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. 1995 Dec;222(6):711–718. doi: 10.1097/00000658-199512000-00004

Intraportal endovascular ultrasonography in the diagnosis of portal vein invasion by pancreatobiliary carcinoma.

T Kaneko 1, A Nakao 1, S Inoue 1, A Harada 1, T Nonami 1, S Itoh 1, T Endo 1, H Takagi 1
PMCID: PMC1235019  PMID: 8526577

Abstract

OBJECTIVE: The purpose of this study was to determine the value of intraportal endovascular ultrasonography (IPEUS) in the diagnosis of portal vein invasion by pancreatobiliary carcinoma. The authors reported their experiences with this new technique and compared it with conventional imaging technologies, such as portography and computed tomography (CT). SUMMARY BACKGROUND DATA: Pancreatobiliary carcinoma often invades the portal vein. Observation of the echogenic band of the portal vein wall by means of a high-frequency, high-resolution intravascular ultrasound catheter allows for the accurate diagnosis of the portal vein invasion. METHODS: A prospective study of 30 consecutive patients with pancreatobiliary carcinoma (16 pancreatic carcinomas, 8 bile duct carcinomas and 6 gallbladder carcinomas) was performed. In 23 cases IPEUS was performed intraoperatively from the superior mesenteric venous route with an 8 French, 20 MHz intravascular ultrasound catheter. In 7 cases IPEUS was performed before surgery from the percutaneous transhepatic route with a 6 French, 20 MHz intravascular ultrasound catheter. The finding of IPEUS was confirmed by pathologic examination of resected specimens and surgical exploration. The results of IPEUS were compared to those of portography and CT. RESULTS: Intraportal endovascular ultrasonography visualized the portal vein wall as an echogenic band with a thickness of 0.5 mm to 1.0 mm. The diagnostic criterion of portal vein invasion was destruction of this echogenic band. Portal vein invasion was found in 15 of 30 cases. Vascular invasion was confirmed by pathologic examination of resected specimens in 10 patients and operative findings in 5. The sensitivity, specificity, and overall accuracy of IPEUS for diagnosis of portal vein invasion was 100%, 93.3%, and 96.7%, respectively. The values were 80%, 67.7%, and 73.3% for portography and 53.3%, 80%, and 66.7%, respectively, for CT. CONCLUSIONS: Intraportal endovascular ultrasonography provided precise information about the relationship between the pancreatobiliary tumor and the portal vein wall. It was capable of accurately detecting or excluding early invasion of the portal vein wall by pancreatobiliary carcinoma.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Engeler C. E., Yedlicka J. W., Letourneau J. G., Castañeda-Zúiga W. R., Hunter D. W., Amplatz K. 1990 ARRS Executive Council Award. Intravascular sonography in the detection of arteriosclerosis and evaluation of vascular interventional procedures. AJR Am J Roentgenol. 1991 May;156(5):1087–1090. doi: 10.2214/ajr.156.5.1826804. [DOI] [PubMed] [Google Scholar]
  2. Geer R. J., Brennan M. F. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg. 1993 Jan;165(1):68–73. doi: 10.1016/s0002-9610(05)80406-4. [DOI] [PubMed] [Google Scholar]
  3. Goldberg B. B., Bagley D., Liu J. B., Merton D. A., Alexander A., Kurtz A. B. Endoluminal sonography of the urinary tract: preliminary observations. AJR Am J Roentgenol. 1991 Jan;156(1):99–103. doi: 10.2214/ajr.156.1.1898578. [DOI] [PubMed] [Google Scholar]
