Evaluation of Resectability of Pancreatic Cancer by MDCT
Multidetector row CT (MDCT) is a useful method for correct diagnosis of pancreatic cancers. Multiphase dynamic contrast-enhanced CT with high iodine concentration contrast medium (350 mgI/ml, 100–135 ml) is necessary for evaluation of predictability of pa
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Evaluation of Resectability of Pancreatic Cancer by MDCT Toshifumi Gabata
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Introduction
Ninety-five percent of pancreatic cancers and pancreatic ductal cancers are adenocarcinomas, which are characterized by rich stromal parenchyma and an infiltrative growth pattern. Even on plain CT large advanced pancreatic cancers obviously invading peripancreatic adipose tissue and peripancreatic blood vessels (celiac artery~splenic artery and common hepatic artery, superior mesenteric artery, splenic vein~portal vein) can be identified in many cases. In contrast, relatively small tumors that do not exceed the pancreatic rim and are resectable are not detectable by plain CT. If pancreatic cancer occludes the main pancreatic duct, caudal pancreatic duct dilatation and atrophy of the pancreatic parenchyma, in other words tumor- associated chronic pancreatitis, are induced. Accordingly, when interpreting plain CT even more important than detection of the tumor itself is meticulous confirmation of the presence/absence of pancreatic duct dilatation and an atrophic, irregular pancreatic parenchyma. Furthermore, in some cases acute pancreatitis may be induced by pancreatic duct occlusion associated with growth of the pancreatic cancer. Especially various findings suggestive of acute pancreatitis such as increased adipose tissue density and exudate accumulation around the pancreas body and tail, and left perirenal fascial thickening can be observed on plain CT too. However, for the early detection of pancreatic cancer and determination of the extent of its spread plain CT, as well as only contrast-enhanced CT, is far from adequate. In this context, contrast-enhanced dynamic CT (dynamic CT) using MDCT is essential. Recently, use of 16–256 multidetector row CT (MDCT) has become widespread, and indeed seems to have become the standard against which other modalities are measured. However, full advantage cannot be taken of the capabilities of MDCT for T. Gabata Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa Prefecture, Japan e-mail: [email protected] © Springer Science+Business Media Singapore 2017 H. Yamaue (ed.), Innovation of Diagnosis and Treatment for Pancreatic Cancer, DOI 10.1007/978-981-10-2486-3_3
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the diagnosis of pancreatic cancer if only past imaging methods used for contrast- enhanced CT are applied. To enhance the detectability of pancreatic cancer and the diagnosis of the extent of its spread, a sufficient volume of a high concentration iodinated contrast medium must be rapidly injected intravenously, a thin slice thickness selected, and multiphasic dynamic CT performed. Since unlike hepatocellular carcinoma it is not possible to establish a high-risk group for pancreatic cancer, if pancreatic cancer is overlooked on the initial CT, on subsequent examinations progression to unresectable advanced pancreatic cancer is almost inevitably found, and so imaging should be conducted using the highest possible quality CT, and every effort made not to overlook any of the early f
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