Three-dimensional volume-rendered multidetector CT imaging of the posterior inferior pancreaticoduodenal artery: its anatomy and role in diagnosing extrapancreatic perineural invasion

Extrapancreatic perineural spread in pancreatic adenocarcinoma contributes to poor outcomes, as it is known to be a major contributor to positive surgical margins and disease recurrence. However, current staging classifications have not yet taken extrapancreatic perineural spread into account. Four...

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Bibliographic Details
Published in:Cancer imaging 2013-12, Vol.13 (4), p.580-590
Main Authors: Patel, Bhavik N, Giacomini, Craig, Jeffrey, R Brooke, Willmann, Juergen K, Olcott, Eric
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Arteries
Humans
Imaging, Three-Dimensional - methods
Multidetector Computed Tomography - methods
Neoplasm Invasiveness
Neovascularization, Pathologic
Pancreas - blood supply
Pancreatic Neoplasms - blood supply
Pancreatic Neoplasms - pathology
Review
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Summary:Extrapancreatic perineural spread in pancreatic adenocarcinoma contributes to poor outcomes, as it is known to be a major contributor to positive surgical margins and disease recurrence. However, current staging classifications have not yet taken extrapancreatic perineural spread into account. Four pathways of extrapancreatic perineural spread have been described that conveniently follow small defined arterial pathways. Small field of view three-dimensional (3D) volume-rendered multidetector computed tomography (MDCT) images allow visualization of small peripancreatic vessels and thus perineural invasion that may be associated with them. One such vessel, the posterior inferior pancreaticoduodenal artery (PIPDA), serves as a surrogate for extrapancreatic perineural spread by pancreatic adenocarcinoma arising in the uncinate process. This pictorial review presents the normal and variant anatomy of the PIPDA with 3D volume-rendered MDCT imaging, and emphasizes its role as a vascular landmark for the diagnosis of extrapancreatic perineural invasion from uncinate adenocarcinomas. Familiarity with the anatomy of PIPDA will allow accurate detection of extrapancreatic perineural spread by pancreatic adenocarcinoma involving the uncinate process, and may potentially have important staging implications as neoadjuvant therapy improves.
ISSN:1470-7330
1740-5025
1470-7330
DOI:10.1102/1470-7330.2013.0051