Pancreatic carcinomaThe introduction of rapid-scanning helical CT has permitted multiple scans to be obtained through the abdomen during different phases of contrast enhancement. The dualphase technique permits images to be obtained when arterial and pancreatic parenchymal features are optimally visible, and then later when hepatic metastases may be better detected. Employing this technique and EUS, Legmann et al studied 30 patients with suspected pancreatic carcinoma. The results did not differ significantly between the two techniques. The sensitivities of CT and EUS were 92% and 100%, respectively, for detecting tumours; the accuracies at predicting resectability were 92% and 89%, respectively; and the overall staging accuracies were 93% for both techniques (Table 4). EUS was found to be more sensitive than CT for detecting hepatic artery encasement but less sensitive for detecting superior mesenteric artery invasion. The authors concluded that thin-sec-tion, dual-phase helical CT is the most accurate CT technique for the imaging of pancreatic neoplasms. Take advantage of this opportunity – cephalexin 500mg to enjoy lowest prices online.

TABLE 4
Determination of resectability in pancreatic cancer: Accuracy of endoscopic ultrasound (EUS) versus computed tomography (CT)

Author (reference) n EUS (%) CT (%)
Legmann et al (2)* 22 89 92
Gress et al (3)* 81 93 60

*Dual-phase helical CT; fThin-section axial CT. 

Other reports evaluating helical CT have demonstrated less impressive results for predicting resectability (86% for CT versus 76% for EUS). Midwinter et al performed helical CT and EUS on a series of 48 patients with suspected pancreatic mass. EUS was superior to helical CT (97% versus 76%) at detecting pancreatic tumours. The two techniques were equally able to identify portal and superior mesenteric vein and lymph node involvement. However, EUS was less accurate at detecting superior mesenteric artery invasion, which was also found by Legmann et al. On the other hand, EUS was more accurate than CT at detecting distant lymph nodes. This might be an appropriate niche indication for EUS because, if distant lymph nodes were shown by EUS-guided fine needle aspiration (EUS FNA) to harbour malignancy, the cancer could not be cured by resection.