Possibilities of CT-perfusion in diagnostics of pancreatic cancer

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Abstract

The article presents a clinical observation of a patient with a pancreatic head tumor, when ultrasound and the standard MSCT protocol with the use of intravenous bolus contrast and multiphase scanning techniques revealed a tumor and its resequence could not be assessed. Inclusion in the protocol of CT scan of perfusion of the pancreas allowed to clearly visualize and localize the tumor, to estimate its size, the relationship with the main vessels. Based on the results of the examination, the patient underwent pancreatoduodenal resection.

About the authors

M. Yu. Kabanov

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: konstantinsementsov@gmail.com
Russian Federation, Saint Petersburg

K. V. Sementsov

North-Western State Medical University named after I.I. Mechnikov

Email: konstantinsementsov@gmail.com
Russian Federation, Saint Petersburg

M. Ya. Belikova

Hospital for Veterans of Wars

Email: konstantinsementsov@gmail.com
Russian Federation, Saint Petersburg

D. M. Yakovleva

North-Western State Medical University named after I.I. Mechnikov

Email: konstantinsementsov@gmail.com
Russian Federation, Saint Petersburg

References

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  2. Нестерюк Я.И. КТ-перфузия при опухолях поджелудочной железы // Медицинская визуализация. – 2015. – № 3. – С. 57–67. [Nerestyuk YaI. CT Perfusion of Pancreatic Tumors. Medical Visualization. 2015;(3):57-67. (In Russ.)]
  3. Долгушин М.Б., Тулин П.Е., Оджарова А.А., и др. КТ-перфузия в дифференциальной диагностике опухолей печени // Медицинская визуализация. – 2015. – № 5. – С. 18–31. [Dolgushin MB, Tulin PE, Odzharova AA, et al. KT-perfuzija v differencial’noj diagnostike opuholej pecheni. Medical Visualization. 2015;(5):18-31. (In Russ.)]
  4. Кармазановский Г.Г. Опухоли поджелудочной железы солидной структуры: протоколы лучевых исследований, дифференциальная диагностика // Медицинская визуализация. – 2016. – № 4. – С. 54–63. [Karmazanovsky GG. Solid Pancreatic Tumors: Protocols of Radiological Examinations and Differential. Medical Visualization. 2016;(4):54-63. (In Russ.)]
  5. Xie Q, Tang Y, Tang Y, et al. Whole-Organ CT Perfusion of the pancreas: Impact of Iterative Reconstruction on Image Quality, Perfusion Parameters and Radiation Dose in 256-Slice CT-Preliminary Findings. PLoS ONE. 2013;8(11):1-8. doi: 10.1371/journal.pone.0080468.

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2. Fig. 1. Computed tomography of the hepatopancreatoduodenal zone into the native scanning phase: a — three-dimensional reformation in the MIP algorithm. The head of the pancreas of a homogeneous structure (arrow), the tumor is not visible; b — three-dimensional reformation in the axial projection. In the body and tail of the pancreas, the main pancreatic duct (arrow)

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3. Fig. 2. Computer tomography in the arterial phase: 3D reconstruction in the algorithm Volume rendering. Variant of the structure of the arteries of the celiac and mesenteric basin. The common hepatic artery departs from the celiac trunk (long arrow), after the passage of the gastroduodenal artery passes into the left hepatic artery. The right hepatic artery (short arrow) independently moves away from the superior mesenteric artery

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4. Fig. 3. Computer tomography of the hepatopancreatoduodenal zone in the arterial phase of scanning: a — three-dimensional reformation in the coronary projection in the MIP algorithm. The head of the pancreas of a homogeneous structure, evenly accumulates a contrast agent (short arrow), the tumor is not visible. In the body of the pancreas, the main pancreatic duct (long arrow) is enlarged; b — three-dimensional reformation in the axial projection in the MIP algorithm. In the body and tail of the pancreas, the main pancreatic duct (arrow)

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5. Fig. 4. CT perfusion of the pancreas: a — perfusion map of blood flow velocity (BF). The tumor in the head of the pancreas is defined as a section of blue and green flowers (short arrow), the boundaries of the tumor with an unchanged parenchyma having a red color (long arrow) are clearly visible; b — three-dimensional reformation in the axial projection. Pancreatic phase. The head of the pancreas (arrow) evenly accumulates the contrast drug, the tumor is not visible; c — blood flow velocity perfusion map (BF). The dimensions of the tumor were 26.6 × 20.3 mm

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6. Fig. 5. CT perfusion of the pancreas: a — perfusion map of blood flow velocity (BF). In the tumor (blue area), ROI2 is established, in the tumor tissue of the head (red section) ROI3; b — graph of the time-density relationship. Red color (№ 1) indicates the dependence of the «time – density» indices in the abdominal aorta, red (№ 2) in the tumor, in green (№ 3) in the pancreatic tissue not involved in the tumor process. Perfusion parameters in the tumor were: BF — 37.5 ml/100 g/min, BV — 3.3 ml/100 g, MTT — 5.5 s; in unchanged head parenchyma: BF — 117 ml/100 g/min, BV — 10.6 ml/100 g, MTT — 8 s

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7. Fig. 6. Computer tomography of the hepatopancreatoduodenal zone in the portal scanning phase: a — three-dimensional reformation in the MIP algorithm. The isthmus of the pancreas (arrow) is attached to the portomecentary trunk, the borders of the tumor are not visible; b — blood flow velocity perfusion map (BF). Tumor (arrow) in the head of the pancreas is closely adjacent to the right side wall of the portal vein (arrow) without retaining the fatty layer. The contour of the vein at the point of contact with the tumor is flattened

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Copyright (c) 2018 Kabanov M.Y., Sementsov K.V., Belikova M.Y., Yakovleva D.M.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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