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First published online July 5, 2006
British Journal of Radiology (2006) 79, 880-887
© 2006 British Institute of Radiology
doi: 10.1259/bjr/19684199
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Pancreatic adenocarcinoma: signs of vascular invasion determined by multi-detector row CT

H Li, MD 1 M S Zeng, MD, Pro 2 K R Zhou, MD, Pro 2 D Y Jin, MD, Pro 3 and W H Lou, MD, Pro 3

1Department of Radiology, The Affiliated First People's Hospital, Shanghai Jiao Tong University, 85 Wujin Road, 200080, Shanghai, Departments of 2Radiology and 3General Surgery, The Affiliated Zhongshan Hospital, Fudan University, 180 Fenglin Road, 200032, Shanghai, P R China


Figure 1
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  		Figure 1. Pancreatic body carcinoma.(a,b) Consecutive axial images showed that the superior mesenteric artery (SMA) was surrounded to more than 50% of the vessel circumference by tumour and the vessel wall appeared infiltrated. Pre-operatively, this case was judged irresectable. At surgical exploration, the SMA was found not to be invaded (only fibrotic infiltration) by tumour and was successfully resected.

 

Figure 2
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  		Figure 2. Tumour in the uncinate process of the head of the pancreas.(a,b) Consecutive axial images showed the superior mesenteric artery (SMA) to be surrounded more than 50% of the vessel circumference by tumour. It was found not to be invaded by tumour at exploration and tumour was successfully resected.

 

Figure 3
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  		Figure 3. Tumour in the uncinate process of the head of the pancreas.(a,b) Axial images and (c,d) 3D images showed that the tumour in the uncinate process of the head of the pancreas eroded a side of the superior mesenteric vein (SMV) vessel wall and penetrated it to form tumour thrombus (arrow). Axial images also showed that the superior mesenteric artery (SMA) was embedded. Surgery confirmed tumour invasion of the SMV and the SMA.

 

Figure 4
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  		Figure 4. Pancreatic head carcinoma.(a,b) Consecutive axial images showed the portal vein (PV) vessel calibre (arrow) was changed, although it was surrounded less than 50% of the vessel circumference by tumour. (c) Volume rendering (VR) 3D image showed that a segment of PV was stenosed. The axial images also showed that the common hepatic artery (CHA) was embedded in tumour and the coeliac artery (CA) was surrounded by more than 50% of the vessel circumference. PV, CHA and CA were proven to be infiltrated at surgical exploration.

 

Figure 5
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  		Figure 5. Tumour in the uncinate process of the head of the pancreas.(a,b) Axial images showed coeliac artery (CA) (short arrow) and common hepatic artery (CHA) (long arrow) embedded in tumour with regular vessel walls, although (c) volume rendering (VR) 3D image showed that the vessel calibre of CA and CHA was unchanged. Surgery confirmed tumour invasion of CA and CHA.

 

Figure 6
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  		Figure 6. Pancreatic head carcinoma. The confluence of the portal vein(PV) and the superior mesenteric vein (SMV) was shown to be surrounded by less than 50% of the vessel circumference by tumour, with unchanged vessel calibre. But a focal area of vessel wall (arrow) was irregular and infiltrated. The confluence of the PV and the SMV was proven to be infiltrated at surgical exploration.

 

Figure 7
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  		Figure 7. Pancreatic head carcinoma.(a,b) Consecutive axial images showed that the superior mesenteric artery (SMA) was embedded in tumour. (c) Volume rendering (VR) 3D image showed a segment of the SMA to be stiffened (arrow) where the vessel calibre was low-grade stenosed. Surgery confirmed tumour invasion.

 

Figure 8
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  		Figure 8. Tumour(T) in the uncinate process of the head of the pancreas tethered the superior mesenteric vein (SMV) (arrow) into a teardrop shape, although the SMV was surrounded by less than 50% of the vessel circumference and vessel wall remained regular. The superior mesenteric artery (SMA) (arrowhead) was also shown to be nearly embedded in tumour. The SMV and the SMA were proven to be infiltrated at surgical exploration.

 




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