Tumor Encasement

In patients with pancreatobiliary tumors, it is important to evaluate portal vein invasion beforesur-gery. CT and DSA have been used for this purpose. 3D CE MR portography is also an accurate way to diagnose portalvein invasion [22,23].

Table 2. Accuracy of 3D CE MR portography; # number of patients with angiography or surgical correlation

Author

Year

Journal

# Patients

Sensitivity

Specificity

Stafford-Johnson [29]

1998

Radiology

13

100%

100%

Wilson [35]

1998

Invest Radiol

27

86%

100%

Kopka [36]

1999

Radiology

140 (60*)

100%

100%

Kreft [30]

2000

Radiology

36

100%

98%

Glockner [37]

2000

AJR

34 (20*)

100%

94%

Ernst[38]

2000

AJR

33

100%

100%

Haliloglu [39]

2000

JMRI

3

100%

Cheng [40]

2001

Transplantation

38

100%

100%

Squillaci [41]

2001

RadiolMed

28

100%

97, 3%

Invasion of the portal vein makes tumor resection with clear margins nearly impossible, thus, removing the patient as a surgical candidate. Tumors in the pancreatic head may encase the SMV, portal vein, and medial splenic vein. These tumors are usually detected early because they cause biliary obstruction, and thereby may be more likely to be resectable. Tumors in the body and tail of the pancreas may become larger before being detected and more commonly occlude the splenic vein. Splenic vein occlusion has a tendency to produce short gastric varices serving as venous collaterals and can be seen on delayed images.

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