The changing role of pancreatic arteriography in the era of computed tomography.

Computed tomography (CT) in the assessment of suspected pancreatic disease, although an excellent screening procedure, has certain shortcomings, such as a significant percentage of inaccurate studies, a low predictive value of the finding of a pancreatic mass, failure to detect small lesions, and inability to differentiate localized masses caused by pancreatitis from those caused by adenocarcinoma. Arteriography provides important additional information in patients with clinically suspected pancreatic lesions and positive findings on CT or other noninvasive screening studies in whom surgical resection is contemplated. This procedure helps determine the presence and resectability of adenocarcinoma and can also demonstrate lesions which may resemble pancreatic adenocarcinoma on CT but which, in reality, are nonmalignant or nonpancreatic or both. Arteriography should no longer be used as a screening procedure but should be performed whenever a potentially resectable pancreatic mass, either cystic or solid is suggested by CT.