Table 3.
Results from VR CT and MRI with lack of interobserver agreement (participant vs. MDT/radiology report)
| Modality | Group | Radiology report | Interobserver disagreement (VR vs. MDT/radiology report) | Clinical remarks |
|---|---|---|---|---|
| CT | LA | Large tumour originating from pancreatic body, infiltrating stomach, duodenum, encasing coeliac trunk | Tumour not identified by 2 participants | Palliative chemotherapy |
| CT | BR | Solid contact of tumour to SMA (< 90°) and SMV | Deemed resectable by participant, vascular contact not identified | Patient underwent Whipple’s procedure, R0 resection, no vascular involvement intraoperatively |
| CT | LA | Large HOP mass, infiltrating mesenteric root, encasing SMA, infiltration of PV | Tumour not identified by participant | Palliative chemotherapy |
| MRI | BR | HOP mass, infiltrating SMV and solid tumour contact with SMA (< 180°) | Deemed resectable by participant | Neoadjuvant treatment, laparotomy, exploration, procedure abandoned due to tumour infiltration over long section of SMA |
| MRI | R | 2.6 HOP mass, no visible infiltration of surrounding vascular structures | Participant unsure if tumour contact to SMV/PV present | Whipple’s procedure performed, R0 resection, no vascular infiltration intraoperatively |
| MR | LA | 5 cm HOP mass with 180° contact to CHA, possible contact to celiac trunk and occlusion of SMV/PV confluence | Participant judges situation as borderline resectable | Palliative chemotherapy |
| MR | BR | 4.7 cm HOP mass with contact to SMV. Previous right hemicolectomy noted with central lymphadenectomy and removal of inferior mesenteric vein, presence of clip noted. Scarring and imaging artefacts in the area | Participant can’t clearly delineate tumour or assess contact to vasculature | Whipple’s procedure performed, R0 resection, tumour lifted off SMV with minimal adherence, ileotransversostomy adherent to pancreatic head, resected, end ileostomy formed. Adjuvant chemotherapy. Early recurrence with distant metastases (pulmonary) |
| MR | R | 2.4 cm HOP mass, < 90° contact of HOP to SMV, other vessels without tumour contact | Participant can’t give a final answer on vascular involvement | Whipple’s procedure performed. R0 resection |
R resectable, BR borderline resectable, LA locally advanced, CT computed tomography, MRI magnetic resonance imaging, HOP head of pancreas, SMA superior mesenteric artery, CHA common hepatic artery, PV portal vein, SMV superior mesenteric vein, MDT multidisciplinary team