1
|
Fernandes DA, Boteon YL, Boteon APCDS, Sousa RMP, Martins DL, Penachim TJ, Barros RHDO, Martins RDCP, Costa LBED, Cazzo E, Gestic MA, Chaim EA, Caserta NMG. Tubulovillous adenoma of the duodenal papilla: radiological-endoscopic and anatomopathological correlation in the surgical proposal. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2020; 66:1190-1195. [PMID: 33027444 DOI: 10.1590/1806-9282.66.9.1190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/22/2020] [Indexed: 02/08/2023]
Abstract
Tubulovillous adenomas of the duodenal ampulla are rare neoplasms. The present report describes a case with radiological-endoscopic and pathological correlation in which the patient underwent duodenal pancreatectomy with good postoperative progression. With advanced imaging methods, especially magnetic resonance and endoscopic ultrasound, locoregional aspects and extraluminal, lymphovascular, and metastatic invasion have been increasingly discussed as contributors to therapeutic decision making. This progression improves lesion staging and is especially useful in selecting eligible candidates for endoscopic treatment.
Collapse
Affiliation(s)
- Daniel Alvarenga Fernandes
- Departamento de Radiologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| | - Yuri Longatto Boteon
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Centre for Liver and Gastrointestinal Research, Institute for Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | | | - Rachid Marwan Pinheiro Sousa
- Departamento de Radiologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| | - Daniel Lahan Martins
- Departamento de Radiologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| | - Thiago José Penachim
- Departamento de Radiologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| | - Ricardo Hoelz de Oliveira Barros
- Departamento de Radiologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| | - Rita de Cássia Perina Martins
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| | - Larissa Bastos Eloy da Costa
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| | - Everton Cazzo
- Departamento de Cirurgia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| | - Martinho Antônio Gestic
- Departamento de Cirurgia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| | - Elinton Adami Chaim
- Departamento de Cirurgia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| | - Nelson Marcio Gomes Caserta
- Departamento de Radiologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM- Unicamp), Campinas, SP, Brasil
| |
Collapse
|
2
|
Lee DH, Kim B, Lee ES, Kim HJ, Min JH, Lee JM, Choi MH, Seo N, Choi SH, Kim SH, Lee SS, Park YS, Chung YE. Radiologic Evaluation and Structured Reporting Form for Extrahepatic Bile Duct Cancer: 2019 Consensus Recommendations from the Korean Society of Abdominal Radiology. Korean J Radiol 2020; 22:41-62. [PMID: 32901457 PMCID: PMC7772383 DOI: 10.3348/kjr.2019.0803] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Radiologic imaging is important for evaluating extrahepatic bile duct (EHD) cancers; it is used for staging tumors and evaluating the suitability of surgical resection, as surgery may be contraindicated in some cases regardless of tumor stage. However, the published general recommendations for EHD cancer and recommendations guided by the perspectives of radiologists are limited. The Korean Society of Abdominal Radiology (KSAR) study group for EHD cancer developed key questions and corresponding recommendations for the radiologic evaluation of EHD cancer and organized them into 4 sections: nomenclature and definition, imaging technique, cancer evaluation, and tumor response. A structured reporting form was also developed to allow the progressive accumulation of standardized data, which will facilitate multicenter studies and contribute more evidence for the development of recommendations.
Collapse
Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Moon Hyung Choi
- Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nieun Seo
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
| | | |
Collapse
|
3
|
Lubner MG, Menias CO, Johnson RJ, Gaballah AH, Shaaban A, Elsayes KM. Villous Gastrointestinal Tumors: Multimodality Imaging with Histopathologic Correlation. Radiographics 2018; 38:1370-1384. [PMID: 30059275 DOI: 10.1148/rg.2018170159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Villous lesions are advanced adenomas that manifest most commonly in the colon; however, they can develop throughout the gastrointestinal tract. The duodenum is the most common small-bowel site of these lesions. Although in most cases these are isolated lesions that occur sporadically, patients with certain specific colorectal cancer syndromes, including familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, may develop multiple advanced adenomas. Villous lesions are important because although they are histologically benign, they may harbor dysplasia and have potential for malignancy. These characteristics make them a primary target for colorectal cancer screening with optical and virtual colonoscopy. However, these lesions can also be symptomatic and detected at diagnostic imaging when patients present for examination. They have characteristic features at a variety of imaging examinations, including barium fluoroscopy, CT, MRI, and endoscopic US. It is important for radiologists to be aware of these lesions, their potential morphologies, and their typical appearances at multimodality imaging. Although villous tumors can be detected at imaging and confirmed with biopsy, owing to limitations in identifying dysplasia and foci of malignancy with the above modalities alone and the potential for malignancy, referral for surgical resection of these lesions ultimately is required. ©RSNA, 2018.
