same contrast injection as group 1 in patients more than 60 years old (group 2, n = 32), and contrast injection at 0.07 mL/kg body weight/s (an upper limit of 4.5 mL/s) over 30 seconds in patients more than 60 years old (group 3, n = 31). Contrast enhancement in the aorta, portal venous system, pancreas, and liver was assessed quantitatively. Two radiologists blinded to the patients' clinical information and the injection protocol used to acquire the CT images graded the degree of contrast enhancement using a 5-point scoring system. The results for the different groups were statistically compared. RESULTS Contrast enhancement in the main phases for all organs was significantly more intense in group 2 than in groups 1 and 3. Cases in which pancreatic enhancement in the pancreatic phase was graded as excessive were more frequently observed in group 2. No statistically significant differences were observed between groups 1 and 3 in either quantitative or visual assessment for enhancement of any organ in any phase. CONCLUSION We recommend reducing the dose and rate of contrast material injection by at least 10% for elderly patients undergoing MDCT examination of the pancreatobiliary region.
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Affiliation(s)
- Shigeki Itoh
- Department of Technical Radiology, Nagoya University School of Health Sciences, Daikou-minami 1-1-20, Higashi-ku, Nagoya 461-8673, Japan.
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Kiresi DA, Kivrak AS, Ecirli S, Toy H. Secondary breast, pancreatic, and renal involvement with non-Hodgkin's lymphoma: Imaging findings. Breast 2006; 15:106-10. [PMID: 16473741 DOI: 10.1016/j.breast.2004.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2004] [Revised: 07/26/2004] [Accepted: 11/22/2004] [Indexed: 11/29/2022] Open
Abstract
The radiologic features in a patient with breast, pancreatic, and renal non-Hodgkin's lymphoma are presented in this paper. Although diagnosis of lymphoma is based on histologic criteria, radiologic techniques may be helpful in the evaluation and follow-up of masses in patients with lymphoma.
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Affiliation(s)
- Demet Aydogdu Kiresi
- Department of Radiology, Selcuk University Meram Medical Faculty, 42080 Konya, Turkey.
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30
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Kim HC, Park SI, Park SJ, Shin HC, Oh MH, Kim CH, Kim TY, Kim HH, Bae WK, Kim IY. Pancreatic carcinoid tumor with obstructive pancreatitis: multislice helical CT appearance: case report. ACTA ACUST UNITED AC 2006; 30:601-4. [PMID: 15688104 DOI: 10.1007/s00261-004-0285-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 10/06/2004] [Indexed: 11/24/2022]
Abstract
Carcinoid tumor of the pancreas is rare. Moreover, obstructive pancreatitis secondary to a pancreatic carcinoid tumor is extremely rare. We report a case of pancreatic carcinoid tumor in a 50-year-old male who presented with pancreatitis. On multislice helical computed tomography, the main pancreatic duct was obstructed by a small round tumor, and the main pancreatic duct proximal to the tumor was dilated. The correlation between the main pancreatic duct and the tumor was well depicted on minimum intensity projection image. This is the first report of multislice helical computed tomorgraphic and minimum intensity projection image findings of a pancreatic carcinoid tumor presenting with pancreatitis.
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Affiliation(s)
- H C Kim
- Department of Diagnostic Radiology, Soonchunhyang University, Cheonan Hospital, 23-20 Bongmyung-dong, Cheonan-si, Chungcheonam-do 330-721, Republic of Korea.
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31
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Abstract
CT is the primary imaging modality of the pancreas. This article reviews the multidector CT technique and its current status in the diagnosis of various pancreatic diseases. Special emphasis is given to the impact of multidetector CT and postprocessing imaging techniques on the staging of pancreatic adenocarcinoma.
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Affiliation(s)
- Raj Mohan Paspulati
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106-5056, USA.
