Color Doppler imaging in the assessment of vascular involvement by pancreatic carcinoma

OBJECTIVE. The aim of our study was to assess the accuracy of color Doppler imaging in diagnosing the involvement of peripancreatic vessels by pancreatic carcinoma. SUBJECTS AND METHODS. We prospectively evaluated the color Doppler images of 61 patients with pancreatic carcinoma. Our evaluations occurred before surgery and focused on vascular involvement. Absence of contact or a short contiguity (less than or equal to 2 cm) between tumors and peripancreatic vessels was considered to be a sign of resectability on color Doppler imaging; a long contiguity (>2 cm), compression, encasement, or thrombosis was considered to be a sign of unresectability. In all patients, the sonographic diagnosis was compared with the surgical results. RESULTS. With color Doppler imaging, we detected signs of vascular involvement in 26 of 33 patients in whom vascular involvement was found at surgery. We detected no vascular involvement in 25 of 28 patients in whom no vascular involvement was found at surgery. No false-positive diagnoses occurred when vascular encasement was revealed by color Doppler imaging. For diagnosis of vascular involvement, the sensitivity, specificity, and overall accuracy of color Doppler imaging were 79%, 89%, and 84%, respectively; positive and negative predictive values were 89% and 79%, respectively. CONCLUSION. Color Doppler imaging is a sensitive and highly specific technique in assessing vascular involvement by pancreatic cancer when absence of contact or vascular encasement is seen. When vascular encasement is detected by color Doppler imaging, a definitive diagnosis of unresectability can be made, and further diagnostic procedures can be avoided. When sonography is used in the initial evaluation of pancreatic cancer, color Doppler imaging can improve the selection of patients for further diagnostic examinations or surgical exploration.