VIENNA - Dynamic gadolinium-enhanced MRI is superior to three-phase spiral CT in the preoperative staging of pancreatic carcinoma, according to Dr. B.J. Op de Beeck in a presentation today at the European Congress of Radiology.
Resection of pancreatic cancer is possible only at an early stage, when the tumor is localized to the pancreas without liver or peritoneal metastases. The choice of imaging modality for preoperative staging of this cancer thus can be critical for patient viability.
Op de Beeck presented the results of research with CT and MR for pancreatic cancer that was conducted at the departments of radiology at Virejee University in Brussels and Ziekenhuis University in Antwerp, the Netherlands. The study involved 32 patients who underwent spiral CT and MR.
The CT images were taken in 5-mm slices at five-second intervals with a Siemens Somatom Plus 4A scanner after 150 ml of iodinated contrast was automatically injected at a rate of 2 cc per second. The MR technique was performed on a Siemens 1.5-tesla Magnetom Vision system, with T1- and T2-weighted sequences in phase with fat suppression and dynamic gadolinium injection.
The images were evaluated in five areas by a panel blinded to the results:
- Tumor detection
- Vascular encasement and obliteration
- Adenopathies
- Liver metastases
- General resectability
The researchers found tumor detectability, with a mean tumor size of 28.3 mm, to be 84.4% for CT and 93.7% for MR. However, adenopathies of <9 mm were seen in 50% of the CT cases and in only 43.7% of the MR cases.
Vascular encasement and obliteration showed up in the CT reports 12.5% and 37.5% of the time, respectively, compared with. 15.6% and 37.5% for MR. Liver metastases were detected on CT in 21.9% of the patients, while MR showed metastases in 25% of the patients.
At both institutions, MR was preferred over CT 57.9% of the time, was considered equal in preoperative staging by 21% of the radiologists, and was considered inferior to CT by 21% of the study respondents.
Attendees at the presentation were quick to point out that the MR technique was far more advanced than the technique used to capture the CT images, and may have skewed the results.
"Although MR showed better results in imaging preoperative staging of pancreatic carcinoma than spiral CT, multislice CT images at faster contrast injection rates and slice intervals with thinner slices may be as good as MR imaging, and warrants research," responded Op de Beeck.
By Jonathan S. Batchelor
AuntMinnie.com staff writer
March 2, 2001
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