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Performance of Multidetector Computed Tomographic Angiography in Determining Surgical Resectability of Pancreatic Head Adenocarcinoma

Kaneko, Osamu F. MD*; Lee, Deborah M. MD; Wong, Jimmie MD*; Kadell, Barbara M. MD*; Reber, Howard A. MD; Lu, David S.K. MD*; Raman, Steven S. MD*

Journal of Computer Assisted Tomography: September-October 2010 - Volume 34 - Issue 5 - p 732-738
doi: 10.1097/RCT.0b013e3181e5d6f7
Abdominal Imaging

Objective: To evaluate the performance of multidetector computed tomographic angiography (MDCTA) in assessing the surgical resectability of pancreatic head adenocarcinoma.

Methods: With institutional review board approval, radiographic, surgical, and pathological records of 203 consecutive patients with adenocarcinoma of the pancreatic head were analyzed retrospectively. Patients were imaged with MDCT scanners using our institution's CTA pancreatic protocol. Images were compared with surgical outcomes to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCTA in determining resectability.

Results: Data were analyzed twice, once with equivocal findings on MDCTA assumed as resectable and again with equivocal cases assumed as unresectable. All equivocal cases were ultimately unresectable; when this was assumed, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were determined to be 100%, 71%, 85%,100% and 89%. Twelve patients deemed resectable by preoperative MDCTA were found to be unresectable on surgical exploration owing to vascular involvement (n = 4), liver metastases (n = 4), and peritoneal involvement (n = 4).

Conclusions: Multidetector CT angiography offers accurate and valuable preoperative assessment of surgical resectability of pancreatic ductal adenocarcinoma. Liver and peritoneal metastases and vascular invasion still remain important pitfalls in preoperative evaluation.

From the *Department of Radiological Science, University of California-Los Angeles, CA; †Department of Radiology, Stanford University Medical Center, Stanford, CA; and ‡Department of General Surgery, University of California-Los Angeles, CA.

Received for publication March 9, 2010; accepted April 30, 2010.

Reprints: Osamu F. Kaneko, Department of Radiological Science, University of California-Los Angeles, Box 957437, 757 Westwood Plaza, Ste. 1621H, Los Angeles, CA 90095-7437 (e-mail: okaneko@ucla.edu).

The authors have no disclosures of funding to report.

© 2010 Lippincott Williams & Wilkins, Inc.