Assessment Of Vascular Invasion Research Articles

Diagnostic value of multi-detector computed tomography angiography (MDCTA) in assessment of vascular invasion and resectability of pancreatic head cancer

Introduction: pancreatic carcinoma is a common gastrointestinal malignancy. Accurate preoperative imaging helps to avoid unnecessary or unsuccessful surgical procedures and reduce the number of aborted pancreatic resections. MDCT is the most widely available and best validated tool for imaging patients with pancreatic adenocarcinoma. Objective: to evaluate the diagnostic value of resectability and local staging of Pancreatic Head Cancer by MDCTA. Materials and methods: This cross-sectional study was conducted on 20 patients referred to the Diagnostic Radiology and Medical Imaging Department at Tanta University Hospitals presenting with pancreatic head cancer. Results: Patients underwent exploratory laparoscopy or laparatomy with progression to a pancreaticoduodenectomy as deemed resectable in 7 (35%) patients, and 6 (30%) of patients underwent exploratory laparoscopy or laparatomy with progression to Gasterojejunostomy, 4 (20%) of patients underwent ERCP for biliary stenting and 3 (15 %) of patients were inoperable. In the studied patients, 15.4% of resectable by MDCTA found to be unresectable at laparoscopy exploratory with true positive was 100%. The MDCTA imaging sensitivity was 100%, specificity was 71%, NPV was 100% and PPV was 87% with accuracy of 90% to assess for resectability.

Intravascular Ultrasound for the Evaluation and Management of Retroperitoneal, Genitourinary Malignancies.

Herein we provide a review of intravascular ultrasound (IVUS) and its ability to assist in the evaluation and surgical management of advanced retroperitoneal, genitourinary tumors. Advanced retroperitoneal tumors such as advanced renal cell carcinoma, bulky retroperitoneal lymphadenopathy associated with advanced testicular carcinoma, large adrenal tumors, and retroperitoneal sarcomas can invade, compress, or distort vascular anatomy making surgical resection challenging and high risk. Intravascular ultrasonography is commonly used by vascular and cardiothoracic surgery to provide a real time assessment of vascular invasion, compression, and aberrant anatomy to assist with pre-operative and/or intraoperative decision-making. However, the application of this technology to assist with cancer surgery has been limited. The use of intravascular ultrasound prior to radical, extirpative, retroperitoneal surgery involving large vessels can aid in the planning and execution of such challenging operations.

Next-generation des-r-carboxy prothrombin for immunohistochemical assessment of vascular invasion by hepatocellular carcinoma

BackgroundWe have previously shown the value of next-generation des-r-carboxy prothrombin (NX-DCP) for predicting vascular invasion in hepatocellular carcinoma (HCC). Since conventional DCP is inaccurate under some conditions, this study aimed to assess whether NX-DCP immunohistochemical staining was related to vascular invasion in HCC.MethodsFifty-six patients scheduled to undergo resection for single HCC were divided into two groups, with and without pathological portal vein invasion. Immunohistochemical features of HCC and sites of vascular invasion were assessed using alpha-fetoprotein (AFP), conventional DCP, and NX-DCP.ResultsPathological portal vein invasion was absent in 43 patients and present in 13 patients. Patient characteristics, pathological background of the liver parenchyma, and tumor-related factors did not differ significantly between the groups. There was no significant difference in the serum AFP level between the groups, whereas levels of conventional DCP (p < 0.0001) and NX-DCP (p < 0.0001) were significantly higher in the vascular invasion group. Immunohistochemical staining showed no significant difference in the staining rate of tumor (67.9% vs. 80.7%, p = 0.08), but NX-DCP stained significantly more at the sites of vascular invasion (15.4% vs. 46.2%, p = 0.01) than conventional DCP. No vascular invasion was stained by AFP.ConclusionsNX-DCP offers better sensitivity for detecting sites of vascular invasion than AFP and conventional DCP.

