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Two-Dimensional Multiplanar and Three-Dimensional Volume-Rendered Vascular CT in Pancreatic Carcinoma

Interobserver Agreement and Comparison with Standard Helical Techniques

Seung Yon Baek1, Douglas H. Sheafor2, Mary T. Keogan3, David M. DeLong2 and Rendon C. Nelson2

1 Department of Radiology, Ewha Womans University Mok Dong Hospital, 911-1 Mok-Dong, Yang-Cheon-Ku, Seoul, 158-710 South Korea.
2 Department of Radiology, Duke University Medical Center, Erwin Rd., Box 3808, Durham, NC 27710.
3 Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215.



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  		Fig. 1A. —60-year-old woman with biopsy-proven adenocarcinoma in head of pancreas. Axial source image from arterial phase of dual-phase helical CT reveals soft-tissue attenuation surrounding superior mesenteric artery (arrow).

All three observers interpreted grade 3 involvement of superior mesenteric artery on axial and combined images. Two observers interpreted grade 1 involvement of superior mesenteric artery on reformatted images.

 


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  		Fig. 1B. —60-year-old woman with biopsy-proven adenocarcinoma in head of pancreas. Two-dimensional curved coronal multiplanar image shows that fat plane (arrows) between mass and right side of superior mesenteric artery is preserved but there is soft-tissue attenuation along left side of superior mesenteric artery (arrowheads).

All three observers interpreted grade 3 involvement of superior mesenteric artery on axial and combined images. Two observers interpreted grade 1 involvement of superior mesenteric artery on reformatted images.

 


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  		Fig. 1C. —60-year-old woman with biopsy-proven adenocarcinoma in head of pancreas. Three-dimensional volume-rendered vascular image shows course and caliber of superior mesenteric artery (arrows) is normal.

All three observers interpreted grade 3 involvement of superior mesenteric artery on axial and combined images. Two observers interpreted grade 1 involvement of superior mesenteric artery on reformatted images.

 


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  		Fig. 2A. —76-year-old woman with biopsy-proven adenocarcinoma in body of pancreas. Axial source image from arterial phase of dual-phase helical CT shows soft-tissue mass surrounding both common hepatic artery (arrow) and splenic artery (arrowheads).

All three observers interpreted grade 3 involvement of common hepatic artery and splenic artery on both axial and combined images. One observer, however, interpreted grade 0 involvement of common hepatic artery and splenic artery on reformatted images, and another observer interpreted grade 1 involvement of common hepatic artery on reformatted images.

 


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  		Fig. 2B. —76-year-old woman with biopsy-proven adenocarcinoma in body of pancreas. Two-dimensional oblique axial multiplanar image also shows soft-tissue mass surrounding common hepatic artery (arrows) and splenic artery (arrowheads).

All three observers interpreted grade 3 involvement of common hepatic artery and splenic artery on both axial and combined images. One observer, however, interpreted grade 0 involvement of common hepatic artery and splenic artery on reformatted images, and another observer interpreted grade 1 involvement of common hepatic artery on reformatted images.

 


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  		Fig. 2C. —76-year-old woman with biopsy-proven adenocarcinoma in body of pancreas. Three-dimensional oblique axial volume-rendered vascular image shows irregular narrowing of proximal portions of common hepatic artery (arrows) and splenic artery (arrowheads).

All three observers interpreted grade 3 involvement of common hepatic artery and splenic artery on both axial and combined images. One observer, however, interpreted grade 0 involvement of common hepatic artery and splenic artery on reformatted images, and another observer interpreted grade 1 involvement of common hepatic artery on reformatted images.

 


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  		Fig. 3A. —56-year-old woman with adenocarcinoma of body of pancreas; patient underwent surgical resection. Axial source image shows low-attenuation mass (arrows) in body of pancreas.

Two observers interpreted grade 0 for all five arteries on all imaging modalities, but one observer interpreted grade 2 involvement of common hepatic artery and grade 3 involvement of splenic artery on reformatted images.

 


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  		Fig. 3B. —56-year-old woman with adenocarcinoma of body of pancreas; patient underwent surgical resection. Two-dimensional curved coronal multiplanar image shows low-attenuation mass (large arrow) in body and dilated pancreatic duct in body and tail. Triangular-shaped lymph node measuring 15 x 10 mm is seen caudad to pancreas (small arrows). Gastroduodenal artery (arrowheads) is not involved.

Two observers interpreted grade 0 for all five arteries on all imaging modalities, but one observer interpreted grade 2 involvement of common hepatic artery and grade 3 involvement of splenic artery on reformatted images.

 

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