[Curved planar reformations in multi-slice spiral CT in pancreatic adenocarcinoma: prediction of invasion of pancreatic and peripancreatic ductal structures].

OBJECTIVE: To investigate the clinical values of the curved planar reformation (CPR) in multi-slice spiral CT (MSCT) in determining the malignant invasion of pancreatic carcinoma into the intrapancreatic and peripancreatic ductal structures.

METHODS: Thirty-seven patients having documented pancreatic carcinoma with tumor involvement of intrapancreatic or peripancreatic ductal structures were enrolled. All patients received dual-phase MSCT scan of upper abdomen. Images generated by CPR technique were used for evaluating the appearances of intrapancreatic and peripancreatic ductal structures.

RESULTS: Malignant invasion of peripancreatic arteries was found in 28 patients and characterized by: obliteration of fat plane between tumor and the artery, with contact surface of more than 180 degrees; stenosis or deformation of the artery; and infarction of the spleen. Invasion of peripancreatic veins was found in 31 patients and characterized by: tumor encasement of the vein, resulting in the narrowing or deformation of the vein; lack of enhancement of the involved venous segment; tumor thrombosis in the venous lumen; and formation of collateral circulation. Invasion of intrapancreatic segment of the common bile duct or pancreatic duct was found in 18 patients and characterized by: sudden interruption of the bile duct or pancreatic duct; narrowing of the bile duct or pancreatic duct; and dilation of the up-stream ducts proximal to the involvement portion. CPR images clearly depicted the direct relationship between tumor mass and the involved ductal structures.

CONCLUSION: Invasion of intrapancreatic or peripancreatic ductal structures by pancreatic carcinoma has certain MSCT imaging features. CPR technique is valuable in depicting these imaging findings.