State-of-the-art ultrasonography is as accurate as helical computed tomography and computed tomographic angiography for detecting unresectable periampullary cancer

Objective. To compare the ability of state-of-the-art ultrasonography with that of helical computed tomography and computed tomographic angiography in detecting unresectable periampullary cancer. In most patients periampullar y cancer is unresectable because of either distant metastasis or local vasc ular involvement. The advent of gray scale and color Doppler ultrasonograph y has improved the ability of ultrasonography to detect vascular involvemen t. Methods. Twenty-three consecutive patients with periampullary cancer wer e enrolled for prospective staging of their disease by comparing helical co mputed tomography and computed tomographic angiography with gray scale and color Doppler ultrasonography of the abdomen. Portal vein, superior mesente ric vein, splenic vein, and superior mesenteric artery involvement was grad ed 0 to 4, grade 0 being no vascular involvement and grade 4 being total oc clusion of the vessel. Agreement between ultrasonography and computed tomog raphic angiography for determining vascular involvement was measured by X-2 analysis. Results. Two patients (9%) were excluded because excessive overl ying bower gas hampered the ability of ultrasonography to visualize the pan creas. For the remaining 21 patients, there was significant agreement betwe en ultrasonography and computed tomographic angiography for detecting vascu lar involvement in ail vessels (P < .001; portal vein, kappa = 0.67; superi or mesenteric vein, kappa = 0.67; splenic vein, kappa = 0.85; and superior mesenteric artery, kappa = 0.59). Ultrasonography was in agreement with com puted tomographic angiography in all cases of unresectability. Both modalit ies were equally poor in preoperatively showing lymphadenopathy and metasta ses. Conclusions. Provided that there is adequate visualization on ultrason ography of the head of the pancreas in the periampullary region, then state -of-the-art gray scale and color Doppler ultrasonography are as accurate as helical computed tomography and computed tomographic angiography for detec ting the unresectability of periampullary cancer. If performed as the initi al investigation and the region of the pancreatic head is clearly shown, an d if vascular encasement or occlusion or distant metastasis is identified, further investigations are unnecessary.