Correlation of CT and operative staging in cancer head of the pancreas

ABSTRACT

In a current series of 150 patients with obstructive jaundice studied by abdominal CT, there were only 30 cases with operatively proved pancreatic carcinoma. A correct CT diagnosis was made in 24 cases [80%] while 6 patients [20%] were incorrectly diagnosed. The primary CT finding of pancreatic carcinoma was a tumour mass with associated bile and or pancreatic duct dilatation. The mass was located in the head in 28 cases [93%] and involved most of the gland in 2 cases [7%]. On CT, the mass was demonstrated as a central hypodense zone in 18 cases representing the hypovascular scirrhous tumour surrounded by normal parenchyma or inflammatory tissue caused by obstructive pancreatitis. In 6 cases, the mass was heterogenous in density. The common bile duct was dilated in all of our cases. A dilated pancreatic duct was seen in 12 cases, Tumour obstruction of the main pancreatic duct causing rupture of lateral side branch ducts resulted in the formation of post obstructive pseudo-cysts in 2 cases. Knowledge of this finding is important to avoid the mis-diagnosis of a tumour as pancreatitis with pseudocysts. The secondary findings of local tumour extension or metastatic diasease help to differentiate malignant masses from benign ones and aid in tumour staging and resectability. One or more of the ancillary findings were seen in 22 out of 24 correctly diagnosed cases. CT diagnosed resectable tumours in 2 cases. During operation however one case only was resectable