Radiology of the Pancreas

Read it at Google Books - Find it at Amazon 2. Brandon JC et al. Pancreatic clefts caused by penetrating vessels: Read it at Google Books - Find it at Amazon 4.

Imaging in Chronic Pancreatitis | Pancreapedia

Last's anatomy, regional and applied. Read it at Google Books - Find it at Amazon 5. Read it at Google Books - Find it at Amazon. Related Radiopaedia articles Anatomy: Edit article Share article View revision history. Synonyms or Alternate Spellings: Support Radiopaedia and see fewer ads. Figure 1 Figure 1. Figure 2 Figure 2. Figure 3 Figure 3. Figure 4 Figure 4. ERCP offers no usefull tumor staging information.

It is doubtfull whether pre-operative bile duct drainage by ERCP is beneficial for the patient [12]. Pre-operative biliary drainage may potentially even increase the risk for post-operative infectious complications. Endoscopic ultrasound is generally accepted as the most sensitive imaging test for the detection of small pancreatic head tumors, particularly when smaller than 2 cm [10].

• N.Y. LIFE Times TEN?
• Pancreas - Carcinoma.
• The Economics of Contemporary Art: Markets, Strategies and Stardom?
• Treatise on Classical Elasticity: Theory and Related Problems (Mathematical and Analytical Techniques with Applications to Engineering)!
• I am Daniel Tahi (The Telesa Series Book 2).
• The Dawn of Liberty (Book III of The Freedom Saga)?
• Search form?

These pancreatic head tumors can be missed even on a technically excellent CT and therefore a 'negative' CT-scan in a patient with a strong suspicion for pancreatic head cancer requires additional imaging with endoscopic ultrasound. Unfortunately, there are only a few centers in The Netherlands with sufficient experience in this operator-dependent-technique.

Endoscopic ultrasound has also been used for local tumor staging, but is currently not frequently used as such in the Netherlands.

Diagnostic laparoscopy, sometimes complemented by laparoscopic ultrasound has been advocated by some as a staging tool. Laparoscopy is much more sensitive than any other technique for the detection of peritoneal implants and superficial liver metastases. Local staging is also feasible by laparoscopic ultrasound. However, a large series has shown, that the yield of laparoscopy after CT is not high enough to justify using this technique routinely [19,20].

On this page:

It may be usefull in selected cases where there is doubt about resectability or when suspected metastatic disease cannot be proven otherwise. Water should be used as oral contrast material.

A precontrast scan of the pancreas can be performed to look for calcifications within the pancreas, which may indicate the presence of a focal pancreatitis. Slice thickness depends on the type of scanner that is used, but should be preferentially mm or less. An early arterial phase-scan delay 20 sec does not add significant information on the staging of the pancreastumor, since there is not enough contrast in the pancreas [8]. Only if the surgeons want to get optimal pre-operative 3D-information on the anatomy of the mesenteric arteries this phase is included.

Bookmark/Search this post

The early-portal phase is also called the pancreatic phase. It has a scan-delay of sec.

• Pancreas | Radiology Reference Article | www.newyorkethnicfood.com.
• Radiology of the pancreas.?
• The Radiology Assistant : Pancreas - Carcinoma!
• Image Gallery.
• Imaging of the pancreas: Part 1.
• Befragung von Kindern und Jugendlichen: Grundlagen, Methoden und Anwendungsfelder (German Edition).

This is the most important phase for detecting and staging a pancreatic tumor. At that moment the normal pancreatic parenchyma will enhance optimally, because it gets all of its bloodsupply through the arterial and capillary system. In this phase there is optimal attenuation difference between the hypodense tumor and the normal enhancing pancreatic parenchyma. This phase helps in the differentiation of liverlesions and usually the mesenteric arteries and veins are well opacified [7]. The 'late portal' or hepatic phase has a scan-delay of sec.

Liver metastases do not get their bloodsupply from the portal venous system and will be seen in this phase as hypovascular or hypodense lesions. This phase is performed for the overall assessment of the abdomen to look for liver metastases, lymphnodes and peritoneal implants. This phase is also helpfull for local staging of the tumor and detection of venous ingrowth. It is of the utmost importance to stage a pancreatic tumor correctly as the clinical consequences of this are enormous.

Overstaging will lead to undertreatment if a laparotomy is not performed in a patient with a potentially resectable tumor. Understaging will lead to an unnecessary laparotomy with all the associated risks. To withhold the chance for curative resection from as few patients as possible, it is important to determine unresectability with a very high specificity, even if this means a lower sensitivity. Some patients will therefore get the benefit of the doubt and undergo a negative exploratory laparotomy.

Radiology of the pancreas.

Since the pancreas has no capsule, pancreatic tumor will easily spread into adjacent structures figure. Because the confluens of the portal and superior mesenteric vein is in direct continuity with the pancreatic head, ingrowth into this vessel will often be the first sign of tumor extension outside the pancreas. Ingrowth into the celiac axis or superior mesenteric artery is always considered a criterium for unresectability. Although partial resection of the portal vein or superior mesenteric vein are technically possible and are being performed, ingrowth into these vessels is considered a criterium for unresectability by most oncologic surgeons in the Netherlands.

Some centers in the US and Japan will resect part of the portal vein in case of tumor ingrowth. Although associated with a worse prognosis, the presence of peripancreatic lymphnode metastases does not constitute a definite contraindication for resection. Limited ingrowth into the peripancreatic fat, ingrowth into the duodenum or the gastroduodenal artery does not render a tumor unresectable as this vessel and the duodenum can be resected en-bloc with the tumor. When there is contiguity between the tumor and the portal or superior mesenteric vein, but the vessel is surrounded by tumor for less than half the circumference.

On the left two cases of pancreatic tumors with tumor-vessel contiguity These patients generally will be given the benefit of the doubt and will be sceduled for operation. Tumor ingrowth into stomach, colon, mesocolon, inferior vena cava or aorta constitute definite criteria for unresectability.

Also the presence of hepatic metastases, peritoneal metastases or para-aortic lymfnode metastases is an absolute sign of unresectability. Mesenteric lymph node metastases, not immediately adjacent to the pancreas usually also indicate unresectability. Liver metastases and distant lymph node metastases should allways be proven by means of cytologic or histologic biopsy before refraining from exploratory laparotomy. Ingrowth into the celiac axis, hepatic artery or superior mesenteric artery also preclude resection. When a fatplane or normal pancreatic parenchyma is visible between the tumor and the vessel, the tumor is usually locally resectable.

When there is tumor-vessel contiguity, but the vessel is surrounded by tumor for less than half the circumference This group of patients will usually get the benefit of the doubt and undergo exploratory laparotomy. On the left a pancreatic tumor in direct contiguity with the confluens of the portal and superior mesenteric vein.

Imaging in Chronic Pancreatitis

This tumor was regarded as unresectable. Most surgeons will consider this a solid criterium for unresectability []. Flattening of the vessel or irregular vascular contours are also indicative of ingrowth. When the tumor surrounds the portal vein or superior mesenteric vein completely ?