Abstract
Objective: To study the value of multiple MR imaging techniques in the diagnosis of pancreatic carcinoma and the assessment of resectbility of the lesion.Methods: MR imaging was performed in 18 patients with surgically and/or pathologically proven pancreatic carcinoma. GRE T1WI, TSE T2WI, GRE T1W1 with fat suppression, delayed enhancement GRE T1WI, MRCP and 3D DCE MRA were used in MR scanning. Tumor involvement of the celiac trunk and its main branches, superior mesenteric artery, the portal, splenic and superior mesenteric veins were prospectively graded on a 0–4 scale based on circumferential contiguity of tumor to vessel.Results: On GRE T1WI and TSE T2WI all the lesions showed slightly hypointense and hyperintense, respectively; On GRE T1WI with fat suppression, all the tumors obviously appeared hypointense; On delayed enhancement GRE T1WI, the lesions displayed irregularly circular enhancement in 14 patients and well-distributed enhancement in 4 patients. MRCP showed extensive bile and main pancreatic duct dilatation with typical “double-duct” sign in 8 patients. On 3D DCE MRA, we thought it was unresectable with more than half circumferential involvement of tumor to vessel, so that the portal, splenic and superior mesenteric veins were involved with 56% (10/18), 39% (7/18) and 67% (12/18), respectively. The celiac trunk and its main branches and superior mesenteric arteries were involved with 22% (4/18) and 17% (3/18), respectively. The pancreatic lesions in 2 cases could be completely resected in the evaluation of MR imaging, which was fitted to the findings of operation by pancreatoduodenectomy. The pancreatic lesions in other 2 cases were partly, resected because there was tumor extension to superior mesenteric vein and/or artery. The tumors in the remaining 14 patients were too large and involved peripancreatic vessels or there were stomach or liver metastases, so these patients were only treated by choledochojejunostomy and gastrojejunstomy.Conclusion: The “all-in-one” MR approach including fast scanning sequences, fat suppression, MRCP and 3D DCE MRA provides the surgeon with diagnosis and assessment of resectability of the lesion prior to surgery of pancreatic carcinoma.
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