Collapse
Affiliation(s)
- Meghan G Lubner
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Christine O Menias
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Rashad J Johnson
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Ayman H Gaballah
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Akram Shaaban
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (M.G.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.O.M.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex (R.J.J.); Department of Radiology, University of Missouri Healthcare, Columbia, Mo (A.H.G.); Department of Radiology, Health Sciences Center, University of Utah, Salt Lake City, Utah (A.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| |
Collapse
|
4
|
Mittal PK, Harri P, Nandwana S, Moreno CC, Muraki T, Adsay V, Cox K, Pehlivanoglu B, Alexander LF, Chatterjee A, Miller FH. Paraduodenal pancreatitis: benign and malignant mimics at MRI. Abdom Radiol (NY) 2017; 42:2652-2674. [PMID: 28660333 DOI: 10.1007/s00261-017-1238-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Paraduodenal pancreatitis, also known as groove pancreatitis, is a rare form of chronic pancreatitis that masquerades as pancreatic adenocarcinoma affecting the pancreaticoduodenal groove, a potential space between the head of the pancreas, duodenum, and common bile duct. Two forms of groove pancreatitis have been described. The segmental form involves the pancreatic head with development of scar tissue within the groove, whereas the pure form affects the groove only, sparing the pancreatic head. Imaging findings of groove pancreatitis often overlap with primary duodenal, ampullary, or pancreatic neoplasms, which often results in a diagnostic challenge. In addition, paraduodenal pancreatitis can be mistaken for cystic pancreatic lesions, especially when there is involvement of the duodenal wall. Preoperative recognition of this entity is very important in order to avoid unnecessary procedures, although surgery, such as pancreaticoduodenectomy, may still be required to relieve obstructive symptoms. In this article, the pathophysiology and magnetic resonance imaging characteristics of paraduodenal pancreatitis and important benign and malignant mimics are discussed.
Collapse
Affiliation(s)
- Pardeep K Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road NE, Building A, Suite AT-627, Atlanta, GA, 30322, USA.
| | - Peter Harri
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road NE, Building A, Suite AT-627, Atlanta, GA, 30322, USA
| | - Sadhna Nandwana
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road NE, Building A, Suite AT-627, Atlanta, GA, 30322, USA
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road NE, Building A, Suite AT-627, Atlanta, GA, 30322, USA
| | - Takashi Muraki
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Volkan Adsay
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelly Cox
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road NE, Building A, Suite AT-627, Atlanta, GA, 30322, USA
| | - Burcin Pehlivanoglu
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren F Alexander
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road NE, Building A, Suite AT-627, Atlanta, GA, 30322, USA
| | - Argha Chatterjee
- Department of Radiology Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Frank H Miller
- Department of Radiology Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
5
|
Chang ST, Jeffrey RB, Patel BN, DiMaio MA, Rosenberg J, Willmann JK, Olcott EW. Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: Preliminary Experience and Implications for Patient Care. Radiology 2016; 281:816-825. [DOI: 10.1148/radiol.2016152790] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
6
|
MDCT and MRI of the ampulla of Vater. Part I: technique optimization, normal anatomy, and epithelial neoplasms. ACTA ACUST UNITED AC 2016; 40:3274-91. [PMID: 26306515 DOI: 10.1007/s00261-015-0528-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The purpose of this two-part article is to review the cross-sectional anatomy of the ampulla and periampullary region, to propose novel and optimized MDCT and MRI techniques that allow accurate evaluation of the ampulla of Vater, and to summarize the cross-sectional imaging features of benign and malignant ampullary conditions. In this first part, we will review the normal anatomy of the ampullary region, provide suggestions on how to optimize evaluation of the ampullary region by MDCT and MRI, and review the imaging features of select epithelial neoplasms of the ampulla. Familiarity with the normal ampullary anatomy and the pathologic conditions involving the ampulla, as well as the use of optimized MDCT and MRI techniques, may improve the diagnostic accuracy of radiologists facing ampullary abnormalities.
