The Evaluation Of MSCT For Peripancreatic Vascular Invasion In Pancreatic Carcinoma

Objective To analysis the image findings of peripancreatic vessel invasion in pancreatic carcinoma using MSCT and evaluate the value of CTA on preoperative assessment.Methods Spiral CT enhancement scanning obtained in Forty-nine patients (28men;21women;age coverage,33~80years)with pancreatic cancer confirmed by surgery and pathology.The row data obtained in every phase were transferred to ADW4.2 postprocessing work-station.CT angiograms were produced with multiprojection volume reconstruction(MPR),maximum-intensity projection(MIP),minimum-intensity projection (MINIP), curve planar reformation(CPR), volume Rendering(VR) to assess the major peripancreatic vessel.The preoperative state of the peripancreatic vessel invaded by tumor were evaluated with three-dimension and axial images bye two radiologist who were blinded to the operative outcome.CT results were correlated with surgical and histopathologic results.Result Correlated stydy was done in 49 patient,Lesions located in uncinate process 8 cases, head and cervical part 33cases, body 5 cases, tail 2cases and whole part 1 case of pancreas respectively. The main peripancreatic vessel invasion including CA 3 cases,CHA 7 cases,SMA 8 cases,PV 16 cases, SMV 24 cases, SV 11 cases,IVC 2 cases respectively, 35 cases with major peripancreatic vessel invaded and 14 cases without major peripancreatic vessel invaded were affirmed in the operation. Whereas 33cases with major peripancreatic vessel invaded and 16 cases without major peripancreatic vessel invaded were affirmed with CTA. The CT signs of peripanereatic arterial invasion based on: vessel embedment in tumor or obliteration; tumor involvement exceeding one-half of the circumference of the vessel; vessel wall irregularity; vessel caliber stenosis and rigor; teardrop;. For prediction of vessel encroachment, MSCT had an accuracy of 87.75%, sensitivity of 88.57%, sensitivity of 85.71% positive predictive value of 93.94% and negative predictive of 75%。In addition,MSCT allowed detection of liver metastases in 2 of 3 cases (66.7),nodal involvement in 5 of 9 cases (55.6%).Conclusion MSCT was more direct-viewing and accurate in assessment of major peripancreatic vessel invaded by pancreatic carcinoma combined with MSCTA. The prediction of peripancreatic vessel invaded with MSCT had prospective guide significance for surgery.