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32
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Itoh S, Takada A, Satake H, Ota T, Ishigaki T. Diagnostic Value of Multislice Computed Tomography for Pancreas Divisum. J Comput Assist Tomogr 2005; 29:452-60. [PMID: 16012299 DOI: 10.1097/01.rct.0000164670.88519.e5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the capabilities of high-resolution oblique coronal reconstruction images obtained by multislice computed tomography (CT) in diagnosing pancreas divisum. METHODS This study included 11 patients with and 53 without pancreas divisum confirmed by direct cholangiopancreatography. Two blinded readers retrospectively interpreted oblique coronal reconstruction images with 0.5-mm continuous slices generated from isotropic or nearly isotropic pancreatic phase images with the scrolling mode and assessed the continuity of the ventral pancreatic duct, dorsal pancreatic duct, and main pancreatic duct in the body. The results were correlated with the findings of direct cholangiopancreatography. Other abnormal findings of the pancreatobiliary region on CT were also recorded in patients with pancreas divisum. RESULTS The sensitivity and specificity of CT for diagnosing pancreas divisum were 100% and 89%, respectively. Computed tomography demonstrated all associated pancreatobiliary diseases. CONCLUSION High-resolution oblique coronal reconstruction images allow us to make a diagnosis of pancreas divisum by depicting the continuity of the pancreatic ducts.
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Affiliation(s)
- Shigeki Itoh
- Department of Technical Radiology, Nagoya University School of Health Sciences, Nagoya 461-8673, Japan.
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33
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Kouvaraki MA, Solorzano CC, Shapiro SE, Yao JC, Perrier ND, Lee JE, Evans DB. Surgical treatment of non-functioning pancreatic islet cell tumors. J Surg Oncol 2005; 89:170-85. [PMID: 15719379 DOI: 10.1002/jso.20178] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Pancreatic endocrine tumors (PETs) are rare neoplasms originating from the amine precursor uptake and decarboxylation (APUD) stem cells. Although the majority of PETs are sporadic, they frequently occur in familial syndromes. PETs may cause a variety of functional syndromes or symptoms of local progression if they are non-functional. General neuroendocrine tumor markers are highly sensitive in the diagnostic assessment of a PET. Imaging studies for tumor localization and staging include computer tomography (CT) scan, magnetic resonance imaging (MRI), In(111)-octreotide scan, MIBG, and endoscopic ultrasonography (EUS). Treatment of PETs often requires a multi-modality approach; however, surgical resection remains the only curative therapy for localized (non-metastatic) disease. Treatment of metastatic disease includes biologic agents, cytotoxic chemotherapy, and liver-directed therapies.
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Affiliation(s)
- Maria A Kouvaraki
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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34
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Takada A, Itoh S, Suzuki K, Iwano S, Satake H, Ota T, Ikeda M, Ishigaki T. Branch duct-type intraductal papillary mucinous tumor: diagnostic value of multiplanar reformatted images in multislice CT. Eur Radiol 2005; 15:1888-97. [PMID: 15765209 DOI: 10.1007/s00330-005-2704-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2004] [Revised: 01/29/2005] [Accepted: 02/03/2005] [Indexed: 01/31/2023]
Abstract
The object of this study was to evaluate the usefulness of high-resolution multiplanar reformatted (MPR) images obtained by multislice CT in demonstrating connection between pancreatic cystic lesions and the main pancreatic duct. The study included 27 lesions with connection to the main pancreatic duct and 12 lesions without. All but one of the former lesions were branch duct-type intraductal papillary mucinous tumors (IPMTs). Oblique and curved MPR images with 0.5 mm continuous slices were generated from pancreatic-phase axial images reconstructed with 0.5 mm or 1 mm thickness at 0.5 mm intervals over a 260 mm field of view. The diagnostic capabilities for demonstrating connection with the main pancreatic duct were compared among axial images, MPR images, and both axial and MPR images in combination using the Brier score. The diagnosis in MPR images for demonstrating connection was more certain than that in axial images (P<0.05). Compared with MPR images alone, the use of both axial and MPR images resulted in further improvements in diagnostic performance, although the difference was not statistically significant. The use of high-resolution MPR images significantly improves diagnostic performance for demonstrating connection between pancreatic cystic lesions and the main pancreatic duct, which is useful for the diagnosis of branch duct-type IPMT.
