Hochauflösende Bildgebung beim Pankreaskarzinom: Prospektiver Vergleich von MRT und 4-Zeilen-Spiral-CT

Grenacher, Lars; Klauß, Miriam; Dukic, L; Delorme, Stefan; Knaebel, H. P.; Düx, M.; Kauczor, HU; Mw, Büchler; Gw, Kauffmann; Gm, Richter

doi:10.1055/s-2004-813642

Cited by 34 publications

(7 citation statements)

References 19 publications

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“…In case of an uncertain diagnosis after (repeated) MDCT scan or EUS, additional imaging with ERCP with biopsy and brush should be performed to identify patients with pancreatic or periampullary malignancies [12]. The value of an additional MRI (or MRCP) in patients with obstructive jaundice without a suspected mass or other cause of obstruction requires further investigation, since the overall detection rate for pancreatic carcinoma is comparable to MDCT [20,21,22]. MDCT is superior to MRI in the assessment of locoregional extension of pancreatic carcinomas, since 3D reformations are excellent to delineate arterial or venous encasement [23,24].…”

Section: Discussionmentioning

confidence: 99%

Role of Endoscopic Ultrasonography in Patients Suspected of Pancreatic Cancer with Negative Helical MDCT Scan

Deerenberg¹,

Poley²,

Hermans

et al. 2011

Dig Surg

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Background: In some patients suspected of pancreatic cancer, no mass can be detected by multidetector computed tomography (MDCT) scan as the cause of biliary obstruction. Methods: All patients suspected of pancreatic cancer between January 2007 and 2009 with a negative MDCT were identified from a database. Results: MDCT was performed for suspected pancreatic cancer in 290 patients, and in 258 a pancreatic mass was found. MDCT failed to establish a diagnosis in 32 patients (11%). In 23 patients (74%) with complete endoscopic ultrasonography (EUS), the cause of the obstruction was correctly diagnosed. A mass in the pancreatic head was found in 15 patients; 13 patients had a malignant tumor, and 2 patients a benign cause of obstruction. Further, EUS diagnosed 3 patients with a superficial adenoma of the papilla and 8 patients with a benign cause of the obstruction. In 5 patients EUS could not detect the cause of obstruction but finally a pancreatic malignancy was diagnosed. The positive predictive value of EUS was 86% and the negative predictive value 63%. Accuracy of MDCT and EUS decreased in the presence of pancreatitis or a biliary endoprosthesis. Conclusion: In patients suspected of pancreatic cancer in whom MDCT fails to demonstrate the cause of obstructive jaundice, EUS identifies 74% of the underlying diseases correctly.

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Section: Discussionmentioning

confidence: 99%

Role of Endoscopic Ultrasonography in Patients Suspected of Pancreatic Cancer with Negative Helical MDCT Scan

Deerenberg¹,

Poley²,

Hermans

et al. 2011

Dig Surg

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“…A recent study showed that contrast-enhanced MDCT was superior to MRI for detection of pancreatic cancer (sensitivity, 100% vs 82%Y94%), with less interobserver variability. 26 In our preliminary experience using gadolinium-enhanced MRI at 3.0 T and 64-row MDCT, the diagnostic accuracy of both methods is equivalent. Magnetic resonance imaging may be slightly superior for detection of small tumors, and 64-row MDCT has advantages in demonstration of vascular infiltration because of its superior spatial resolution.…”

Section: Detection Of Adenocarcinoma: Mri Versus Ctmentioning

confidence: 88%

“…23,33 Occasionally, MRI may detect small liver metastases not detected by CT. 18 However, with the development of MDCT with its multiplanar imaging capability, contrast-enhanced MDCT may be more efficient than gadolinium-enhanced MRI for pancreatic cancer detection and staging. 26 Pancreatic adenocarcinoma is often associated with chronic pancreatitis, not by coincidence, because chronic pancreatitis bears a dramatically increased risk to develop cancer. Both diseases show decreased signal intensity on T2-weighted GRE images and decreased contrast enhancement of masslike lesions.…”

Section: Mri Stagingmentioning

confidence: 99%

State-of-the-Art Magnetic Resonance Imaging of Pancreatic Cancer

Schima

Ba‐Ssalamah²,

Goetzinger³

et al. 2007

Topics in Magnetic Resonance Imaging

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Technical advances of magnetic resonance imaging (MRI), including ultrahigh-field magnetic resonance at 3.0 T, parallel imaging techniques, and multichannel receive coils of the abdomen, have promoted MRI of the pancreas. For adenocarcinoma, which is the most common malignant pancreatic tumor, helical CT has been most often used for detection and staging, but it has limitations in the detection of small cancers 2 cm in diameter or less (sensitivity, 63%). Moreover, it is not very accurate in determining nonresectability, because small liver metastases, peritoneal carcinomatosis, and subtle signs of vascular infiltration may be missed. At ultrahigh field at 3.0 T, gadolinium-enhanced MRI using volume-interpolated 3-dimensional gradient-recalled echo pulse sequences with near-isotropic voxels are very useful for detection of subtle abnormalities. Mangafodipir-enhanced MRI reveals a very high tumor-pancreas contrast, which helps to diagnose small cancers. Contrast-enhanced MRI is a problem-solving tool in case of equivocal CT: it helps to differentiate between cancer and focal pancreatitis. Neuroendocrine carcinoma may present with a spectrum of appearances at MRI, but the primary tumor and liver metastases are hypervascular in approximately 70%. In this article, pancreas imaging protocols for 1.5 and 3.0 T are explained. We present the imaging features of pancreatic cancer and the important questions in staging, which should be addressed by the radiologist.

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“…Contrast-enhanced techniques for both CT and MRI, combined with multiplanar reconstruction and maximal intensity projection post-processing, have improved the capability to identify and stage the extent of the tumor and extra-pancreatic involvement [ 25 ] , especially vascular arterial and venous infiltration, with an accuracy for resectability of about 90% for both CT and MRI in a direct comparison [ 26 , 27 ] .…”

Section: Staging Of Pancreatic Carcinomamentioning

confidence: 99%