Angiographic Evaluation of Pancreatic Carcinoma

Abstract

There is considerable divergence of opinion regarding the reliability of angiography in the evaluation of adenocarcinoma of the pancreas. The incidence of angiographic abnormalities in proved cases ranges from 90 per cent in a retrospective analysis by Lunderquist (1) to 29 per cent in a prospective analysis by Nebesar and Pollard (3). Ranniger and Saldino (4) reported positive findings in 58 per cent of cases. Moskowitz et al. (2) emphasized the difficulty in distinguishing the angiographic features of chronic pancreatitis from those of carcinoma. In view of these conflicting reports, we recently reviewed our own angiographic experience in pancreatic carcinoma. The results indicate that pancreatic angiography is reliable in the detection of pancreatic carcinoma, usually reliable in differentiating carcinoma from pancreatitis, and helpful in evaluating inoperability. Material and Methods Since 1964, 300 patients with suspected pancreatic carcinoma have had angiographic evaluation at The University of Michigan Medical Center or Wayne County General Hospital. Forty-one of these patients had a final diagnosis of carcinoma of the pancreas, with histologic confirmation in 36. In 5 patients, clinical and angiographic features were sufficiently characteristic to justify the diagnosis of pancreatic carcinoma, although for a variety of reasons histologic confirmation was not obtained. The clinical records and angiograms of these 41 patients were reviewed. In addition, records and arteriograms were reviewed in 9 patients in whom a false positive angiographic diagnosis of carcinoma was made. Cases of ampullary carcinoma and cholangiocarcinoma, although angiographically similar to pancreatic carcinoma, are not included in this study. Data for this report are also derived from an angiographic study of 51 cases of pancreatitis by Reuter et al. (5), and from review of angiograms in 28 cases of pancreatitis studied at The University of Michigan Medical Center. Angiographic features which were specifically studied included: 1. Encasement: Abnormal arterial narrowing, suggestive of compression or invasion by an adjacent neoplasm. Although more frequently smooth (Fig. 2), encasement may appear serpiginous or serrated (Figs. 1 and 4). Serrated irregularity is usually recognized in large vessels, while serpiginous encasement is seen in small vessels. 2. Pathologic Vessels: Very small vessels of abnormal course and irregular caliber. Some of these vessels probably represent neovascularity (Figs. 2 and 6). Other represent deformed or invaded pre-existing vessels and the appearance merges with that of small vessel encasement. 3. Arterial Obstructions: May be seen in large arteries (celiac, superior mesenteric, hepatic, splenic, gastroduodenal) (Fig. 3) or small arteries of less then 2 mm diameter (pancreaticoduodenal arcades, dorsal pancreatic, pancreatico magna and their branches) (Fig. 5).