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Affiliation(s)
- Akira Takada
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
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35
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Abstract
Hepatocellular carcinoma is one of the most common causes of cancer death worldwide. Numerous surgical and nonsurgical treatment options are available for the management of patients with HCC. Successful long-term outcome is dependent on early detection of HCC, as well as accurate delineation of the number and location of tumor nodules. We present the different manifestations of hepatocellular carcinoma as depicted by multidetector-row CT with advanced image processing.
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Affiliation(s)
- Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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36
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Faria SC, Tamm EP, Loyer EM, Szklaruk J, Choi H, Charnsangavej C. Diagnosis and staging of pancreatic tumors. Semin Roentgenol 2004; 39:397-411. [PMID: 15372753 DOI: 10.1016/j.ro.2004.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Silvana C Faria
- Department of Radiology, Division of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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37
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Tunaci M. Multidetector row CT of the pancreas. Eur J Radiol 2004; 52:18-30. [PMID: 15380844 DOI: 10.1016/j.ejrad.2004.03.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2004] [Revised: 03/15/2004] [Accepted: 03/18/2004] [Indexed: 01/21/2023]
Abstract
Multidetector CT (MDCT) has gained a great role in clinical imaging practice in a short time. Its major advantages are faster image acquisition and improved z-axis resolution. In spite of the advent of other imaging modalities CT is still the gold standard for the evaluation of pancreatic pathology. In this article, a review of the utility of MDCT in pancreatic applications is given with emphasis on acquisition techniques tailored to contrast material pharmacokinetics to improve lesion detection and characterization.
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Affiliation(s)
- Mehtap Tunaci
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, 34390 CAPA, Istanbul, Turkey.
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38
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Abstract
Abdominal imaging with multi-detector row computed tomography (CT) can be performed during short breath holds. On 16-channel multi-detector row CT scanners, the effective detector row thickness, depending on the manufacturer, is typically 1.0-1.5 mm, which results in a beam collimation of 16-24 mm. At a gantry rotation speed of 0.5 second and a pitch of 1, the table travel speed will be 32-48 mm/sec. At a smaller effective detector row thickness and a narrower beam collimation, a slightly higher pitch may be needed to obtain short-breath-hold CT scans. Typically, transverse scans are viewed at a reconstructed section thickness of 3-5 mm, with thinner sections used for CT angiography and whenever off-axial reformations are obtained. The radiologic technique should be optimized according to the transverse section thickness used for interpretation, and the contrast material administration protocol should be optimized according to the clinical problem, with the scanning triggered for enhancement of a target organ.
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Affiliation(s)
- Sanjay Saini
- Department of Radiology, Harvard Medical School and Massachusetts General Hospital, 32 Fruit St, Boston, MA 02114, USA.
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39
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Kamel IR, Lawler LP, Corl FM, Fishman EK. Patterns of collateral pathways in extrahepatic portal hypertension as demonstrated by multidetector row computed tomography and advanced image processing. J Comput Assist Tomogr 2004; 28:469-77. [PMID: 15232377 DOI: 10.1097/00004728-200407000-00006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pancreatic neoplasm can compromise the portal vein or its tributaries, resulting in extrahepatic portal hypertension. Collateral channels may develop, usually in a hepatopetal direction. These include gastroepiploic veins, short gastric veins, left gastric vein, left colic veins, and spontaneous splenorenal shunts. We present the spectrum of these collaterals as delineated by multidetector row computed tomography with advanced image processing. Delineation of these collaterals is important before surgery so as to avoid possible uncontrollable bleeding if they are inadvertently disrupted.
