Ultrasonic evaluation of superior mesenteric vein in cancer of the pancreatic head Poster No.: C-1430 Congress: ECR 2012 Type: Authors: Keywords: DOI: Scientific Exhibit E. Fisenko, N. Vetsheva, E. Pershina; Moscow/RU Pathology, Neoplasia, Observer performance, Comparative studies, Ultrasound-Spectral Doppler, Ultrasound-Colour Doppler, Ultrasound, Pancreas, Oncology, Abdomen 10.1594/ecr2012/C-1430 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 8
Purpose To identify ultrasonic criteria for involvement of superior mesenteric vein in the neoplastic process of the pancreatic head in order to determine the proper treatment protocol of patients with tumors of the pancreatic head. Methods and Materials To explore superior mesenteric vein we confirm the visualisation of the head of pancreas from the longitudinal section. To make it proper the transducer must be located along the inferior vena cava. The ultrasound image in longitudinal section shows the head of pancreas that is located along the inferior vena cava and separated with superior mesenteric vein. The main segment of pancreas lies superficially, the deeper one, that is located behind to superior mesenteric vein, is the hamulus (fig.1). Integrated ultrasound ( B-mode, color mapping and spectral analysis of blood flow in tumor vessels and in extrapancreatic vessels) was performed 52 patients with tumor of the pancreatic head (men - 43, women - 9 mean age 58.3±8.5 years). We used ultrsound transducer with frequency 3,5 mhz. 9 patients were diagnosed pseudotumorous pancreatitis, 14 had cysticformation ( 7 - pseudocyst, 3 - cystadenoma mucinous, 4 - intraduct cystadenocarcinoma), 29 - cancer. Images for this section: Page 2 of 8
Fig. 1: normal ultrasound anatomy of the pancreas head (H). Longitudinal section. Scanning along the vena cava inferior (VCI). VMS - vena mesenterica superior; VP - portal vein; h - hamulus. Page 3 of 8
Results Compression of superior mesenteric vein by the cancer cause vein narrowing with monophasic blood flow (fig.2) (proved by spectral analysis of blood flow) without integrity or vascular wall damage. According to B - mode tumor invasion of vein wall was characterized by the thickening of the wall, irregular venous wall, constriction and interrupton of interface of vein. Diagnostic value of this method was poor: sensitivity rate - 71%, specifity rate - 91% and accuracy rate - 87%. An additional criteria for the involvement of the superior mesenteric vein wall was obtained by carrying out spectral analysis of blood flow in the area of assumed invasion of the wall: venous blood flow acquired pulsatory character (fig 3,4). Using Doppler ultrasound allowed to raise of diagnostic information of involvement superior mesenteric vein as compared to using only gray scale: sensivity to 91%, specificity to 97%, diagnostic accuracy to 94%. Images for this section: Page 4 of 8
Fig. 2: compression of superior mesenteric vein (vms) by the cancer (T) of pancreatic head (P) without invasion - monophasic blood flow. Fig. 3: Variants of the pulsatory blood flow in cases of superior mesenteric vein (vms) invasion by cancer (T) of pancreatic head. Page 5 of 8
Fig. 4: Variants of the pulsatory blood flow in cases of superior mesenteric vein (vms) invasion by cancer (T) of pancreatic head. Page 6 of 8
Conclusion Ultrasound examination of patients with tumors of the pancreatic head should be performed with the use of Doppler ultrasound and spectral analysis of blood flow, wich provides additional criteria for the involvement of the superior mesenteric vein in the neoplastic process and improves the diagnostic information. References 1. V.Sandrikov, E.Fisenko, I.Zima. ########### ############## ########### ## ############ ###################. ############ ###########. #####, 2008, ######. 2. E.Fisenko, N. Vetsheva. ###### ######### ####### ########## #### # ######### # ############# #################### ###### ## ########### ############ ###. ###### # ######. ###.17 ########## ###################### ######, ######. ####, #.##I #5. ########## #38, 2011, #.74 3. E.Fisenko, N. Vetsheva. ############## ######## ########## # ########## ####### ####### ########## #### ### ####### ####### ############# ######. ######## ######### ######## ##. #.#.###########, 2011, #6,#2, #.322-323. ###. XVIII ############## ######### ######## ########### ##### ### "########## ######## ############# ##########". 4. Machi J., Staren E.D. Ultrasound for Surgeous. - Philadelphia, USA, 2005. - 506 p. 5. Henningsen C. Clinical Guide to Ultrasonography. - Mosby, USA, 2004.-p.49-57. Personal Information E.Fisenko MD, PHD, Associated Professor Russias Research Sergery Center/ Moscow. N. Vetsheva MD, PHD Center of Sergery Vishnevskogo/Moscow. E. Pershina, MD, Radiology Resident Page 7 of 8
pershina86@mail.ru Russias Research Sergery Center/ Moscow. Page 8 of 8