Ultrafast Magnetic Resonance Imaging Improves the Staging of Pancreatic Tumors

Abstract

ObjectiveThis prospective study was undertaken to evaluate the accuracy of a noninvasive "all-inone" staging method in predicting surgical resectability in patients with pancreatic or periampullary tumors. Summary Background DataDespite progress in imaging techniques, accurate staging and correct prediction of resectability remains one of the chief problems in the management of pancreatic tumors. Staging algorithms designed to separate operable from inoperable patients to save the latter an unnecessary laparotomy are becoming increasingly complex, expensive, timeconsuming, invasive, and not without risks for the patient. MethodsBetween August 1996 and February 1997, 58 consecutive patients referred for operation of a pancreatic or periampullary tumor were examined clinically and by 5 staging methods: 1) percutaneous ultrasonography (US); 2) ultrafast magnetic resonance imaging (UMRI); 3) dual-phase helical computed tomography (CT); 4) selective visceral angiography; and 5) endoscopic cholangiopancreatography (ERCP). The assessment of resectability by each procedure was verified by surgical exploration and histologic examination. ResultsThe study comprised 40 male and 18 female patients with a median age of 63 years. Thirty-five lesions were located in the pancreatic head (60%), 11 in the body (19%), and 1 in the tail of the gland (2%); there were 9 tumors of the ampulla (16%) and 2 of the distal common duct (3%). All five staging methods were completed in 36 patients. For reasons ranging from metallic implants to contrast medium allergy or because investigations already had been performed elsewhere, US was completed in 57 (98%), UMRI in 54 (93%), CT in 49 (84%), angiography in 48 (83%), and ERCP in 49 (84%) of these 58 patients. Signs of unresectability found were vascular involvement in 22 (38%), extrapancreatic tumor spread in 16 (26%), liver metastases in 10 (17%), lymph node involvement in 6 (10%), and peritoneal nodules in only 2 patients (3%). These findings were collated with those of surgical exploration in 47 patients (81 %) and percutaneous biopsy in 5 (9%); such invasive 393

Assessment of surgical resectability of pancreatic adenocarcinomas with multidetector computed tomography: What are the possibilities and problems?

“…The metastatic liver lesions in these cases may have been too small to be detected by MDCT, they did not have sufficient density difference with the liver parenchyma, or they were located on the surface of liver. The sensitivity of MDCT to determine hepatic metastases ranges from 75% to 87% in the literature (23)(24)(25). In a study on the detection of liver metastases with MRI and spiral CT, the accuracy of spiral CT and MRI were reported as 87% and 93%, respectively (24).…”

“…The sensitivity of MDCT to determine hepatic metastases ranges from 75% to 87% in the literature (23)(24)(25). In a study on the detection of liver metastases with MRI and spiral CT, the accuracy of spiral CT and MRI were reported as 87% and 93%, respectively (24). The sensitivity of positron emission tomography (PET) was found to be 70%, and the specificity was found to be 95%; a positive correlation was found between decreases in metastatic lesion size and decreases in those rates (26).…”

Real‐time detection of hepatic micrometastases from pancreatic cancer by intraoperative fluorescence imaging

“…[5][6][7][8][9][10] Advanced imaging modalities, including multidetector computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI), have enabled high-resolution diagnostic imaging of hepatic diseases; however, some small lesions still may go undetected. [11][12][13][14] Recently, a highly sensitive fluorescent imaging technique using a near-infrared camera system has been developed and has made it possible to identify small hepatic tumors during surgery. 15, 16 We applied this technique to pancreatic cancer treatment to detect hepatic micrometastases, which may not be detected by conventional preoperative or intraoperative diagnostic modalities; herein, we report the preliminary results of our procedure.…”

MRI of the pancreas: tumours and tumour-simulating processes

“…1). Several studies have compared CT with contrast-enhanced MRI regarding tumour detection and staging [9][10][11] . Gadolinium-enhanced dynamic breathhold MR imaging proved to be at least equal to singleslice helical CT in lesion detection [9,10] .…”