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Affiliation(s)
- Ihab R Kamel
- Russel H Morgan Department of Radiology, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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40
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Gong JS, Xu JM. Role of curved planar reformations using multidetector spiral CT in diagnosis of pancreatic and peripancreatic diseases. World J Gastroenterol 2004; 10:1943-7. [PMID: 15222042 PMCID: PMC4572236 DOI: 10.3748/wjg.v10.i13.1943] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To investigate the role of curved planar reformations using multidetector spiral CT (MSCT) in diagnosis of pancreatic and peripancreatic diseases.
METHODS: From October 2001 to September 2003, 47 consecutive patients with pancreatic or peripancreatic diseases, which were confirmed by operation, endoscopic retrograde cholangiopancreatography and clinical follow-up, were enrolled in this study. CT scanning was performed at a MSCT with four rows of detector. A set of images with an effective thickness of 1.0-2.0 mm and a gap of 0.5-1.0 mm (50% overlap) were acquired in all patients for post-processing. Curved planar reformations were carried out by drawing a curved line on transverse source images, coronal or sagittal multiplanar reformations according to certain anatomic structures (such as cholangiopancreatic ducts or peripancreatic vessels) and the position of lesion.
RESULTS: With thin collimation, MSCT could acquire high-quality curved planar reformations to display the profile of the whole pancreas, to trace the cholangiopancreatic ducts and peripancreatic vessels, and to show the relationship of lesions with pancreas and peripancreatic anatomic structures in one curved plane, which facilitates diagnosis and rapid communication of diagnostic information with referring physicians.
CONCLUSION: MSCT with thin collimation could be used to create high-quality curved planar reformations in evaluating pancreatic and peripancreatic diseases with pertinent anatomic information and relative pathologic signs to facilitate the diagnosis and enhance communication with the referring physician. Curved planar reformations can serve as supplements for transverse images in diagnosis and management of pancreatic and peripancreatic diseases.
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Affiliation(s)
- Jing-Shan Gong
- Department of Radiology, Shenzhen People's Hospital (Second Affiliated Hospital, School of Medicine, Jinan University), Shenzhen 518020, Guangdong Province, China.
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41
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Vargas R, Nino-Murcia M, Trueblood W, Jeffrey RB. MDCT in Pancreatic adenocarcinoma: prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations. AJR Am J Roentgenol 2004; 182:419-25. [PMID: 14736675 DOI: 10.2214/ajr.182.2.1820419] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of our study was to determine the negative predictive value of MDCT with curved planar reformations for detecting vascular invasion and predicting overall resectability in patients with pancreatic adenocarcinoma. MATERIALS AND METHODS Imaging findings related to vascular invasion and overall tumor resectability in 25 patients who underwent contrast-enhanced biphasic MDCT evaluation were correlated with actual vessel invasion and overall resectability determined at surgery and pathologic examination. The presence of vascular invasion was assessed in 110 major peripancreatic vessels in 22 patients who underwent resection. RESULTS On MDCT, 23 (92%) of 25 patients were deemed to have resectable pancreatic adenocarcinoma. The tumors in the remaining two (8%) were considered not resectable because of the presence of vascular invasion (which was confirmed in only one patient at surgery). Of those 23 patients deemed to be candidates for curative resection on the basis of MDCT results, 20 were found to have resectable adenocarcinoma at time of surgery, yielding a negative predictive value for MDCT of 87% (20/23 patients) for overall resectability. In the other three patients, adenocarcinoma was deemed to be unresectable because of small metastases to the liver (two patients) or to the peritoneum (one patient) discovered at surgery. For detection of vascular invasion, MDCT yielded a negative predictive value of 100% (108/108 vessels) with no false-negative findings and an accuracy of 99% (109/110 vessels) with 108 true-negative findings, one true-positive finding, and one false-positive finding. CONCLUSION Our preliminary data on MDCT show that the technique has excellent negative predictive value for vascular invasion and good negative predictive value for overall tumor resectability in patients with pancreatic adenocarcinoma, suggesting an improvement over previous results reported using single-detector CT. The problem of undetected micrometastases to the liver and peritoneum remains.
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Affiliation(s)
- Rafael Vargas
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, Room H1307, Stanford, CA 94305, USA
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