Differential diagnosis and analysis of pancreatic cancer resectability using CT and MRI

The purpose of this publication is to comprehend the modern achievements of radiological diagnosis in surgical oncopancreatology via a critical analysis of recent English-language publications. CT and MRI are essential diagnostic methods in surgical and oncological pancreatology. The possibilities of tomography examination regarding analysis of tumor dimension, CT criteria for pancreatic cancer diagnosis, assessment of vascular invasion, differential diagnosis of tumors, as well as estimation of possible early postoperative complications and radiological features of the region of interest after neoadjuvant and adjuvant therapy for pancreatic tumors are critically analyzed. The role of modern diagnostic methods in improvement of treatment directly related to the early staging of pancreatic tumors is negligible, since the factors affecting the phases of slow and rapid tumor growth are unclear. Most likely, cyclic clinical and radiological evaluation of the pancreas will not give the expected results and is associated with advanced financial and physical costs. Perhaps, one of the approaches for effective treatment of pancreatic cancer will be the recognition of the need for laboratory and instrumental examinations by each patient. Acceptable frequency of examinations and own funds are determined by a patients himself in this case.

Interobserver Agreement in Vascular Invasion Scoring and the Added Value of Immunohistochemistry for Vascular Markers to Predict Disease Relapse in Stage I Testicular Nonseminomas.

Vascular invasion has been identified as an informative risk factor for relapse in stage I testicular nonseminomas, used to tailor treatment. We investigated interobserver agreement in vascular invasion reporting and studied the potential additional value of immunohistochemistry for vascular markers for predicting relapse. Patients (n=52) with stage I testicular nonseminomas undergoing surveillance (1993-2006) were included (median follow-up of 66 mo). Two formalin-fixed paraffin-embedded blocks with >1 cm tissue and tumor/normal parenchyma interface were stained with hematoxylin and eosin and CD31, FVIII, and D2-40. Slides were assessed by 3 independent testicular germ cell tumor-dedicated pathologists, and agreement was assessed using Cohen κ statistic. Sensitivity, specificity, and accuracy of vascular invasion scoring in predicting relapse were calculated. Agreement among testicular germ cell tumor-dedicated pathologists was moderate (κ=0.49 to 0.54), as was performance in predicting disease relapse (particularly, specificity of 86%). Immunohistochemistry increased overall sensitivity (71%), but decreased specificity (71%) in predicting relapse. All patients (n=8) with both blood and lymphatic vascular invasion developed a relapse. In multivariable analysis (including age, tumor size, rete testis invasion, and serum tumor markers), only vascular invasion had an independent impact in predicting relapse. Assessment of vascular invasion by testicular germ cell tumor-dedicated pathologists is good and is clinically meaningful, predicting disease relapse. Immunohistochemistry for vascular markers improves sensitivity of detecting disease relapse and allows for the identification of high-risk patients with both blood and lymphatic vascular invasion simultaneously, potentially of interest for tailored chemotherapy.

Application value of multiple imaging techniques in the MDCT combined with assessment of vascular invasion using a tumor-to-vessel contact computed tomography grading system in preoperative evaluation of pancreatic cancer

Application value of multiple imaging techniques in the MDCT combined with assessment of vascular invasion using a tumor-to-vessel contact computed tomography grading system in preoperative evaluation of pancreatic cancer

Pancreatic ductal adenocarcinoma and local staging with MDCT: Effect of tube voltage and iodine load on assessment of vascular involvement

