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| Value of CT to evaluate mesangial invasion in pancreatic head cancer |
| FENG Pei1,2, PAN Jingjing2, LIU Tong2, FAN Wei2, Xu Lei1 |
1. Department of Radiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China;
2. Department of Radiology, Characteristics Medical Center of PLA Rocket Force, Beijing 100088, China |
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Abstract Objective To evaluate the value of CT in the evaluation of mesopancreas invasion of pancreatic head carcinoma (PHC). Methods The clinical and CT imaging data of 58 PHC patients who underwent total mesopancreas excision (TMpE) and were pathologically confirmed to have R0 resection from February 2016 to January 2022 in Characteristics Medical Center of PLA Rocket Force were retrospectively analyzed. All the patients were divided into recurrence group (30 cases) and non-recurrence group (28 cases) by 1 year follow-up. A total of five imaging levels, including the posterior border of the superior mesenteric vein-portal vein, the right edge of the opening of the celiac trunk, the right edge 2 cm above the opening of the celiac trunk, the right edge of the opening of the superior mesenteric artery, and the anterior edge of the left renal vein inferior vena cava confluence-abdominal aorta connection were selected to measure the CT values of mesopancreas region in the plain scanning, arterial-phase and venous-phase of the two groups, and the rate of change of the CT values of the arterial-phase and venous-phase was calculated. ROC analysis was performed on the three-phase CT values and the rate of change of CT values in the arterial-phase and venous-phase of the mesopancreas at five levels in the recurrence group to evaluate the diagnostic efficacy of the mesopancreas invasion and to compare the differences in efficacy between diagnostic indicators. Results The plain scan CT values, arterial-phase CT values and venous-phase CT values in 5 imaging levels were significantly different between the recurrence group and the non-recurrence group (P<0.05).The rate of change of arterial-phase and venous-phase CT values in the mesopancreas of the two groups showed no difference at the imaging level of the right margin 2 cm above the opening of the celiac trunk, and there were differences at the remaining four imaging levels. The rate of change of arterial-phase CT values were 187.0% vs.24.0%, 85.7% vs. 25.2%, 198.7% vs. 29.3%, 668.1% vs. 33.0% (P<0.05). The rate of change of venous-phase CT values were 297.0% vs. 35.0 %, 140.4% vs. 31.5%, 402.1% vs. 33.4%, 142.9% vs. 47.4% (P<0.05). There was no difference in the efficacy of each diagnostic index in the evaluation of mesopancreas invasion in the same observation level. The indexes in the superior mesenteric vein-portal posterior margin level had the largest AUC value(0.886, 95%CI: 0.786-0.951) with a specificity of 95.8% and sensitivity of 83.3%. Conclusions CT has a certain clinical value in the evaluation of mesopancreas invasion of PHC, and can provide a new basis for the scope of total mesopancreas excision of pancreas and postoperative treatment.
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Received: 24 June 2024
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2024, Vol. 35 
