CARCINOMA OF THE HEAD OF THE PANCREAS - EVALUATION OF THE PANCREATICODUODENAL VEINS WITH DYNAMIC CT - POTENTIAL FOR IMPROVED ACCURACY IN STAGING

PURPOSE: To determine if detection of abnormal dilatation of pancreaticoduodenal veins can improve the accuracy of computed tomographic (CT) staging of pancreatic adenocarcinoma. MATERIALS AND METHODS: CT scans obtained during bolus administration of contrast material in 86 patients (aged 34-85 years) with pancreatic head carcinoma were reviewed. The diameter of the small veins that surround the head of the pancreas was measured (normal diameter of gastrocolic trunk, less than or equal to 7 mm; of anterior superior pancreaticoduodenal vein, less than or equal to 4 mm; of posterior superior pancreaticoduodenal vein, less than or equal to 4 mm). RESULTS: Twenty-nine abnormally dilated peripancreatic veins were identified in 22 patients. Twenty-two of these dilated veins were in 16 patients with other CT criteria of tumor unresectability; seven dilated veins were in six patients with tumors deemed resectable at CT. All tumors in these latter six patients were unresectable at surgery. CONCLUSION: Although dilatation of these small peripancreatic veins without other CT criteria of tumor unresectability is an unusual finding, it may be a reliable sign of unresectable pancreatic carcinoma.