Purpose : In patients with pancreatic ductal adenocarcinoma (PDAC) a low-tube-voltage, high-iodine-load multidetector computed tomography (MDCT) protocol has been shown to increase tumour conspicuity compared to normal-tube-voltage, normal-iodine-load (standard) protocol. The aim of this study was to prospectively compare a low-tube-voltage with high- or normal-iodine-load MDCT protocol with a standard protocol regarding vascular involvement in patients with PDAC. Material and Methods: Thirty consecutive patients (16 women-14 men; mean age 67 and 65 years, respectively) with PDAC, deemed primary resectable at the multidisciplinary board, underwent twice preoperative triple-phase MDCT according to: (i) 120-kV standard protocol (PS; 0.75g iodine (I)/kg body weight, n =30) and (ii) 80-kV protocol A (PA; 0.75g I/kg, n =14) or protocol B (PB; 1g I/kg, n =16). Two independent readers evaluated vascular involvement and accuracy per protocol was calculated. A third reader calculated the vessel-to-tumour contrast-to-noise ratio (CNR). Statistical analysis was performed with the Chi-square test. Standard of reference was surgical and histopathological findings. Results : For readers 1/2, the accuracy of PS, PA, and PB was 91/91, 92/94, and 92/90%, respectively ( P >0.05). Compared to PS, PA and PB showed significantly higher artery-to-tumour CNR in the parenchymal phase ( P =0.015 and 0.0016, respectively) and vein-to-tumour CNR in the portal-venous phase (both, P <0.001). PB had significantly higher artery - to-tumour CNR compared to PA in parenchymal phase ( P =0.049). Conclusions : In primary resectable PDAC, vascular involvement was assessed with similarly high accuracy with all protocols. Low-tube-voltage protocols, particularly with high-iodine-load, increase the vessels-to-tumour CNR compared to standard protocol and may prove beneficial in patients with locally advanced tumours where assessment of vascular invasion may be challenging.

Resectability assessment of enhanced CT and contrast-enhanced endoscopic ultrasonography for the periampullary neoplasm.

199 Background: To evaluate the efficacy of enhanced CT and contrast-enhanced endoscopic ultrasonography (CE-EUS) for assessment of the resectability of periampullary neoplasm. Methods: a prospective analysis of 93 patients with periampullary neoplasm underwent CT and CE-EUS was conducted to compare the imaging data with the surgical and pathological findings, in order to evaluate their efficacies for the resectability assessment. Results: There was no significant difference in sensitivity and specificity between CT and CE-EUS in adjacent organ invasion, lymph node metastasis and liver metastasis (p &gt; 0.05). For the diagnosis of periampullary neoplasm and assessment of vascular invasion, CE-EUS was better than CT (94.6% vs 84.1%,P = 0.023; 96.2% vs 85.9%, P = 0.041). Logistic regression showed that the accuracy of CE-EUS in determining adjacent organ invasion was correlated with the tumor size, and vascular invasion was correlated with the tumor location and size. Conclusions: CE-EUS has advantages in the assessment of the resectability of periampullary neoplasm, especially for the assessment of vascular invasion, and can be used as a supplementary Imaging technology to the enhanced CT.

Vascular Resection in Pancreatic Cancer.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignant tumors and represents the fifth most common cause of cancer-related deaths. It is associated with a poor prognosis, likely due to the tendency of the tumor for early local and distant spread. One of the major obstacles of effectively treating PDAC is the often late diagnosis. Among all options currently available for PDAC, surgical resection offers the only potential cure with 5-year survival rate of approximately 15-20%. However, in the absence of metastatic disease, which precludes resection, assessment of vascular invasion is an important parameter for determining resectability for pancreatic cancer. The vascular involvement in patients with pancreatic carcinoma ranges between 21 and 64%. Historically, vascular involvement has been considered a contraindication to resective cure. Meanwhile, the surgical approach of pancreatoduodenectomy (PD) combined with vascular resection and reconstruction has been widely applied in clinical practice to remove the tumor completely. Therefore, vascular invasion is no longer a surgical contraindication and the rate of surgical resection has greatly increased. Moreover, PD combined with vascular resection can account for 20 to 25% of the total cases of PD surgery in a number of the larger pancreas treatment centers. The aim of this review is to provide an overview of management and outcome of vascular resection in PDAC surgery.

