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Local Staging of Pancreatic Carcinoma with Multi–Detector Row CT: Use of Curved Planar Reformations—Initial Experience¹

¹ From the Departments of Radiology, Lucas MRS Center (R.W.P., L.C.C., C.F.B., M.N.M., R.E.M., R.B., R.B.J.) and Statistics (J.H.), Stanford University, Calif; and Department of Radiology, Veterans Administration Palo Alto Health Care System, Calif (M.N.M.). Received May 4, 2001; revision requested June 22; final revision received May 8, 2002; accepted May 28. R.W.P. supported by a research grant from the Max Kade Foundation. Address correspondence to R.W.P., Department of Radiology, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria (e-mail: rupert.prokesch@univie.ac.at).

View larger version (161K): [in a new window]   Figure 1a. Curved planar reformations of normal pancreas and surrounding vasculature show (a) pancreatic duct (arrow), (b) celiac axis (white arrow) and hepatic artery (black arrow), (c) superior mesenteric artery (arrow), and (d) splenic (black arrow) and portal veins (open arrow).

View larger version (121K): [in a new window]   Figure 1b. Curved planar reformations of normal pancreas and surrounding vasculature show (a) pancreatic duct (arrow), (b) celiac axis (white arrow) and hepatic artery (black arrow), (c) superior mesenteric artery (arrow), and (d) splenic (black arrow) and portal veins (open arrow).

View larger version (162K): [in a new window]   Figure 1c. Curved planar reformations of normal pancreas and surrounding vasculature show (a) pancreatic duct (arrow), (b) celiac axis (white arrow) and hepatic artery (black arrow), (c) superior mesenteric artery (arrow), and (d) splenic (black arrow) and portal veins (open arrow).

View larger version (121K): [in a new window]   Figure 1d. Curved planar reformations of normal pancreas and surrounding vasculature show (a) pancreatic duct (arrow), (b) celiac axis (white arrow) and hepatic artery (black arrow), (c) superior mesenteric artery (arrow), and (d) splenic (black arrow) and portal veins (open arrow).

View larger version (153K): [in a new window]   Figure 2a. Images in 56-year-old woman with pancreatic adenocarcinoma deemed resectable at imaging and proved at surgery. (a, b) Transverse contrast-enhanced CT images show dilated middle to distal pancreatic duct (arrowheads) and low-attenuating mass (arrow) in the neck of pancreas, abutting splenic vein. (c) Curved planar reformation of pancreatic duct demonstrates relative dilatation of middle to distal portion resulting from mass (arrow). (d) Curved planar reformation of splenic vein (arrows), superior mesenteric vein (arrowheads), and portal vein (*) shows no involvement of these vessels.

View larger version (153K): [in a new window]   Figure 2b. Images in 56-year-old woman with pancreatic adenocarcinoma deemed resectable at imaging and proved at surgery. (a, b) Transverse contrast-enhanced CT images show dilated middle to distal pancreatic duct (arrowheads) and low-attenuating mass (arrow) in the neck of pancreas, abutting splenic vein. (c) Curved planar reformation of pancreatic duct demonstrates relative dilatation of middle to distal portion resulting from mass (arrow). (d) Curved planar reformation of splenic vein (arrows), superior mesenteric vein (arrowheads), and portal vein (*) shows no involvement of these vessels.

View larger version (80K): [in a new window]   Figure 2c. Images in 56-year-old woman with pancreatic adenocarcinoma deemed resectable at imaging and proved at surgery. (a, b) Transverse contrast-enhanced CT images show dilated middle to distal pancreatic duct (arrowheads) and low-attenuating mass (arrow) in the neck of pancreas, abutting splenic vein. (c) Curved planar reformation of pancreatic duct demonstrates relative dilatation of middle to distal portion resulting from mass (arrow). (d) Curved planar reformation of splenic vein (arrows), superior mesenteric vein (arrowheads), and portal vein (*) shows no involvement of these vessels.

View larger version (72K): [in a new window]   Figure 2d. Images in 56-year-old woman with pancreatic adenocarcinoma deemed resectable at imaging and proved at surgery. (a, b) Transverse contrast-enhanced CT images show dilated middle to distal pancreatic duct (arrowheads) and low-attenuating mass (arrow) in the neck of pancreas, abutting splenic vein. (c) Curved planar reformation of pancreatic duct demonstrates relative dilatation of middle to distal portion resulting from mass (arrow). (d) Curved planar reformation of splenic vein (arrows), superior mesenteric vein (arrowheads), and portal vein (*) shows no involvement of these vessels.

View larger version (169K): [in a new window]   Figure 3a. Images in 52-year-old woman with jaundice, abdominal pain, and weight loss due to unresectable pancreatic cancer. (a) Transverse contrast-enhanced CT image shows hypoattenuating mass in the head of the pancreas (*) abutting splenic vein (arrow). (b-d) Curved planar reformations (cpr) show mass adjacent to and deforming superior mesenteric vein (black arrows), inferior mesenteric vein (imv) (arrowheads), and splenic vein (white arrows).

View larger version (134K): [in a new window]   Figure 3b. Images in 52-year-old woman with jaundice, abdominal pain, and weight loss due to unresectable pancreatic cancer. (a) Transverse contrast-enhanced CT image shows hypoattenuating mass in the head of the pancreas (*) abutting splenic vein (arrow). (b-d) Curved planar reformations (cpr) show mass adjacent to and deforming superior mesenteric vein (black arrows), inferior mesenteric vein (imv) (arrowheads), and splenic vein (white arrows).

View larger version (172K): [in a new window]   Figure 3c. Images in 52-year-old woman with jaundice, abdominal pain, and weight loss due to unresectable pancreatic cancer. (a) Transverse contrast-enhanced CT image shows hypoattenuating mass in the head of the pancreas (*) abutting splenic vein (arrow). (b-d) Curved planar reformations (cpr) show mass adjacent to and deforming superior mesenteric vein (black arrows), inferior mesenteric vein (imv) (arrowheads), and splenic vein (white arrows).

View larger version (141K): [in a new window]   Figure 3d. Images in 52-year-old woman with jaundice, abdominal pain, and weight loss due to unresectable pancreatic cancer. (a) Transverse contrast-enhanced CT image shows hypoattenuating mass in the head of the pancreas (*) abutting splenic vein (arrow). (b-d) Curved planar reformations (cpr) show mass adjacent to and deforming superior mesenteric vein (black arrows), inferior mesenteric vein (imv) (arrowheads), and splenic vein (white arrows).