Collapse
|
7
|
Suh CH, Tirumani SH, Shinagare AB, Kim KW, Rosenthal MH, Ramaiya NH, Baheti AD. Diagnosis and management of duodenal adenocarcinomas: a comprehensive review for the radiologist. ACTA ACUST UNITED AC 2014; 40:1110-20. [DOI: 10.1007/s00261-014-0309-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
8
|
Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography. Eur Radiol 2014; 25:391-401. [DOI: 10.1007/s00330-014-3430-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/18/2014] [Accepted: 09/03/2014] [Indexed: 01/16/2023]
|
9
|
Wei W, Yu Y, Lv W, Deng K, Yuan L, Zhao Y. Predictive value of dual-energy spectral computed tomographic imaging on the histological origin of carcinomas in the ampullary region. ABDOMINAL IMAGING 2014; 39:702-10. [PMID: 24590398 DOI: 10.1007/s00261-014-0098-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the value of dual-energy spectral computed tomographic imaging (DESCT) to predict the origin of carcinomas in the ampullary region. MATERIALS AND METHODS Fifty-seven patients with suspected ampullary region carcinomas underwent DESCT prior to biopsy or surgery. Among those patients, 30 were pancreatic adenocarcinomas, 11 were biliary adenocarcinomas, 16 were adenocarcinomas of the ampulla diagnosed by biopsy and/or pathological examination before or after surgical operation. We compared the CT spectral imaging features among the adenocarcinomas with the above-mentioned three different origins. RESULTS Iodine concentration thresholds of 16.36, 21.86, and 21.86 mg/mL yielded a sensitivity and specificity of 100% for distinguishing between common bile duct adenocarcinomas and pancreatic adenocarcinomas in the arterial phase (AP), portal venous phase (PP), and delayed phase (DP), respectively. Thresholds of 16.70, 24.33, and 26.43 mg/mL yielded a sensitivity and specificity of 100% for distinguishing between common bile duct adenocarcinomas and ampullary adenocarcinomas in the AP, PP, and DP, respectively. Iodine concentration thresholds of 16.66 and 17.78 mg/mL yielded a sensitivity and specificity of 100% for distinguishing between ampullary adenocarcinomas and pancreatic adenocarcinomas in the PP and DP, respectively. CONCLUSION DESCT with multiple parameters can provide useful diagnostic information and may be used to predict the histological origin of carcinomas in the ampullary region.
Collapse
Affiliation(s)
- Wei Wei
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, No. 17 Lujiang Road, Hefei, 230001, China,
| | | | | | | | | | | |
Collapse
|
10
|
Abnormalities of the Distal Common Bile Duct and Ampulla: Diagnostic Approach and Differential Diagnosis Using Multiplanar Reformations and 3D Imaging. AJR Am J Roentgenol 2014; 203:17-28. [DOI: 10.2214/ajr.13.11288] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
11
|
Nikolaidis P, Hammond NA, Day K, Yaghmai V, Wood CG, Mosbach DS, Harmath CB, Taffel MT, Horowitz JM, Berggruen SM, Miller FH. Imaging Features of Benign and Malignant Ampullary and Periampullary Lesions. Radiographics 2014; 34:624-41. [DOI: 10.1148/rg.343125191] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
12
|
Wang FB, Ni JM, Zhang ZY, Zhang L, Wu WJ, Wang D, Ji Y, Gong L. Differential diagnosis of periampullary carcinomas: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography. ACTA ACUST UNITED AC 2014; 39:506-17. [DOI: 10.1007/s00261-014-0085-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
13
|
Patel BN, Giacomini C, Jeffrey RB, Willmann JK, Olcott E. Three-dimensional volume-rendered multidetector CT imaging of the posterior inferior pancreaticoduodenal artery: its anatomy and role in diagnosing extrapancreatic perineural invasion. Cancer Imaging 2013; 13:580-90. [PMID: 24434918 PMCID: PMC3893903 DOI: 10.1102/1470-7330.2013.0051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Extrapancreatic perineural spread in pancreatic adenocarcinoma contributes to poor outcomes, as it is known to be a major contributor to positive surgical margins and disease recurrence. However, current staging classifications have not yet taken extrapancreatic perineural spread into account. Four pathways of extrapancreatic perineural spread have been described that conveniently follow small defined arterial pathways. Small field of view three-dimensional (3D) volume-rendered multidetector computed tomography (MDCT) images allow visualization of small peripancreatic vessels and thus perineural invasion that may be associated with them. One such vessel, the posterior inferior pancreaticoduodenal artery (PIPDA), serves as a surrogate for extrapancreatic perineural spread by pancreatic adenocarcinoma arising in the uncinate process. This pictorial review presents the normal and variant anatomy of the PIPDA with 3D volume-rendered MDCT imaging, and emphasizes its role as a vascular landmark for the diagnosis of extrapancreatic perineural invasion from uncinate adenocarcinomas. Familiarity with the anatomy of PIPDA will allow accurate detection of extrapancreatic perineural spread by pancreatic adenocarcinoma involving the uncinate process, and may potentially have important staging implications as neoadjuvant therapy improves.
