Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography*

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We assessed the accuracy of dynamic contrast-enhanced computed tomography (CT) in the diagnosis and staging of 213 patients with pancreatic carcinoma and compared it with the accuracy of angiography and surgery. A correct CT diagnosis of pancreatic carcinoma was made in 207 of 213 (97%) patients. Tumors were located in the pancreatic head in 64%, the body in 22%, and the tail in 10%, and enlarged the pancreas diffusely in 4%. CT staged 25 (12%) patients as having potentially resectable tumors and 188 (88%) as having unresectable tumors on the basis of local extension (72%), contiguous organ invasion (43%), vascular invasion (82%), and distant metastases (50%). Compared with angiography in 60 patients, CT detected vascular invasion missed on angiography in 20%, and angiography detected invasion missed by CT in 5%. In these latter cases, other CT criteria of unresectability were present, and angiography provided no significant staging information. Compared with surgery in 71 patients, CT accurately predicted unresectable tumors in 100% of patients and resectable tumors in 72% of patients.

Eleven of the patients with CT-resectable tumors underwent resection. Median survival was 22.7 months, with four patients alive at a median of 15.5 months postoperatively. Palliative resections were performed in six patients, and median survival was 14.4 months.

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    2016, Gastroenterology Clinics of North America
    Citation Excerpt :

    In a head-to-head prospective comparison of the diagnostic yield of MDCT to EUS, DeWitt and colleagues4 found MDCT to have lower sensitivity of overall cancer detection (86% vs 98% for EUS, P = .01), but MDCT was equivalent to EUS for tumor nodal staging. Although CT imaging overall has a high positive predictive value of more than 90% for tumor detection,13,14 it is limited by poor detection of small tumors, critically those tumors in the early resectable stage, small hepatic metastases, and peritoneal implants.15,16 On MRI, pancreatic tumors appear as a hypoenhancing lesion on T1-weighted images compared with the surrounding pancreatic parenchyma.3

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*

Presented at the 79th Annual Meeting of the North Pacific Surgical Association, Tacoma, Washington, November 13–14, 1992.

1

From the Department of Radiology, University of Washington School of Medicine, Virginia Mason Medical Center, Seattle, Washington.

2

From the Department of General Surgery University of Washington School of Medicine, Virginia Mason Medical Center, Seattle, Washington.

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