CT findings of pancreatic ductal adenocarcinoma at King Chulalongkorn Memorial Hospital: A study of 40 cases with histological verification

Abstract

Background : The incidence of pancreatic cancer has been increasing. CT scan is effective and standard modality for imaging of pancreatic cancer.

Objective : To describe CT findings in pancreatic ductal adenocarcinoma at King Chulalongkorn Memorial Hospital and to subgroup analyze the enhancement patterns and presence of metastasis of each histological grading.

Setting : Department of Radiology and Department of Pathology, Faculty of Medicine, Chulalongkorn University

Design : Retrospective descriptive study

Materials and Methods : Preoperative dual phase abdominal CT scans and pathological reports of 40 patients with pancreatic adenocarcinoma in King Chulalongkorn Memorial Hospital from 2003 to 2008 were retrospectively reviewed.

Results : In 40 patients, 13 were male and 27 were female with their mean age of 61.9 ± 2.36 years old. Most common location was pancreatic head in 29 patients. The tumor size ranged from 1.4-10.9 cm with the mean of 3.9 cm. On the precontrast study, 28 tumors were isodense and 12 tumors were hypodense. On arterial phase, all were hypodense. On portovenous phase, 36 tumors were hypodense and 4 tumors were isodense. Pancreatic duct dilatation was seen in12 patients (30%) and bile duct dilatation was seen in13patients (32.5%). Arterial involvement was seen in 22 patients (55%); the splenic artery was the most commonly involved. Venous involvement was seen in 27 patients (67.5%); the splenic vein and SMV were the most commonly involved. Adjacent organ invasion was seen in 17 patients (42.5%); the duodenum was the most commonly involved. Regional node involvement was seen in 12 patients (30%); the aortocaval node was the most commonly involved. Metastasis was seen in 15 patients (37.5%); liver metastasis was the most common. There was no statistically significant correlation of enhancement pattern and the presence of metastasis with tumor grading.

Conclusion : The most common CT findings of pancreatic ductal adenocarcinoma was ill-defined mass with hypodensity on arterial phase. The most common location was pancreatic head. There was no statistically significant correlation of enhancement pattern and the presence of metastasis with tumor grading.