Purpose: To document our experience with spiral hydro-CT of the pancre
as based on a combination of pharmacologic intestinal paralysis and wa
ter distension of the stomach and duodenum with specific reference to
tumor detection rate, differentiation of malignant versus benign tumor
s and assessment of tumor resectability in a prospective study on 211
consecutive patients. Material and methods: Between May 1994 und Septe
mber 1997, 211 patients with suspect of pancreatic neoplasm from clini
cal, laboratory or other imaging data were examined. Our Hydro-CT tech
niques were based on intravenous injection of 40 mg N-butylscopolamini
umbromid (Buscopan) for intestinal paralysis, gastric and duodenal wal
l distension by oral administration of an average of 1.5 l warm tap wa
ter, 30 degrees RAO patient's positioning, individualized contrast inj
ection technique using portal vein enhancement as reference and thin s
lice spiral CT (3 mm slice thickness, 6 mm table feed and 3 mm seconda
ry reconstruction). Examined parameters were: (1) tumor detection rate
, (2) differentiation of malignant versus benign disease, (3) differen
tial diagnosis and (4) accuracy of assessment of resectability by iden
tification of infiltration into adjacent organs and vessel structures
relevant for resectability such as splenic, superior mesenteric, porta
l vein and celiac trunk, superior mesenteric, splenic and hepatic arte
ries. As gold standard for positive tumor detection and description su
rgery (of potentially resectable tumors) and microscopic diagnosis (of
clearly unresectable tumors) were used and for negative tumor detecti
on an event-free survival of six months, respectively. Results: 96% of
the examinations were well tolerated. In only 4% was on-site administ
ration of a gastric tube required because of vomiting. In 2% of the pa
tients a slight allergic reaction to the contrast medium was seen. The
prevalence of a pancreatic neoplasm was 37,8%. In tumor detection Hyd
ro-CT reached an overall accuracy of 94,8% with a sensitivity of 93,7%
and a specificity of 95,2%. 52 patients underwent surgical exploratio
n 34 of whom with tumorfree resection margins (RO resection) correspon
ding to a resection of 42,5%. In those assessment of resectability rea
ched an overall accuracy of 94,6% with a sensitivity of 91,2% and spec
ificity of 95,6%. Conclusion: The new technique of Hydro-CT based on t
hin slice and spiral methodology including pharmacologic intestinal pa
ralysis and water distension results in a high tumor detection rate an
d reliable assessment of resectability.