THIN-SECTION CONTRAST-ENHANCED COMPUTED-TOMOGRAPHY ACCURATELY PREDICTS THE RESECTABILITY OF MALIGNANT PANCREATIC NEOPLASMS

A prospective diagnostic study was designed to determine the ability o f thin-section contrast-enhanced computed tomography (CT) to predict t he resectability of malignant neoplasms of the pancreatic head. Patien ts with a presumed resectable pancreatic neoplasm referred during a 21 -month period were studied with abdominal CT performed at 1.5-mm secti on thickness and 5-mm slice interval during the bolus phase of intrave nous contrast enhancement. CT criteria for resectability included the absence of extrapancreatic disease, no evidence of arterial encasement , and a patent superior mesenteric-portal venous confluence. Of 145 pa tients evaluated, 42 were considered to have resectable tumors by CT c riteria, and 37 (88%) underwent potentially curative pancreaticoduoden ectomy. Six patients were found to have a microscopically positive ret roperitoneal resection margin; no patient had a grossly positive resec tion margin. Five (12%) of 42 patients were found at laparotomy to hav e unresectable, locally advanced or metastatic tumors. Thin-section co ntrast-enhanced CT is an essential component of the preoperative evalu ation for pancreaticoduodenectomy and can prevent needless laparotomy in most patients with locally advanced or metastatic disease.