Preoperative Assessment of Vascular Invasion in Pancreatic CancerValue of CT_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Zixing , CHEN Guangwen , SONG Bin

Department of Radiology, West China Hospital, Sichuan University， Chengdu 610041, China;

Corresponding author：

Keywords：

Pancreatic cancer; Vascular invasion; Tomography/X-ray computed, Multislice helical CT; Anatomy; Angiography; Preoperative evaluation

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Objective To probe CT grading criteria of vascular invasion in pancreatic cancer. Methods Retrieved articles in CNKI and PubMed about value of CT in preoperative assessment of vascular invasion in pancreatic cancer last ten years. Results Multislice helical CT is considered the best imaging method to assess the invaded peripancreatic vessels in pancreatic cancer. There are different CT criteria of vascular invasion in pancreatic cancer based on extension of hypodense tumor and its relation to blood vessels, on the degree of circumferential contiguity of tumor to vessel, on the degree of lumen stenosis, and on the degree of contiguity between tumor and vessels combined vascular caliber. Conclusion CT grading criteria are not uniform, each one has defects.

Citation： HUANG Zixing,CHEN Guangwen,SONG Bin. Preoperative Assessment of Vascular Invasion in Pancreatic CancerValue of CT. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(11): 939-943. doi: Copy

1.	Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009 [Ｊ]. CA Cancer J Clin, 2009; 59(4): 225-249.
2.	Katz MH, Hwang R, Fleming JB, et al. Tumor-node-metastasis staging of pancreatic adenocarcinoma [Ｊ]. CA Cancer J Clin, 2008; 58(2): 111-125.
3.	Standing S Ed. Gray’s Anatomy-The Anatomical Basis of Clinical Practice [M]. 39th eds. Elsevier: Churchill Livingstone, 2004: 1223-1225.
4.	Chong M, Freeny PC, Schmiedl UP. Pancreatic arterial anatomy: depiction with dual-phase helical CT [Ｊ]. Radiology, 1998; 208(2): 537-542.
5.	National Comprehensive Cancer Network. NCCN clinical pr-actice guidelines in oncologyTM: pancreatic adenocarcainoma.V.1.2009 [EB/OL]. http: www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdf, 2009-11-16.
6.	Michl P, Pauls S, Gress TM. Evidence-based diagnosis and staging of pancreatic cancer [Ｊ]. Best Pract Res Clin Gastroenterol, 2006; 20(2): 227-251.
7.	Bipat S, Phoa SS, van Delden OM, et al. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis [Ｊ]. J Comput Assist Tomogr, 2005; 29(4): 438-445.
8.	宋彬, 徐隽, 闵鹏秋. 胰腺的血管系统 [Ｊ]. 中国医学计算机成像杂志, 2002; 8(4): 217-222.
9.	Vedantham S, Lu DS, Reber HA, et al. Small peripancreatic veins: improved assessment in pancreatic cancer patients using thin-section pancreatic phase helical CT [Ｊ]. AJR Am J Roentgenol, 1998; 170(2): 377-383.
10.	Balachandran A, Darden DL, Tamm EP, et al. Arterial variants in pancreatic adenocarcinoma [Ｊ]. Abdom Imaging, 2008; 33(2): 214-221.
11.	Yang SH, Yin YH, Jang JY, et al. Assessment of hepatic arterial anatomy in keeping with preservation of the vasculature while performing pancreatoduodenectomy: an opinion [Ｊ]. World J Surg, 2007; 31(12): 2384-2391.
12.	Volpe CM, Peterson S, Hoover EL, et al. Justification for visceral angiography prior to pancreaticoduodenectomy [Ｊ]. Am Surg, 1998; 64(8): 758-761.
13.	Fletcher JG, Wiersema MJ, Farrell MA, et al. Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT [Ｊ]. Radiology, 2003; 229(1): 81-90.
14.	张红梅, 周纯武, 赵心明, 等. 多层螺旋CT三期增强扫描在胰腺癌术前评估中的价值 [Ｊ]. 癌症进展杂志, 2008; 6(5): 504-509.
