Comprehensive Preoperative Assessment of Pancreatic Adenocarcinoma with 64-Section

Darren D. D. Brennan, MB, BCh, BAO, MSc(Rad Sci), MRCPI, FFR(RCSI), FRCR ; Giulia A. Zamboni, MD ; Vassilios D. Raptopoulos, MD ; Jonathan B. Kruskal, MD, PhD

1 From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, CC-377, Boston, MA 02215. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received February 28, 2007; revision requested March 16 and received May 31; accepted June 11. G.A.Z. received a research grant from Toshiba; V.D.R. received research grants from Toshiba and E-Z-EM; remaining authors have no financial relationships to disclose.

Pancreatic adenocarcinoma is a common gastrointestinal malignancy that has a poor prognosis and for which successful surgical resection is the only method of cure. Preoperative staging and assessment can be performed with a number of modalities. Multidetector (64-section) volumetric computed tomography (CT) allows rapid anatomic coverage coupled with excellent spatial resolution. Understanding the technical parameters necessary for successful pancreatic CT angiography is crucial. Carefully timed scan acquisition maximizes the difference in attenuation between the neoplasm and the pancreatic parenchyma and allows accurate local and distant staging as well as assessment of local resectability. In addition, angiographic data sets can be rendered to create displays of the local venous and arterial anatomy that are familiar to surgeons. Advanced rendering can also be used to create pancreaticographic type images. The TNM system of staging for pancreatic adenocarcinoma is not frequently included in radiology reporting but is important for deciding on optimal therapy and neoadjuvant therapy.