Collapse
Affiliation(s)
- Bhavik N Patel
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - R Brooke Jeffrey
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Juergen K Willmann
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Eric Olcott
- Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Health Care System, Palo Alto, CA, USA
| |
Collapse
|
14
|
Fong ZV, Tan WP, Lavu H, Kennedy EP, Mitchell DG, Koniaris LG, Sauter PK, Rosato EL, Yeo CJ, Winter JM. Preoperative imaging for resectable periampullary cancer: clinicopathologic implications of reported radiographic findings. J Gastrointest Surg 2013; 17:1098-106. [PMID: 23553385 DOI: 10.1007/s11605-013-2181-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 03/01/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND High-resolution, multiphase, computed tomography (CT) is a standard preoperative test prior to pancreatectomy, yet the clinical significance of routinely reported findings remains unknown. METHODS We identified patients who underwent a pancreaticoduodenectomy for a periampullary adenocarcinoma (PA) over the previous 5 years and had a pancreas protocol CT at our institution. Clinicopathologic implications of reported CT findings were evaluated. RESULTS There were 155 pancreatic ductal adenocarcinomas (PDA) and 47 non-pancreatic PAs. No mass was visualized on CT in 6 % of PDAs and 23 % of non-pancreatic PA. A size discrepancy of ≥1 cm between radiographic and pathologic tumor diameters was observed in 40 % of PAs, with CT underestimating the size in most instances (75 %). Radiographically enlarged lymph nodes were not associated with true lymph node metastases in PDAs (70 % lymph node positive cases were enlarged on CT vs 74 % lymph node negative, p = 0.5), but were associated with a preoperatively placed biliary endoprosthesis (63 % with endoprosthesis were enlarged vs 37 % no endoprosthesis, p = 0.013). Major visceral vessel involvement on CT was not associated with a vascular resection (3 % with CT vessel involvement vs 2 % without, p = 0.8) or a positive uncinate resection margin (24 vs 20 %, respectively, p = 0.6). DISCUSSION While dedicated pancreas protocol CT provides unprecedented detail, the test may lead to overinterpretation of the extent of disease in some instances. A radiographic suggestion of enlarged lymph nodes and vascular involvement does not necessarily preclude exploration with curative intent. CTs with local disease should be reported in an objective template and carefully reviewed by a multidisciplinary group of surgeons, radiologists, and oncologists to avoid missing an opportunity for neoadjuvant therapy or cure by resection.
Collapse
Affiliation(s)
- Zhi Ven Fong
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
|
16
|
|
17
|
Pathways of extrapancreatic perineural invasion by pancreatic adenocarcinoma: evaluation with 3D volume-rendered MDCT imaging. AJR Am J Roentgenol 2010; 194:668-74. [PMID: 20173143 DOI: 10.2214/ajr.09.3285] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this article is to familiarize radiologists with the common pathways of extrapancreatic perineural invasion of pancreatic adenocarcinoma and to highlight the potential value of 3D volume-rendered MDCT in its diagnosis. CONCLUSION The perineural plexuses closely follow peripancreatic vessels, which are well depicted by contrast-enhanced 3D volume-rendered imaging, thus facilitating the diagnosis of extrapancreatic perineural invasion of pancreatic adenocarcinoma.
Collapse
|