15.	Callery MP, Chang KJ, Fishman EK, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement [Ｊ]. Ann Surg Oncol, 2009; 16(7): 1727-1733.
16.	吴苾, 宋彬. 影像学新技术在消化系统的临床应用 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(2): 222-229.
17.	Mehmet Erturk S, Ichikawa T, Sou H, et al. Pancreatic adenocarcinoma: MDCT versus MRI in the detection and assessment of locoregional extension [Ｊ]. J Comput Assist Tomogr, 2006; 30(4): 583-590.
18.	Kawamoto S, Lawler LP, Horton KM, et al. MDCT of intraductal papillary mucinous neoplasm of the pancreas: evaluation of features predictive of invasive carcinoma [Ｊ]. AJR Am J Roentgenol, 2006; 186(3): 687-695.
19.	Tamm EP, Loyer EM, Faria S, et al. Staging of pancreatic cancer with multidetector CT in the setting of preoperative chemoradiation therapy [Ｊ]. Abdom Imaging, 2006; 31(5): 568-574.
20.	Tamm EP, Loyer EM, Faria SC, et al. Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer [Ｊ]. Abdom Imaging, 2007; 32(5): 660-667.
21.	Loyer EM, David CL, Dubrow RA, et al. Vascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT [Ｊ]. Abdom Imaging, 1996; 21(3): 202-206.
22.	Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT [Ｊ]. AJR Am J Roentgenol, 1997; 168(6): 1439-1443.
23.	O’Malley ME, Boland GW, Wood BJ, et al. Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT [Ｊ]. AJR Am J Roentgenol, 1999; 173(6): 1513-1518.
24.	Phoa SS, Reeders JW, Stoker J, et al. CT criteria for venous invasion in patients with pancreatic head carcinoma [Ｊ]. Br J Radiol, 2000; 73(875): 1159-1164.
25.	Brügel M, Rummeny EJ, Dobritz M. Vascular invasion in pancreatic cancer: value of multislice helical CT [Ｊ]. Abdom Imaging, 2004; 29(2): 239-245.
26.	Mazzeo S, Cappelli C, Caramella D, et al. Evaluation of vascular infiltration in resected patients for pancreatic cancer: comparison among multidetector CT, intraoperative findings and histopathology [Ｊ]. Abdom Imaging, 2007; 32(6): 737-742.
27.	Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography [Ｊ]. Am J Gastroenterol, 2004; 99(3): 492-501.
28.	Conlon KC, Dougherty E, Klimstra DS, et al. The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy [Ｊ]. Ann Surg, 1996; 223(2): 134-140.
29.	Baek SY, Sheafor DH, Keogan MT, et al. Two-dimensional multiplanar and three-dimensional volume-rendered vascular CT in pancreatic carcinoma: interobserver agreement and comparison with standard helical techniques [Ｊ]. AJR Am J Roentgenol, 2001; 176(6): 1467-1473.
30.	Legmann P, Vignaux O, Dousset B, et al. Pancreatic tu-mors: comparison of dual-phase helical CT and endoscopic sonography [Ｊ]. AJR Am J Roentgenol, 1998; 170(5): 1315-1322.
31.	Valls C, Andía E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery [Ｊ]. AJR Am J Roentgenol, 2002; 178(4): 821-826.
32.	Nakayama Y, Yamashita Y, Kadota M, et al. Vascular encasement by pancreatic cancer: correlation of CT findings with surgical and pathologic results [Ｊ]. J Comput Assist Tomogr, 2001; 25(3): 337-342.
33.	宋卫峰, 陆勇, 林晓珠, 等. 胰腺癌血管侵犯的不同CT诊断标准的研究 [Ｊ]. 中国医学计算机成像杂志, 2007; 13(1): 32-36.
34.	Li H, Zeng MS, Zhou KR, et al. Pancreatic adenocarcinoma: signs of vascular invasion determined by multi-detector row CT [Ｊ]. Br J Radiol, 2006; 79(947): 880-887.
35.	Li H, Zeng MS, Zhou KR. Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion [Ｊ]. J Comput Assist Tomogr, 2005; 29(2): 170-175.
36.	李卉, 周康荣, 靳大勇, 等. 胰腺癌侵犯胰周动静脉CT诊断标准的临床价值 [Ｊ]. 中华肿瘤杂志, 2007; 29(2): 147-150.
37.	宋彬, 周翔平. 腹部影像学与腹部外科学的关系 [Ｊ]. 中国普外基础与临床杂志, 2003; 10(1): 62-63.