Resectibility assessment of enhanced CT and contrast-enhanced endoscopic ultrasonography for the periampullary neoplasm

To evaluate the efficacy of enhanced CT and contrast-enhanced endoscopic ultrasonography (CE-EUS) for assessment of the resectibility of periampullary neoplasm. a retrospective analysis of 93 patients with periampullary neoplasm underwent CT and CE-EUS was conducted to compare the imaging data with the surgical and pathological findings, in order to evaluate their efficacies for the resectibility assessment. There was no significant difference in sensitivity and specificity between CT and CE-EUS for the evaluation of adjacent organ invasion, lymph node metastasis and liver metastasis (P > 0.05). For the diagnosis of periampullary neoplasm and assessment of vascular invasion, CE-EUS was better than CT (94.6% vs 84.1%, P = 0.023; 96.2% vs 85.9%, P = 0.041). Logistic regression indicated that the accuracy of CE-EUS in determing adjacent organ invasion was correlated with the tumor size, and vascular invasion was correlated with the tumor location and size. CE-EUS has advantages in the assessment of the resectibility of periampullary neoplasm, especially for the assessment of vascular invasion, and can be used as a supplementary Image technology to the enhanced CT.

Assessment of vascular invasion in pancreatic carcinoma by MDCT

BackgroundPancreatic cancer is one of the aggressive cancers with poor resectability and survival rates. The relationship to adjacent vessels must be assessed before deciding the choice of treatment. AimAssessment of the MDCT signs of arterial and venous invasion in pancreatic carcinoma. Subjects and methodsTotal of 179 of the major peripancreatic vessels (CA; CHA; SMA; PV; SMV) in 47 patients who underwent surgery for pancreatic cancer after MDCT were assessed at surgery and compared with CT findings. Statistical analysis of the findings was done using Chi square test. Results115 vessels were not invaded at surgery, while the remaining 64 vessels were invaded (22 arteries and 42 veins). There was over all statistically significant difference between arterial and venous invasion regarding stenosis, occlusion, infiltration and circumferential involvement of the vessel wall. ConclusionAssessment of vascular invasion is crucial in the evaluation of resectability for pancreatic cancer. MDCT is an accurate diagnostic tool for peripancreatic vascular invasion in cancer pancreas.

The role of immunohistochemistry in the detection of vascular invasion in specimens of endoscopic submucosal dissection

INTRODUCTION: Endoscopic submucosal dissection (ESD) of early neoplasias of the gastrointestinal tract (GIT) has been increasingly applied as an alternative to invasive surgical procedures, with the aim to preserve the patient's organ and quality of life, although it does not allow the histopathological analysis of lymph nodes. Previous studies demonstrated that the presence of neoplastic emboli in lymphatic (lymphatic vascular invasion [LVI]) or blood vessels (blood vascular invasion [BVI]) is considered a positive predictive factor for the occurrence of lymph node metastasis. The assessment of vascular invasion carried out only by routine hematoxylin and eosin staining (HE) may yield both falsepositive and false-negative results. D2-40 is a specific monoclonal antibody to the lymphatic endothelium. Thus, it is useful for identifying LVI and distinguishing if tumor embolization is found in blood or lymphatic vessels. OBJECTIVE: To determine the role of immunohistochemistry (IHC) in the assessment of ESD specimens by comparing the detection of LVI and BVI by HE and IHC with D2-40 and CD34 immunolabeling. METHOD: We conducted the IHC study using D2-40 and CD34 markers (pan-endothelial) in 30 cases of ESD with histological diagnosis of carcinoma in order to assess the presence of LVI and BVI. RESULTS: The detection of LVI was more prevalent than BVI. Three out of six cases with LVI were false-positive by HE and six were false-negative by IHC. Regarding BVI, five cases were identified and one was false-negative by IHC. CONCLUSION: Our results indicated that the histopathological analysis of ESD specimens by exclusively routine HE staining does not allow proper evaluation of BVI or LVI.

