Value of three-dimensional reconstructions in pancreatic carcinoma using multidetector CT: initial results

Abstract

Aim: To evaluate the use of three-dimensional imaging of pancreatic carcinoma using multidetector computed tomography (CT) in a prospective study.

Methods: Ten patients with suspected pancreatic tumors were examined prospectively using multidetector CT (Somatom Sensation 16, Siemens, Erlangen, Germany). The images were evaluated for the presence of a pancreatic carcinoma and invasion of the peripancreatic vessels and surrounding organs. Using the isotropic CT data sets, a three-dimensional image was created with automatic vascular analysis and semi-automatic segmentation of the organs and pancreatic tumor by a radiologist. The CT examinations and the three-dimensional images were presented to the surgeon directly before and during the patient's operation using the Medical Imaging Interaction Toolkit-based software "ReLiver". Immediately after surgery, the value of the two images was judged by the surgeon. The operation and the histological results served as the gold standard.

Results: Nine patients had a pancreatic carcinoma (all pT3), and one patient had a serous cystadenoma. One tumor infiltrated the superior mesenteric vein. The infiltration was correctly evaluated. All carcinomas were resectable. In comparison to the CT image with axial and coronal reconstructions, the three-dimensional image was judged by the surgeons as better for operation planning and consistently described as useful.

Conclusion: A 3D-image of the pancreas represents an invaluable aid to the surgeon. However, the 3D-software must be further developed in order to be integrated into daily clinical routine.

Figure 1

Lateral view of the three-dimensional model of a pancreatic carcinoma (pale green) in the processus uncinatus. There is contact between the tumor and the superior mesenteric vein but no invasion.

Figure 2

Patient with stage T3 pancreatic carcinoma with portal vein invasion; the preoperative assessment was correct. A: Axial slice through tumor; B: Three-dimensional reconstruction, frontal view (tumor = pale green); C: Three-dimensional reconstruction, cranial view (tumor = pale green).