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Role
of Helical Computed Tomography and Ultrasonography in Evaluation of
Pancreatic Neoplastic Lesions
Hanan El-Ahwal, Abdel Monem Darwish , Ghada Raslan
Department of Diagnostic Radiology, Faculty of Medicine, Tanta
University, Egypt
Tanta Med. Sc. J 2008; 3(3):4-14
Article type: Original article
Background/Aim: Pancreatic cancer carries an
extremely poor prognosis. The long term survival rate of patients
with pancreatic cancer is dependent on presence of lymph node
metastasis, invasion of peri-pancreatic tissues including blood
vessels, anterior pancreatic capsule & peri-pancreatic nerve roots.
The aim of this study was to detect US & spiral CT manifestations of
different pancreatic neoplastic lesions with certain emphasis on the
sensitivity of combined US/sCT for detection of malignancy. Patients
& Methods: This study included 40 patients who clinically suspected
to have pancreatic neoplastic lesions. They were 22 males and 18
females, and their age ranged between 18 and 86 years. All the
patients were subjected to the followings: 1)-Full history taking
and clinical examination.2)-Laboratory
investigations.3)-Abdomino-pelvic US study with stress on the
pancreatic region.4)-Abdomino-pelvic spiral CT with stress on the
pancreatic region.5)-Finally the diagnosis was confirmed by ERCP-guided
biopsy of 26 lesions, intra-operative true-cut biopsy of 10 lesions,
CT-guided biopsy of 2 lesions, and US-guided biopsy of the remaining
2 lesions. Results: The mean age of the studied patients was 54.2
years, and the most common presenting complaint was abdominal pain
in 28 patients, followed by jaundice in 26 cases. Diabetes mellitus
was reported in 7/40(17.5%) of the patients. Total serum bilirubin
was elevated in 65% of the patients, serum alkaline phosphatase was
increased in 40 % of the cases, and carbohydrate antigen19-9 (CA
19-9) serum level was elevated in 77.5 % of them. The pancreatic
head was the most common site for affection with these lesions and
seen in 26 cases, followed by the body seen in 7 cases. The
commonest size of the studied lesions ranged between 40<60mm. On
both imaging modalities, 27 lesions had cystic and solid components
and the remaining 13 lesions were completely solid. Thirty one
lesions showed ill-defined outlines, and 27 lesions showed
non-homogenous enhancement after IV injection of contrast medium on
sCT. Adenocarcinoma was the most common histopathological variety
examined and was seen in 33 patients. Intrahepatic biliary radicals
dilatation (IHBRD) was detected in 26 patients with pancreatic head
cancer. SCT was more beneficial than US in demonstration of
vascular, and peripancreatic invasion.US was superior to sCT in
detection of tiny hepatic deposits, and both imaging modalities
seemed to have equal capability in detection of para-aortic
lymphadenopathy, and the sensitivity of the combined US/sCT for
detection of malignancy was 92.5%. Conclusions: Transabdominal US
plays a fundamental role in diagnosis of tumors of the pancreas.
Yet, it is an operator dependent technique. Spiral CT is another
valuable technique for localization of the primary tumor,
determination of its local extension, and detection of metastases.
Combination of both imaging modalities increases the sensitivity for
detection of malignancy. Both imaging modalities are not capable of
establishing diagnosis with histological certainty and this always
requires biopsy and histopathological examinations.
ICID 870832 |