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Diagnosis and staging of pancreatic carcinoma: comparison of manganofodipir trisodium‐enhanced magnetic resonance imaging and dynamic contrast‐enhanced spiral computed tomography. BJS 1999; 86: 420-420.

Published: 2nd January 2003

Authors: L. J. King, J. R. G. Bell, J. C. Healy, Z. Amin, D. Predolac, A. Wotherspoon et al.

Background

The efficacy of manganofodipir trisodium (MnDPDP)‐enhanced magnetic resonance imaging (MRI) and dual‐phase dynamic contrast‐enhanced spiral computed tomography (CT) in the diagnosis and staging of pancreatic carcinoma was compared.

Method

Nineteen patients (eight men) aged 50–84 (mean 64) years with known or suspected pancreatic carcinoma were prospectively evaluated with MRI and CT. Precontrast T1 and T2 MRI sequences were supplemented by axial and coronal T1 images at 1·0 T, 20 min and 24 h following intravenous infusion of MnDPDP 0·5 ml/kg. Spiral CT was performed before contrast and dynamically after contrast during the pancreatic and portal venous phases of enhancement. The MRI and CT images were assessed independently by two observers blinded to the results of the other modality. The presence, site and size of any focal pancreatic mass were recorded and potential resectability was assessed by evaluating extraglandular extension, vascular involvement, lymphadenopathy, peritoneal spread and presence of hepatic metastases. Findings on MRI and CT were compared with the findings at surgery.

Results

Pancreatic adenocarcinomas were diagnosed histologically in 15 of 19 patients. MRI and CT each identified all of the proven malignancies. Clear evidence of irresectability with liver metastases or vascular invasion was identified in six of 15 patients at MRI, who did not therefore go on to surgery. In one of these six patients the CT findings were equivocal. Nine of the 15 patients went on to laparoscopy (n = 2) or laparotomy (n = 7). Of␣these nine patients seven were correctly assessed as resectable or␣irresectable on MRI and six by CT. The overall accuracy for assessing resectability was therefore 87 per cent for MRI and 73 per cent for CT. Liver metastases were confidently identified in three of 15 patients on both MRI and CT. Two patients with indeterminate liver lesions on CT were shown to have only benign liver lesions (cysts or haemangiomas) on MRI.

Conclusion

MnDPDP‐enhanced MRI performed slightly better than dual‐phase dynamic contrast‐enhanced CT in the preoperative assessment of pancreatic tumour resectability. MRI also appears to offer an advantage in the evaluation of associated focal liver lesions. © 1999 British Journal of Surgery Society Ltd

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