Assessment of vascular invasion in gastric cancer: A comparative study

To evaluate and compare detection of lymphatic and blood vessel invasion (LVI and BVI) by hematoxylin-eosin (HE) and immunohistochemistry (IHC) in gastric cancer specimens, and to correlate with lymph node status. IHC using D2-40 (a lymphatic endothelial marker) and CD34 (a pan-endothelial marker) was performed to study LVI and BVI in surgical specimens from a consecutive series of 95 primary gastric cancer cases. The results of the IHC study were compared with the detection by HE using McNemar test and kappa index. The morphologic features of the tumors and the presence of LVI and BVI were related to the presence of lymph node metastasis. A χ(2) test was performed to obtain associations between LVI and BVI and other prognostic factors for gastric cancer. The detection rate of LVI was considerably higher than that of BVI. The IHC study identified eight false-positive cases and 13 false-negative cases for LVI, and 24 false-positive cases and 10 false-negative cases for BVI. The average Kappa value determined was moderate for LVI (κ = 0.50) and low for BVI (κ = 0.20). Both LVI and BVI were statistically associated with the presence of lymph node metastasis (HE: P = 0.001, P = 0.013, and IHC: P = 0.001, P = 0.019). The morphologic features associated with LVI were location of the tumor in the distal third of the stomach (P = 0.039), Borrmann's macroscopic type (P = 0.001), organ invasion (P = 0.03) and the depth of tumor invasion (P = 0.001). The presence of BVI was related only to the depth of tumor invasion (P = 0.003). The immunohistochemical identification of lymphatic and blood vessels is useful for increasing the accuracy of the diagnosis of vessel invasion and for predicting lymph node metastasis.

Vascular invasion in pancreatic cancer: Imaging modalities, preoperative diagnosis and surgical management.

Pancreatic cancer is associated with a poor prognosis, and surgical resection remains the only chance for curative therapy. In the absence of metastatic disease, which would preclude resection, assessment of vascular invasion is an important parameter for determining resectability of pancreatic cancer. A frequent error is to misdiagnose an involved major vessel. Obviously, surgical exploration with pathological examination remains the "gold standard" in terms of evaluation of resectability, especially from the point of view of vascular involvement. However, current imaging modalities have improved and allow detection of vascular invasion with more accuracy. A venous resection in pancreatic cancer is a feasible technique and relatively reliable. Nevertheless, a survival benefit is not achieved by curative resection in patients with pancreatic cancer and vascular invasion. Although the discovery of an arterial invasion during the operation might require an aggressive management, discovery before the operation should be considered as a contraindication. Detection of vascular invasion remains one of the most important challenges in pancreatic surgery. The aim of this article is to provide a complete review of the different imaging modalities in the detection of vascular invasion in pancreatic cancer.

Assessment of vascular invasion by bone and soft tissue tumours of the limbs: usefulness of MDCT angiography

To evaluate the accuracy of computed tomography angiography (CTA) in predicting arterial encasement by limb tumours, by comparing CTA with surgical findings (gold standard). Preoperative CTA images of 55 arteries in 48 patients were assessed for arterial status: cross-sectional CTA images were scored as showing a fat plane between artery and tumour (score 0), slight contact between artery and tumour (score 1), partial arterial encasement (score 2) or total arterial encasement (score 3). Reformatted CTA images were assessed for arterial displacement, rigid wall, stenosis or occlusion. At surgery, arteries were classified as free or surgically encased; 45 arteries were free and 10 were surgically encased. Multivariate logistic regression identified the axial CTA score as a relevant predictor for arterial encasement and subsequent vascular intervention during surgery. All sites where CTA showed a fat plane between the tumour and the artery were classified as free at surgery (n = 28/28). The sensitivity of total arterial encasement on CTA (score 3) was 90%, specificity 93%, accuracy 93% and positive likelihood ratio 13.5. CTA evidence of total arterial encasement is a highly specific indication of arterial encasement. The presence of fat between the tumour and the artery on CTA rules out arterial involvement at surgery.

Vasküler İnvazyonların Değerlendirilmesinde Sanal Anjioskopi:BT Anjiografiden Daha Güvenilir midir?

Vasküler İnvazyonların Değerlendirilmesinde Sanal Anjioskopi:BT Anjiografiden Daha Güvenilir midir?

