“Peripancreatic strands appearance” in pancreatic body and tail carcinoma: evaluation by multi-detector CT with pathological correlation

Abstract

In pancreatic body and tail carcinoma, "peripancreatic strands appearance" is frequently seen on multidetector CT (MDCT). The purpose of this study was to clarify the pathological and clinical implications of peripancreatic strands appearance. We retrospectively evaluated MDCT images in 17 patients with pancreatic body and tail carcinoma who underwent surgical resection. Peripancreatic strands appearance was defined as the strands structure deriving from the primary lesion and associated with increased CT attenuation of surrounding adipose tissues. All CT examinations were performed by contrast-enhanced MDCT with a multiplanar reformation technique. Peripancreatic strands appearance was detected on MDCT in 13 (76%) patients. The maximum width of the peripancreatic strands seen on MDCT was 1.55 ± 0.36 mm (range, 1.0-2.5 mm). This CT finding was well correlated with extrapancreatic carcinoma invasion with marked fibrotic thickening of adipose tissue septa, including microvessels. This pathological finding was confirmed in all 13 patients with positive CT finding whereas it was not confirmed in the 4 patients with negative CT finding. Peripancreatic strands appearance on MDCT in pancreatic body and tail carcinoma reflects extrapancreatic carcinoma invasion with marked fibrotic thickening of adipose tissue septa. This CT finding would indicate the property of carcinoma aggressiveness.