MDCT with three-dimensional fusion images in the preoperative evaluation of pancreaticoduodenectomy

Abstract

Objective To study the role of MDCT with 3D fusion images in the preoperative evaluation of pancreaticoduodenectomy. Methods 37 patients who underwent pancreaticoduodenectomy from March 2016 to May 2018 in the Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University were included in this retrospective study. All patients underwent a dual-phase enhanced MDCT before operation. The volume data of enhanced MDCT were transmitted to a dedicated CT post-processing workstation. The 3D images, including the tumor, pancreas, portal vein system, arterial system, pancreatic and biliary tract, were reformatted respectively before the fusion imaging. Two reviewers analyzed the tumor location and its spatial relations with the pancreaticobiliary system, peripancreatic vessels and vascular variations by means of zooming, rotating, splitting and transparent displaying on fusion images. Then, the assessed items were compared to the surgical and pathological findings. Results The 3D fusion images of 37 patients in this study depicted the tumor, pancreas, peripancreatic vessels and pancreatic and biliary tract clearly. Compared with the intraoperative and pathological findings, the accuracy of both tumor detection and localization with the 3D fusion images was 100%. To compare the intraoperative findings, visualization and variation detection of the celiac, splenic, common hepatic, gastroduodenal, hepatic, and superior mesenteric arteries, and the superior mesenteric and portal veins were all 100%. Visualizations of the anterior superior pancreaticoduodenal artery (ASPDA), posterior superior pancreaticoduodenal artery (PSPDA), inferior pancreaticoduodenal artery (IPA) and dorsal pancreatic artery (DPA) were 85.7%, 82.8%, 72.2% and 75.8%, respectively. Conclusion The MDCT 3D fusion imaging technology allowed one stop preoperative assessment of pancrea-ticoduodenectomy, especially in clearly outlining the tumor location and its spatial relations with the surrounding surgical anatomies before surgery. Key words: Pancreaticoduodenectomy; Multi-detector computed tomography; 3-dimensional reconstruction; Evaluation