Computed tomographic assessment of vascular invasion and resectability of mediastinal masses in dogs and a cat

AIMS: To assess the sensitivity of non-angiographic contrast-enhanced computed tomography (CT) to determine the presence of vascular invasion of cranial mediastinal masses in dogs and a cat, and to evaluate the association between vascular invasion and peri-operative mortality. METHODS: A retrospective study was conducted on 25 dogs and one cat. CT scans were completed with slices ranging from 2 to 10 mm. CT images were evaluated by a board-certifi ed radiologist blinded to previous diagnoses and surgical fi ndings. Each CT study was evaluated for vascular invasion, defi ned as disruption of the vessel wall and extension of the mass into the vessel lumen. Data retrieved from the surgery reports included surgical approach, whether vascular invasion was present, the surgeon's decision on operability, and post-operative complications. RESULTS: Computed tomographic evaluation revealed 25/26 masses had no evidence of vascular invasion. During surgical exploration, 10/26 masses were found to invade major regional vasculature; the cranial vena cava (CVC) was the vessel most commonly invaded (7/10 animals), and 4/7 (57%) patients with invasion of the CVC were euthanised or died in the perioperative period, from surgical or disease-related problems, which was signifi cantly higher than patients without vascular invasion (p=0.045). CONCLUSIONS: Non-angiographic contrast-enhanced CT was signifi cantly less sensitive for detecting vascular invasion of cranial mediastinal masses when compared with surgical evaluation. If the CVC was invaded by a tumour there was a signifi cant risk of death peri-operatively when compared with non-invasive cases. CLINICAL RELEVANCE: Due to the signifi cantly higher mortality risk associated with invasion of the CVC, a more sensitive method than CT should be investigated to determine vascular invasion of mediastinal masses pre-operatively.

Pancreatic cancer—EUS and early diagnosis

Over the last decades, the incidence of pancreatic cancer has increased. Prognosis remains poor despite rapid improvements in imaging technologies and therapeutic modalities. Curative treatment is dependant on early diagnosis. One of the most promising techniques for early detection of pancreatic lesions seems to be endoscopic ultrasound (EUS). With or without fine needle aspiration (FNA), it has been described as highly sensitive and accurate in staging. Superior to other imaging modalities in early studies, results in later publications declined. There are three fundamental different techniques of EUS available at present: radial scanning scopes, linear scanning scopes and radial or linear scanning probes, each with different pros and cons. Indications for EUS are persistent epigastric and/or back pain, acute onset of diabetes in the elderly, unclairified weight loss and suspect results in ultrasonography, especially in individuals over 45 years of age and in high-risk subpopulations. In early studies, EUS was superior or at least equal to other imaging modalities regarding sensitivity, determining tumour size and extent, lymph node involvement and vascular infiltration. With rapid advances in technology, first of all, computed tomography (CT) and magnetic resonance imaging have reached better results. The highest accuracy in assessing extent of primary tumour, locoregional extension, vascular invasion, distant metastasis, tumour TNM stage and tumour resectability seems to have helical CT, whereas EUS has the highest accuracy in assessing tumour size and lymph node involvement. For assessment of tumour resectability, a combination of CT and EUS seems to be the procedure with the highest accuracy. Some new techniques promise improvement of the diagnostic yield of EUS. In differentiation to focal inflammation, contrast-enhanced EUS has shown to increase sensitivity and specificity for pancreatic cancer. Another major problem is the assessment of vascular invasion. 3D reconstructions additional to conventional EUS seemed to improve the evaluation of vessel-tumour-relationships. Endoscopic ultrasound is not a foolproof method; there are several reasons for failure, and it shows a high interobserver variety even among experienced endosonographers. Nevertheless, EUS proved to have a high negative predictive value. Poor overall survival rates and some reports of high survival rates among small resected stage 1 ductal adenocarcinomas suggest a high benefit for screening and early detection of pancreatic neoplasia, and treatment of precursor lesions might prevent their progression to invasive cancer. Because of low incidence and the lack of accurate, inexpensive and non-invasive diagnostic tests for early disease, screening for pancreatic cancer and its precursor lesions in the entire population is not reasonable. But a EUS- and CT-based screening among high-risk individuals discovered pancreatic neoplasms in eight of 78 patients, in contrast to no pancreatic neoplasia among 149 control subjects. Screening for pancreatic cancer and its precursor lesions in the general population is not feasible, but high-risk subpopulations seem to be suitable targets for screening programs. EUS is an essential tool for diagnosis and assessment of extension and resectability of pancreatic tumours.

