Peripancreatic Vascular Invasion Research Articles

Relationship between surgical R0 resectability and findings of peripancreatic vascular invasion on CT imaging after neoadjuvant S-1 and concurrent radiotherapy in patients with borderline resectable pancreatic cancer

BackgroundBorderline resectable pancreatic cancer (BRPC) is frequently associated with positive surgical margins and a poor prognosis because the tumor is in contact with major vessels. This study evaluated the relationship between the margin-negative (R0) resection rate and findings indicating peripancreatic vascular invasion on multidetector computed tomography (MDCT) imaging after neoadjuvant chemoradiotherapy (NACRT) in patients with BRPC.MethodsTwenty-nine BRPC patients who underwent laparotomy after neoadjuvant S-1 with concurrent radiotherapy were studied retrospectively. Peripancreatic major vessel invasion was evaluated based on the length of tumor-vessel contact on MDCT. The R0 resection rates were compared between the progression of vascular invasion (PVI) group and the non-progression of vascular invasion (NVI) group.ResultsThere were 3 patients with partial responses (10%), 25 with stable disease (86%), and 1 with progressive disease (3%) according to the RECISTv1.1 criteria. Regarding vascular invasion, 9 patients (31%) were classified as having PVI, and 20 patients (69%) were classified as having NVI. Of the 29 patients, 27 (93%) received an R0 resection, and all the PVI patients received an R0 resection (9/9; R0 resection rate = 100%) while 90% (18/20) of the NVI patients underwent an R0 resection. The exact 95% confidence interval of risk difference between those R0 resection rates was − 10.0% [− 31.7–20.4%].ConclusionsPatients with BRPC after NACRT achieved high R0 resection rates regardless of the vascular invasion status. BRPC patients can undergo R0 resections unless progressive disease is observed after NACRT.Trial registrationUMIN-CTR, UMIN000009172. Registered 23 October 2012

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 neuroendocrine neoplasms: Correlation between MR features and pathological tumor grades

This study investigated the accuracy of MRI features in differentiating the pathological grades of pancreatic neuroendocrine neoplasms (PNENs). A total of 31 PNENs patients were retrospectively evaluated, including 19 cases in grade 1, 5 in grade 2, and 7 in grade 3. Plain and contrastenhanced MRI was performed on all patients. MRI features including tumor size, margin, signal intensity, enhancement patterns, degenerative changes, duct dilatation and metastasis were analyzed. Chi square tests, Fisher's exact tests, one-way ANOVA and ROC analysis were conducted to assess the associations between MRI features and different tumor grades. It was found that patients with older age, tumors with higher TNM stage and without hormonal syndrome had higher grade of PNETs (all P<0.05). Tumor size, shape, margin and growth pattern, tumor pattern, pancreatic and bile duct dilatation and presence of lymphatic and distant metastasis as well as MR enhancement pattern and tumor-topancreas contrast during arterial phase were the key features differentiating tumors of all grades (all P<0.05). ROC analysis revealed that the tumor size with threshold of 2.8 cm, irregular shape, pancreatic duct dilatation and lymphadenopathy showed satisfactory sensitivity and specificity in distinguishing grade 3 from grade 1 and grade 2 tumors. Features of peripancreatic tissue or vascular invasion, and distant metastasis showed high specificity but relatively low sensitivity. In conclusion, larger size, poorlydefined margin, heterogeneous enhanced pattern during arterial phase, duct dilatation and the presence of metastases are common features of higher grade PNENs. Plain and contrast-enhanced MRI provides the ability to differentiate tumors with different pathological grades.

Value of contrast-enhanced ultrasound in evaluating peripancreatic vascular invasion and resectability of pancreatic cancer

Value of contrast-enhanced ultrasound in evaluating peripancreatic vascular invasion and resectability of pancreatic cancer

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.