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009 [Ｊ]. CA Cancer J Clin, 2009; 59(4): 225-249.
2. Katz MH, Hwang R, Fleming JB, et al. Tumor-node-metastasis staging of pancreatic adenocarcinoma [Ｊ]. CA Cancer J Clin, 2008; 58(2): 111-125.
3. Standing S Ed. Gray’s Anatomy-The Anatomical Basis of Clinical Practice [M]. 39th eds. Elsevier: Churchill Livingstone, 2004: 1223-1225.
4. Chong M, Freeny PC, Schmiedl UP. Pancreatic arterial anatomy: depiction with dual-phase helical CT [Ｊ]. Radiology, 1998; 208(2): 537-542.
5. National Comprehensive Cancer Network. NCCN clinical pr-actice guidelines in oncologyTM: pancreatic adenocarcainoma.V.1.2009 [EB/OL]. http: www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdf, 2009-11-16.
6. Michl P, Pauls S, Gress TM. Evidence-based diagnosis and staging of pancreatic cancer [Ｊ]. Best Pract Res Clin Gastroenterol, 2006; 20(2): 227-251.
7. Bipat S, Phoa SS, van Delden OM, et al. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis [Ｊ]. J Comput Assist Tomogr, 2005; 29(4): 438-445.
8. 宋彬, 徐隽, 闵鹏秋. 胰腺的血管系统 [Ｊ]. 中国医学计算机成像杂志, 2002; 8(4): 217-222.
9. Vedantham S, Lu DS, Reber HA, et al. Small peripancreatic veins: improved assessment in pancreatic cancer patients using thin-section pancreatic phase helical CT [Ｊ]. AJR Am J Roentgenol, 1998; 170(2): 377-383.
10. Balachandran A, Darden DL, Tamm EP, et al. Arterial variants in pancreatic adenocarcinoma [Ｊ]. Abdom Imaging, 2008; 33(2): 214-221.
11. Yang SH, Yin YH, Jang JY, et al. Assessment of hepatic arterial anatomy in keeping with preservation of the vasculature while performing pancreatoduodenectomy: an opinion [Ｊ]. World J Surg, 2007; 31(12): 2384-2391.
12. Volpe CM, Peterson S, Hoover EL, et al. Justification for visceral angiography prior to pancreaticoduodenectomy [Ｊ]. Am Surg, 1998; 64(8): 758-761.
13. Fletcher JG, Wiersema MJ, Farrell MA, et al. Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT [Ｊ]. Radiology, 2003; 229(1): 81-90.
14. 张红梅, 周纯武, 赵心明, 等. 多层螺旋CT三期增强扫描在胰腺癌术前评估中的价值 [Ｊ]. 癌症进展杂志, 2008; 6(5): 504-509.
15. Callery MP, Chang KJ, Fishman EK, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement [Ｊ]. Ann Surg Oncol, 2009; 16(7): 1727-1733.
16. 吴苾, 宋彬. 影像学新技术在消化系统的临床应用 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(2): 222-229.
17. Mehmet Erturk S, Ichikawa T, Sou H, et al. Pancreatic adenocarcinoma: MDCT versus MRI in the detection and assessment of locoregional extension [Ｊ]. J Comput Assist Tomogr, 2006; 30(4): 583-590.
18. Kawamoto S, Lawler LP, Horton KM, et al. MDCT of intraductal papillary mucinous neoplasm of the pancreas: evaluation of features predictive of invasive carcinoma [Ｊ]. AJR Am J Roentgenol, 2006; 186(3): 687-695.
19. Tamm EP, Loyer EM, Faria S, et al. Staging of pancreatic cancer with multidetector CT in the setting of preoperative chemoradiation therapy [Ｊ]. Abdom Imaging, 2006; 31(5): 568-574.
