PANCREATIC-CANCER - VALUE OF DUAL-PHASE HELICAL CT IN ASSESSING RESECTABILITY

PURPOSE: To evaluate the use of dual-phase helical computed tomography (CT) (with or without CT angiography) to assess resectability in pati ents suspected to have pancreatic cancer. MATERIALS AND METHODS: Tumor resectability was prospectively evaluated in 89 patients who later un derwent surgery for suspected pancreatic cancer. Helical CT scans were obtained in the vascular phase and a phase of maximal hepatic enhance ment. CT angiograms were produced with multiprojection volume reconstr uction and maximum-intensity projection. CT results were correlated wi th surgical and histopathologic results. RESULTS: Helical CT allowed d etection of pancreatic cancer in 74 of 76 cases (97%). There were six false-positive results (positive predictive value, 92%). For predictio n of irresectability, helical CT had an accuracy of 91%, negative pred ictive value of 79%, and sensitivity of 91%. Helical CT allowed detect ion of liver metastases in 21 of 28 cases (75%), nodal involvement in 13 of 24 cases (54%), and vascular invasion in 35 of 40 cases (88%). C T angiography demonstrated 30 of the 35 cases of vascular invasion det ected with helical CT (86%). CONCLUSION: Use of dual-phase helical CT improves prediction of resectability in patients with pancreatic cance r. CT angiography cannot show all of the findings seen on helical scan s.