Assessment of Vascular Invasion by Musculoskeletal Tumors of the Limbs: Use of Contrast-enhanced MR Angiography

To prospectively evaluate the accuracy of contrast material-enhanced magnetic resonance (MR) angiography in the evaluation of vascular invasion by bone and soft-tissue tumors, with surgery serving as the reference standard. This study was approved by the regional ethics committee, and all patients gave informed consent. Preoperative MR angiograms and MR images of 31 sites in 30 patients with bone or soft-tissue sarcomas (n = 21) or other tumors (n = 9) were assessed for features of vascular invasion. All images were prospectively evaluated by two musculoskeletal radiologists working in consensus. MR images were evaluated for the presence of a fat plane between the vessels and the tumor and partial or total encasement of vessels. MR angiograms were evaluated for the presence of vascular displacement, stenosis, or occlusion. MR imaging and MR angiographic features of vascular invasion were graded. Imaging findings were correlated with surgical findings and classified as negative if there was no vascular invasion and as positive if there was vascular invasion. Among the 31 cases, 20 were classified as negative and 11 were classified as positive at surgery. All but three cases with a gap between the tumor and the vessels on MR images were classified as free and without adhesions at surgery. All cases with arterial stenoses at MR angiography had tumoral adhesion or tumoral encasement at surgery. MR imaging had a sensitivity of 64%, a specificity of 95%, a positive predictive value of 88% a negative predictive value of 83%, and an accuracy of 84% in the detection of vascular invasion on the basis of findings of partial or total encasement. MR angiography had a sensitivity of 82%, a specificity of 85%, a positive predictive value of 75%, a negative predictive value of 90%, and an accuracy of 84% in the detection of vascular invasion on the basis of the findings of a stenosis. On contrast-enhanced MR angiograms, findings of stenosis were sensitive and specific in the detection of arterial invasion. MR imaging evidence of partial or total encasement is highly specific in the detection of vascular invasion, while MR imaging evidence of a gap between the tumor and the vessels excludes an arterial invasion.

Assessment of vascular invasion in pancreatic head cancer with multislice spiral CT: value of multiplanar reconstructions.

The use of multiplanar reconstructions (MPRs) generated from multislice spiral CT (MSCT) data sets in the preoperative assessment of vascular invasion in pancreatic cancer was evaluated. Forty patients underwent biphasic high-resolution MSCT prior to surgery for pancreatic head cancer. Image reconstruction included thin-slice axial, sagittal and coronal MPRs as well as an MPR perpendicular to the course of a major peripancreatic vessel in proximity to the tumor. CT criteria for vascular invasion were: (1) circumferential involvement >180 degrees and (2) vessel narrowing. Imaging findings of 52 vessels were correlated with surgical and histopathological reports. Regarding the CT criterion circumferential involvement, vascular invasion was demonstrated on axial MPRs with a sensitivity and specificity of 58 and 97%. For the assessment with coronal and sagittal MPRs sensitivity was only 47%. Vascular invasion was recognized best on perpendicular MPRs with a sensitivity, specificity and accuracy of 74, 97 and 88%, respectively. Vessel narrowing was a less reliable CT criterion for vascular invasion, mainly due to the lower specificity of 91% obtained with each available MPR. Thin-slice MPRs oriented perpendicularly to a possibly invaded vessel exactly depict the grade of circumferential involvement and thus have the capability to improve the assessment of vascular invasion in pancreatic cancer.