Comparison of Double Contrast-Enhanced Ultrasound and MDCT for Assessing Vascular Involvement of Pancreatic Adenocarcinoma: Preliminary Results Correlated with Surgical Findings

To investigate the accuracy of double contrast-enhanced ultrasound (DCEUS) for assessing vascular involvement by pancreatic adenocarcinoma. 38 patients with pancreatic adenocarcinoma proven by postoperative pathology or biopsy were enrolled in this study. DCEUS (intravenous microbubbles combined with an oral contrast agent) and 16-row multi-detector CT (MDCT) were performed preoperatively to assess vascular invasion by pancreatic adenocarcinoma. The diagnostic accuracy of DCEUS and MDCT for assessing vascular involvement was calculated and compared. ROC curves were used to evaluate the diagnostic confidences of the two methods. The inter- and intra-observer reliability of DCEUS for assessing vascular invasion was investigated in the present study. Almost perfect agreement between DCEUS and MDCT was obtained using Kappa analysis (k = 0.83, p = 0.000). Compared with surgical findings, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of peripancreatic vascular invasion were 66.67 %, 100 %, 100 %, 60 %, and 77.78 %, respectively, for DCEUS and 75 %, 100 %, 100 %, 66.67 %, and 83.33 %, respectively, for MDCT. There was no significant difference in accuracy between DCEUS and MDCT for evaluating peripancreatic vascular invasion (p = 0.108). The combination of DCEUS and MDCT increased the diagnostic confidence in assessing peripancreatic vascular invasion with an area under ROC curve from 0.83 for DCEUS (p = 0.025) and 0.88 for MDCT (p = 0.011) to 0.92 for both combined (p = 0.005). The intra- and inter-observer reproducibility were both almost perfect for assessing the peripancreatic vascular invasion by DCEUS with a Kappa value of 0.94 (p = 0.000) for intra-observer and 0.83 (p = 0.000) for inter-observer. DCEUS could be considered as a reliable and accurate method for evaluating the peripancreatic vascular invasion of pancreatic adenocarcinoma.

The CT signs of peripancreatic vascular invasion in pancreatic carcinoma

目的 分析多层螺旋CT(MSCT)胰腺检查,胰腺癌侵及胰周主要动、静脉的不同CT表现特征.方法 MSCT诊断胰腺癌68例患者中,33例行手术治疗(其中12例行胰十二指肠切除术,21例剖腹探查发现不可切除),病理结果均证实为胰腺导管细胞癌.术中由手术者仔细探查胰周主要血管[肠系膜上动脉(SMA)、腹腔干(CA)、肝动脉(HA)、肠系膜上静脉(SMV)及门静脉主干(PV)].结果 165支受检血管中,手术探查发现103 支血管未受侵犯,其余62支血管受侵,MSCT术前检查,8.1%(5/62)受侵血管误判为未受侵犯(假阴性).其余受侵的胰周主要动、静脉(57支)具有不同的CT表现特征:胰周主要动脉受侵时,均被肿瘤包绕大于管周的1/2或完全包埋于肿瘤中.胰周主要静脉受侵时,部分静脉血管被肿瘤包绕小于管周的1/2:SMV为4支(4/17),PV为2支(2/13),但同时均出现管壁受浸润或管腔狭窄或管腔形态改变;胰周静脉受侵犯时出现管腔狭窄或闭塞的机会较胰周动脉大:SMV为11支(11/17),PV为12支(12/13),而CA为3支(3/8),HA为 4支(4/7),SMA为4支(4/12);胰周静脉受侵犯时管壁呈浸润性改变的比例较胰周动脉高:SMV为11支(11/17),PV为7支(7/13),而CA为3支(3/8),HA为2支(2/7),SMA为6支(6/12).结论胰周动、静脉受侵及时,其CT表现具有不同特征。

