Mahnoor Hafeez Ur Rehman, Ateeque Ahmed Khan


Objectives: The objective of our study was to determine the accuracy of CT using pancreatic protocol for detecting vascular invasion in patients with pancreatic carcinoma.

Study Design: Cross -Sectional prospective study

Place and Duration of Study: Department of Diagnostic Radiology and imaging, Civil Hospital Karachi, from October 2015 to December 2016,

Methods: Thirty consecutive male and female patients having obstructive jaundice with age range of 40-75 undergoing MDCT were included in this study. All patients selected were ERCP guided biopsy proven cases of pancreatic adenocarcinoma. Based on vessel invasion, we assigned patients to one of two CT groups: Vascular invasion & Vascular sparing. The vessels studied were coeliac trunk, common hepatic artery, and superior mesenteric artery.  At Civil Hospital, pancreatic adenocarcinoma is considered to be unresectable on MDCT if vascular invasion is present which is defined as tumor-to-vessel contiguity > 50% in the peripancreatic vessel. Other studied factors were age, gender and size of the tumor. The radiologic findings were correlated with per-operative findings at exploratory laparotomy, which were taken as gold standard. Descriptive statistics were calculated and Chi square test was used to determine the correlation between the variables. All findings were analyzed using SPSS 20.0 software. Those patients whose MDCT meets the CT criteria of unresectability underwent palliative Common Bile Duct stenting and those who meet don’t meet the CT criteria subsequently underwent Whipple’s Procedure.

Results: There were 86.6% male and 13.4% female patients in the study. The mean age was 58 ±9.2years and mean size of the tumor was 5.2 cm. The results showed that by MDCT scan positive findings were observed in 61.2% cases and per-operative positive findings were observed in 62.3% cases. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of spiral CT in identifying non resectability of pancreatic carcinoma were 91.6%, 83.3%, 95.6%, 71.4% and 90.0% respectively.

Conclusion: MDCT has a high positive predictive value for vascular invasion and good accuracy for determining overall tumor non resectability in patients with pancreatic carcinoma.

KEY WORDS: Pancreatic Carcinoma, pancreas, unresectability, vascular invasion, CT.

Full Text:



Zakharova OP, Karmazanovsky GG, Egorov VI. Pancreatic adenocarcinoma: Outstanding problems. World J Gastrointest Surg. 2012 May 27;4(5):104-13.

Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, Macari M, Megibow AJ, Miller FH, Mortele KJ, Merchant NB. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology. 2014 Jan;270(1):248-60.

Vikram R, Balachandran A. Imaging in staging and management of pancreatic ductal adenocarcinoma. Indian journal of surgical oncology. 2011 Jun 1;2(2):78-87.

Karmazanovsky G, Fedorov V, Kubyshkin V, Kotchatkov A. Pancreatic head cancer: accuracy of CT in determination of resectability. Abdominal imaging. 2005 Aug 1;30(4):488-500.

Miura F, Takada T, Amano H, Yoshida M, Furui S, Takeshita K. Diagnosis of pancreatic cancer. HPB. 2006 Oct 1;8(5):337-42.

Andersson R, Vagianos CE, Williamson RC. Preoperative staging and evaluation of resectability in pancreatic ductal adenocarcinoma. Hpb. 2004 Mar 1;6(1):5-12.

Chaudhary V, Bano S. Imaging of the pancreas: Recent advances. Indian journal of endocrinology and metabolism. 2011 Jul 1;15(5):25.

Prokesch RW, Chow LC, Beaulieu CF, Nino-Murcia M, Mindelzun RE, Bammer R, Huang J, Jeffrey Jr RB. Local Staging of Pancreatic Carcinoma with Multi–Detector Row CT: Use of Curved Planar Reformations—Initial Experience 1. Radiology. 2002 Dec;225(3):759-65.

Tummala P, Junaidi O, Agarwal B. Imaging of pancreatic cancer: An overview. Journal of gastrointestinal oncology. 2011 Aug 15;2(3):168-74.

Khan IM, Aurangzeb M, Tayyab M. Palliative surgery for pancreatic carcinoma. JCPSP, Journal of the College of Physicians and Surgeons Pakistan. 2010;20(11):719-22.

Vargas R, Nino-Murcia M, Trueblood W, Jeffrey Jr RB. MDCT in pancreatic adenocarcinoma: prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations. American Journal of Roentgenology. 2004 Feb;182(2):419-25.

Buchs NC, Chilcott M, Poletti PA, Buhler LH, Morel P. Vascular invasion in pancreatic cancer: imaging modalities, preoperative diagnosis and surgical management. World J Gastroenterol 2010;16(7):818–31.

Brennan DD, Zamboni GA, Raptopoulos VD, Kruskal JB. Comprehensive Preoperative Assessment of Pancreatic Adenocarcinoma with 64-Section Volumetric CT 1. Radiographics. 2007 Nov;27(6):1653-66.

Kaneko OF, Lee DM, Wong J, Kadell BM, Reber HA, Lu DS, et al. Performance of multidetector computed tomographic angiography in determining surgical resectability of pancreatic head adenocarcinoma. J Comput Assist Tomogr 2010;34(5):732–8.

Ahmad Z, Din NU, Minhas K, Moeen S, Ahmed A. Epidemiologic Data, Tumor Size, Histologic Tumor Type and Grade, Pathologic Staging and Follow Up in Cancers of the Ampullary Region and Head of Pancreas in 311 Whipple Resection Specimens of Pakistani Patients. Asian Pacific journal of cancer prevention: APJCP. 2014 Dec;16(17):7541-6.

Hassanen O, Ghieda U, Eltomey MA. Assessment of vascular invasion in pancreatic carcinoma by MDCT. The Egyptian Journal of Radiology and Nuclear Medicine. 2014 Jun 30;45(2):271-7.

Li H, Zeng MS, Zhou KR, Jin DY, Lou WH. Pancreatic adenocarcinoma: signs of vascular invasion determined by multidetector row CT. Br J Radiol 2006;79(947):880–7.

Zeman RK, Cooper C, Zeiberg AS, Kladakis A, Silverman PM, Marshall JL, Evans SR, Stahl T, Buras R, Nauta RJ, Sitzmann JV. TNM staging of pancreatic carcinoma using helical CT. AJR. American journal of roentgenology. 1997 Aug;169(2):459-64.

Roche CJ, Hughes ML, Garvey CJ, Campbell F, White DA, Jones L, Neoptolemos JP. CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas. American Journal of Roentgenology. 2003 Feb;180(2):475-80.

Megibow AJ, Bosniak MA, Ambos MA, Beranbaum ER. Thickening of the celiac axis and/or superior mesenteric artery: a sign of pancreatic carcinoma on computed tomography. Radiology. 1981 Nov;141(2):449-53.

Zamboni GA, Kruskal JB, Vollmer CM, Baptista J, Callery MP, Raptopoulos VD. Pancreatic Adenocarcinoma: Value of Multidetector CT Angiography in Preoperative Evaluation 1. Radiology. 2007 Dec;245(3):770-8.


  • There are currently no refbacks.

© Copyright PJR 2008-