G Caproni

Evaluation of vascular infiltration in resected patients for pancreatic cancer: comparison among multidetector CT, intraoperative findings and histopathology

BackgroundTo assess vascular infiltration is crucial in surgical planning of pancreatic cancer. Our aim was to assess the capability of multidetector CT in detecting vascular infiltration.MethodsWe evaluated 37 patients with pancreatic tumors. The relation between tumor and vessels was classified: grade 0: no contact between lesion and vessel; grade I: focal contiguity without modification of the vessel caliber; grade II: lesion surrounding the vessel, without reduction of its lumen; grade III: cancer surrounding the vessel with reduction or obstruction of its lumen. CT grades were compared to intraoperative findings and histopathology.ResultsWe evaluated 52 critical vessels with the following CT grades: grade 0 (4 cases), grade I (13 cases), grade II (17 cases), grade III (18 cases). Vascular resection was performed in 26 patients, with a total of 31 resected vessels (3 of grade 0, 5 of grade I, 8 of grade II, 15 of grade III). Histopathology excluded vascular infiltration in 4/4 cases with grade 0 and in 10/13 cases with grade I and confirmed it in 14/17 cases with grade II and 14/18 cases with grade III.ConclusionsMultidetector CT is accurate in detecting vascular involvement and provides pre-operative information to effectively plan resection.

Multidetector CT in the evaluation of retroperitoneal fat tissue infiltration in ductal adenocarcinoma of the pancreatic head: correlation with histopathological findings

BackgroundNeoplastic infiltration of the retroportal fat tissue is a critical parameter in tumor staging and in surgical planning because it frequently represents a site of persistence and recurrence of disease.MethodWe evaluated 64 patients affected by ductal adenocarcinoma of the pancreatic head/uncinate process, submitted to curative surgery. Suspicion of infiltration (micro or macroinfiltration) of the retroportal margin arose at MDCT in cases of obliteration, irregularity, or abnormal density of the fatty layer localized between the medial surface of the pancreatic head/uncinate process and the mesenteric artery.ResultsCT suggested the infiltration of the retroportal tissue in 27 cases (10 microinfiltration, 17 macroinfiltration). At histopathology, the presence of infiltration was confirmed in 21/27 (78%) cases. In all CT cases of microinfiltration, the retroperitoneal resection margin was not infiltrated, while all cases (6) with infiltration of the retroperitoneal margin were macroinfiltrated at CT. The sensitivity of CT was 80%, specificity of 84% with an overall diagnostic accuracy of 82%.ConclusionMDCT is accurate in the assessment of the neoplastic infiltration of the retroportal fat tissue.

Abdominal Aorta and Renal Arteries

The recent advent of newer multidetector computer tomography (MDCT) scanners has dramatically changed the role of magnetic resonance imaging (MRI) in the evaluation of the abdominal aorta and its peripheral branches, due to its faster acquisition times, higher spatial resolution allowing to obtain submillimetric sections with voxel isotropy, greater technical simplicity, wider availability, and lower overall cost. However, lack of ionizing radiation and of intravenous administration of iodinated contrast material remain substantial advantages of MRI over MDCT, that make it the technique of choice for young patients and individuals with high serum creatinine values. Moreover, for the assessment of renal arteries MRI offers not only adequate anatomical detail but, and more importantly, is also able to provide quantitative data relative to renal blood flow, as well as to yield functional information about the parenchymal effect of a vascular stenosis by means of phase contrast and perfusion techniques, respectively. In this particular concern, MRI may be successfully proposed as a novel noninvasive tool for functional evaluation of the kidneys.