Pancreatic Adenocarcinoma

To establish preliminarily the different diagnostic criteria for peripancreatic arterial and venous invasion in pancreatic carcinoma by comparing their multidetector-row computed tomography (MDCT) appearances with surgical exploration. Among 101 patients with pancreatic carcinoma examined by MDCT, 54 candidates accepting surgery were preoperatively evaluated for vascular invasion based on CT signs (A-E): arterial embedment in tumor or venous obliteration; tumor involvement exceeding one-half of the circumference of the vessel; vessel wall irregularity; vessel caliber stenosis; teardrop superior mesenteric vein (SMV). The peripancreatic major vessels (n = 224) were examined carefully by surgeons during the operation. During surgical exploration, 78 vessels were found to be invaded. With sign A (B, C, or D) as the CT criterion for peripancreatic vascular invasion, the sensitivity of arterial and venous invasion was 66% (97%, 45%, or 41%) and 14% (49%, 63%, or 55%), respectively; the specificity of absence of arterial and venous invasion was 100% (91%, 99%, or 100%) and 100% (all 100%). In this study, there were 3 SMVs appearing teardrop (sign E), which were all confirmed to be invaded. It is recommended that the CT diagnostic criteria for arterial and venous invasion should be dealt with differently. The criteria of arterial invasion are the presence of sign A or the combination of sign B with one of signs C and D. The criteria of venous invasion are the presence of one of the following signs: sign A, sign B, sign C, sign D, and sign E.

The CT diagnostic criteria for peripancreatic vascular invasion in pancreatic carcinoma

目的 探讨多层螺旋CT(MSCT)胰腺检查,胰腺癌侵犯胰周主要血管的CT诊断标准,以期提高判断的敏感性和特异性.方法 MSCT检查诊断为胰腺癌的72例病人中,37例行手术治疗,13例行胰十二指肠切除术,24例剖腹探查发现不可切除,病理结果均证实为胰腺导管细胞癌.术中由手术者仔细探查胰周主要血管(肠系膜上动脉、腹腔干、肝动脉、肠系膜上静脉及门静脉主干).结果肿瘤包绕血管超过管周一半作为判断胰周主要血管受侵的标准,对动脉受侵的敏感性和特异性分别为92.9%(13/14)和90%(72/80),对静脉为57.1%(20/35)和100%(35/35);管壁呈浸润性改变作为标准,判断动脉受侵的敏感性和特异性为35.7%(5/14)和98.8%(79/80),静脉为62.9%(22/35)和100%(35/35);管腔狭窄作为标准,对动、静脉受侵判断的敏感性分别为14.3%(2/12)和65.7%(23/35),特异性均为100%.动脉被肿瘤包埋、静脉管腔闭塞,血管均为受侵.结论 CT须以不同的判断标准来诊断胰周主要动、静脉受侵与否.动脉受侵的判断标准为:动脉被肿瘤包埋,或(1)肿瘤包绕动脉大于管周一半,且同时出现(2)管壁浸润或(3)管腔狭窄;而静脉受侵的判断标准为:静脉管腔闭塞,或①肿瘤包绕静脉大于管周一半,②管壁浸润,③管腔狭窄,具备三者表现之一,即判为静脉受侵。

CT of carcinoma of the pancreas: Different mode of spread according to lesion site

Thirty-seven patients were evaluated on computed tomography concerning the different modes of spread (peripancreatic vascular invasion and peritoneal implanting) in the pancreatic carcinoma arising in the four anatomic segments. Each was graded from 0 to 3. The median diameter of the adenocarcinomas was 4.5 cm. It was found that high propensity for vascular invasion occurred in the carcinomas of the body and neck, probably due to the anatomical proximity of the these structures, and the high incidence of intraperitoneal seeding in the carcinomas of the tail was found probably because of its intraperitoneal location.

CT features of carcinoma of the pancreas: relativity to tumor sites

Twenty-one patients with carcioma of the pancreas were analyzed regarding the propensities for hepatic metastasis, peripancreatic vascular invasion, peritoneal implantation, and ascites. Tumors were located at the head(n=5), neck(n=1), body(n=9), tail(n=5), and body and tail(n=1). For every parameter, the grade was scored and compared. Liver metastases were present in 11 patients(52%)and frequently associated with carcinoma of the head. Vascular invasions of the celiac trunk, superior mesenteric, and splenic vessels were seen in 11 patients(52%). Eight out of nine patients with carcinoma of the body(89%) showed peripancreatic vascular involvement. Intraperitoneal tumor implanation was present in 16 patients(76%), which slightly more prone to have ascites than those of the body(33%). None of the carcinomas of the head or neck was associated with ascites. It was concluded that the high incidence of vascular invasion in carcinomas of the body was due to anatomical approximations to vascular structures and that the higher incidence of intraperitoneal seeding in carcinomas of the tail was due to anatomical bases of intraabdominal location.