20. Tamm EP, Loyer EM, Faria SC, et al. Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer [Ｊ]. Abdom Imaging, 2007; 32(5): 660-667.
21. Loyer EM, David CL, Dubrow RA, et al. Vascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT [Ｊ]. Abdom Imaging, 1996; 21(3): 202-206.
22. Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT [Ｊ]. AJR Am J Roentgenol, 1997; 168(6): 1439-1443.
23. O’Malley ME, Boland GW, Wood BJ, et al. Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT [Ｊ]. AJR Am J Roentgenol, 1999; 173(6): 1513-1518.
24. Phoa SS, Reeders JW, Stoker J, et al. CT criteria for venous invasion in patients with pancreatic head carcinoma [Ｊ]. Br J Radiol, 2000; 73(875): 1159-1164.
25. Brügel M, Rummeny EJ, Dobritz M. Vascular invasion in pancreatic cancer: value of multislice helical CT [Ｊ]. Abdom Imaging, 2004; 29(2): 239-245.
26. Mazzeo S, Cappelli C, Caramella D, et al. Evaluation of vascular infiltration in resected patients for pancreatic cancer: comparison among multidetector CT, intraoperative findings and histopathology [Ｊ]. Abdom Imaging, 2007; 32(6): 737-742.
27. Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography [Ｊ]. Am J Gastroenterol, 2004; 99(3): 492-501.
28. Conlon KC, Dougherty E, Klimstra DS, et al. The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy [Ｊ]. Ann Surg, 1996; 223(2): 134-140.
29. Baek SY, Sheafor DH, Keogan MT, et al. Two-dimensional multiplanar and three-dimensional volume-rendered vascular CT in pancreatic carcinoma: interobserver agreement and comparison with standard helical techniques [Ｊ]. AJR Am J Roentgenol, 2001; 176(6): 1467-1473.
30. Legmann P, Vignaux O, Dousset B, et al. Pancreatic tu-mors: comparison of dual-phase helical CT and endoscopic sonography [Ｊ]. AJR Am J Roentgenol, 1998; 170(5): 1315-1322.
31. Valls C, Andía E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery [Ｊ]. AJR Am J Roentgenol, 2002; 178(4): 821-826.
32. Nakayama Y, Yamashita Y, Kadota M, et al. Vascular encasement by pancreatic cancer: correlation of CT findings with surgical and pathologic results [Ｊ]. J Comput Assist Tomogr, 2001; 25(3): 337-342.
33. 宋卫峰, 陆勇, 林晓珠, 等. 胰腺癌血管侵犯的不同CT诊断标准的研究 [Ｊ]. 中国医学计算机成像杂志, 2007; 13(1): 32-36.
34. Li H, Zeng MS, Zhou KR, et al. Pancreatic adenocarcinoma: signs of vascular invasion determined by multi-detector row CT [Ｊ]. Br J Radiol, 2006; 79(947): 880-887.
35. Li H, Zeng MS, Zhou KR. Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion [Ｊ]. J Comput Assist Tomogr, 2005; 29(2): 170-175.
36. 李卉, 周康荣, 靳大勇, 等. 胰腺癌侵犯胰周动静脉CT诊断标准的临床价值 [Ｊ]. 中华肿瘤杂志, 2007; 29(2): 147-150.
37. 宋彬, 周翔平. 腹部影像学与腹部外科学的关系 [Ｊ]. 中国普外基础与临床杂志, 2003; 10(1): 62-63.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preoperative Assessment of Vascular Invasion in Pancreatic CancerValue of CT

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