Spiral CT and the pre-operative assessment of pancreatic adenocarcinoma

Aim: To determine the value of spiral computed tomography (CT) in the pre-operative assessment of pancreatic carcinoma. Patients and methods: Fifty patients with proven pancreatic carcinoma referred for pancreatoduodenectomy underwent pre-operative spiral CT using a dedicated pancreatic protocol to determine tumour resectability. Twenty-eight patients subsequently underwent surgical exploration. Results: Pre-operative imaging suggested that 15 tumours were resectable, and macroscopic clearance was complete in 13 giving a positive predictive value (PPV) of 87%. PPV of irresectability was 92%. CT underestimated locally advanced disease (n=2), missed small hepatic metastases (n=1), and lymphadenopathy (n=1). CT overestimated SMV encasement in I case, otherwise prediction of vascular patency and compromise was correct. The conspicuity of small resectable carcinomas was improved by spiral scanning. Conclusion: The optimised pancreatic parenchymal enhancement and vascular opacification achieved by spiral CT improves tumour detection of small carcinomas, allows accurate assessment of peripancreatic vessels, and reliably predicts both resectable and irresectable disease, CT remains inherently limited in the prediction of early extrapancreatic non-vascular spread and of lymphatic metastases.