Intraportal endovascular ultrasonography in pancreatic cancer--a new technique for the diagnosis of portal vein invasion: a preliminary report.

BACKGROUND

Intraportal endovascular ultrasonography was performed to diagnose portal vein invasion in pancreatic cancer.

METHODS

In six patients the intravascular ultrasonographic catheter was introduced during operation through the superior mesenteric vein into the intrahepatic portal vein. The catheter was gradually withdrawn and the cross-sectional images of the area under investigation were recorded. The findings of intraportal endovascular ultrasonography were compared with the histologic findings of the resected specimen, preoperative computed tomographic scan and arterial portogram.

RESULTS

The wall of the portal vein was visualized as an echogenic band with a thickness of 0.5 to 1.0 mm. Lymph nodes along the portal vein could also be visualized. In three of four resected cases, the wall of the portal vein was intact and portal vein invasion was diagnosed as negative by intraportal endovascular ultrasonography. In one of the resected cases, the portal vein invasion was diagnosed by intraportal endovascular ultrasonography only. These findings were confirmed by histologic examination. In two unresected cases, the portal invasion of the tumor was diagnosed as positive by imaging diagnosis including intraportal endovascular ultrasonography. This finding was confirmed by operative findings. In all patients portal invasion of the tumor could be diagnosed accurately.

CONCLUSIONS

Intraportal endovascular ultrasonography provides important information about the resectability of pancreatic cancer.