VASCULAR INVOLVEMENT IN PANCREATIC ADENOCARCINOMA - REASSESSMENT BY THIN-SECTION CT

We defined computed tomographic (CT) criteria of vascular involvement by pancreatic carcinoma and used these criteria to assess vascular inv olvement in 56 patients with pancreatic adenocarcinoma. CT of the panc reas was performed at 1.5-mm section thickness and 5-mm section interv als during a bolus phase of intravenous contrast enhancement. The type of vascular involvement was correlated with surgical and pathologic f indings. When there was fat-plane (type A) or normal pancreatic parenc hyma (type B) separating the tumor from adjacent vessels, the tumor co uld be resected without venous resection in 21 of 22 patients (95%). W hen the tumor was inseparable from the vessels but the points of conta ct formed a convexity against the vessel (type C), CT was not reliable in predicting whether or not the tumor was fixed against the vessel. When the tumor was partially encircling (type D) the vessel, the tumor was fixed against the vessels in most cases. The resectable rate was 47%, but resection would also require venous resection. When the tumor was completely encircling (type E) or occluding (type F) the vessel, all tumors were not resectable with a negative margin. Thin-section CT with bolus intravenous contrast enhancement improved the ability to a ssess vascular involvement in pancreatic adenocarcinoma.