  4. Kaneko T., Nakao A., Harada A., Nomami T., Takagi H. Intraportal endovascular ultrasonography in pancreatic cancer--a new technique for the diagnosis of portal vein invasion: a preliminary report. Surgery. 1994 Apr;115(4):438–444. [PubMed] [Google Scholar]
  5. Kaneko T., Nakao A., Inoue S., Harada A., Nonami T., Takagi H. Intracaval endovascular ultrasonography for intracaval tumor thrombus. J Am Coll Surg. 1994 Nov;179(5):604–606. [PubMed] [Google Scholar]
  6. Mannell A., van Heerden J. A., Weiland L. H., Ilstrup D. M. Factors influencing survival after resection for ductal adenocarcinoma of the pancreas. Ann Surg. 1986 Apr;203(4):403–407. doi: 10.1097/00000658-198604000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Mimura H., Takakura N., Kim H., Hamazaki K., Tsuge H., Ochiai Y. Block resection of the hepatoduodenal ligament for carcinoma of the bile duct and gallbladder. Surgical technique and a report of 11 cases. Hepatogastroenterology. 1991 Dec;38(6):561–567. [PubMed] [Google Scholar]
  8. Nakao A., Nonami T., Harada A., Kasuga T., Takagi H. Portal vein resection with a new antithrombogenic catheter. Surgery. 1990 Nov;108(5):913–918. [PubMed] [Google Scholar]
  9. Nimura Y., Hayakawa N., Kamiya J., Maeda S., Kondo S., Yasui A., Shionoya S. Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology. 1991 Apr;38(2):170–175. [PubMed] [Google Scholar]
  10. Noguchi T., Makuuchi M., Maruta F., Kakazu T., Kawasaki S. Intraportal US with 20-MHz and 30-MHz scanning catheters. Work in progress. Radiology. 1993 Jan;186(1):203–205. doi: 10.1148/radiology.186.1.8416565. [DOI] [PubMed] [Google Scholar]
  11. Strijk S. P., Boetes C., de Boer H. H., Yap S. H., Rosenbusch G. Percutaneous transhepatic portography in pancreatobiliary carcinoma: evaluation of resectability. Gastrointest Radiol. 1982;7(4):357–362. doi: 10.1007/BF01887671. [DOI] [PubMed] [Google Scholar]
  12. Tashiro S., Tsuji T., Kanemitsu K., Kamimoto Y., Hiraoka T., Miyauchi Y. Prolongation of survival for carcinoma at the hepatic duct confluence. Surgery. 1993 Mar;113(3):270–278. [PubMed] [Google Scholar]
  13. Tashiro S., Uchino R., Hiraoka T., Tsuji T., Kawamoto S., Saitoh N., Yamasaki K., Miyauchi Y. Surgical indication and significance of portal vein resection in biliary and pancreatic cancer. Surgery. 1991 Apr;109(4):481–487. [PubMed] [Google Scholar]
  14. Tobis J. M., Mallery J. A., Gessert J., Griffith J., Mahon D., Bessen M., Moriuchi M., McLeay L., McRae M., Henry W. L. Intravascular ultrasound cross-sectional arterial imaging before and after balloon angioplasty in vitro. Circulation. 1989 Oct;80(4):873–882. doi: 10.1161/01.cir.80.4.873. [DOI] [PubMed] [Google Scholar]
  15. Vellet A. D., Romano W., Bach D. B., Passi R. B., Taves D. H., Munk P. L. Adenocarcinoma of the pancreatic ducts: comparative evaluation with CT and MR imaging at 1.5 T. Radiology. 1992 Apr;183(1):87–95. doi: 10.1148/radiology.183.1.1312736. [DOI] [PubMed] [Google Scholar]
  16. Willett C. G., Lewandrowski K., Warshaw A. L., Efird J., Compton C. C. Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy. Ann Surg. 1993 Feb;217(2):144–148. doi: 10.1097/00000658-199302000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. vanSonnenberg E., D'Agostino H. B., Sanchez R. L., Goodacre B. B., Esch O. G., Easter D. E., Gosink B. B. Percutaneous intraluminal US in the gallbladder and bile ducts. Radiology. 1992 Mar;182(3):693–696. doi: 10.1148/radiology.182.3.1535882. [DOI] [PubMed] [Google Scholar]

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