多层螺旋CT对胰腺癌周围血管侵犯及肿瘤可切除性的术前评估

【摘要】目的：探讨术前CT对胰腺癌周围血管侵犯和肿瘤可切除性的评估价值。方法：回顾性分析经病理证实的98例胰腺癌的CT多期增强表现,根据其胰周血管侵犯情况及胰腺癌可切除标准,将所有病例分为可切除组、潜在可切除组和不可切除组。以手术及病理结果作为金标准,评价CT对胰腺癌周围血管的诊断效能及肿瘤可切除性的诊断符合率。结果：98例胰腺癌中,术前CT诊断可切除组37例,潜在可切除组38例,不可切除组23例。与手术及病理结果对照,CT对胰周动脉受侵的诊断符合率、敏感度、特异度分别为92.2%、89.9%、92.8%;对胰周静脉受侵的诊断符合率、敏感度、特异度分别为96.9%、95.6%、97.3%。术前CT对可切除组、潜在可切除组、不可切除组的诊断符合率分别为为97.3%、86.8%、91.3%。结论：CT多期增强扫描对胰腺癌周围血管受侵情况的评估具有重要价值,有利于术前评估肿瘤的可切除性。     

胰腺癌胰外神经侵犯的CT诊断

目的:研究CT对胰腺癌胰外神经侵犯的诊断价值.方法:32例外科手术和病理证实的胰腺癌,术前1个月内均行螺旋CT检查.回顾性分析肿瘤大小、胰周血管侵犯、淋巴结转移和胰外神经侵犯情况,根据胰周腹腔神经丛主干及腹腔神经节周围软组织改变确定胰外神经侵犯的CT征象.以病理结果为标准,分析CT对胰外神经侵犯的准确性、特异性和敏感性,以及胰外神经侵犯与肿瘤大小、胰周血管侵犯、淋巴结转移的相关性.结果:32例胰腺癌,病理发现胰内和(或)胰周神经侵犯27例(84.4%),胰内合并胰周神经侵犯24例(75%),单纯胰内神经侵犯3例(9.4%).CT发现22例(68.8%)胰外神经侵犯,CT诊断胰腺癌胰外神经侵犯的敏感性、特异性、准确性分别为87.0%、77.8%、84.4%.胰外神经侵犯与肿瘤大小(Spearman,P=0.428>0.05)、淋巴结转移(Fisher's exact test,P=0.506>0.05)无相关性,与血管侵犯(Spearman,r=0.54,P=0.001<0.05)具有相关性.结论:CT对胰腺癌胰外神经侵犯有较高的预测率.胰周间隙密度增高,出现条带状致密影,或出现不规则软组织块影提示已有肿瘤的神经侵犯.     

16层螺旋CT兼容性血管成像对胰腺癌胰周主要血管侵犯的诊断价值

目的探讨16层螺旋CT兼容性血管成像对胰腺癌胰周主要血管侵犯的诊断及其价值。方法对48例胰腺癌患者采用MSCT肝脏兼容性双期增强扫描方式,以多平面容积重建(MPVR)、容积重建(VR)血管成像技术,行胰周主要动脉、门静脉血管成像,并多角度观察胰周主要动脉、静脉血管的侵犯情况。结果胰腺癌胰周毗邻的动脉主干受侵30例,主要静脉受侵41例,胰周血管受侵的表现特征:1肿瘤压迫侵蚀局部血管弧形变扁,边缘轻度不规则;2血管僵直管腔狭窄变细,边缘毛糙或锯齿状改变;3孤立性或非孤立性脾静脉阻塞;4胰周侧支循环血管扩张迂曲;5胰周区域性门静脉高压。结论 MSCTA、CTPV对胰腺癌胰周主要血管侵犯的准确诊断和不可切除性评估提供较为可靠的依据。     

胰腺癌的CT影像表现与临床病理因素及血管生成的关系

目的研究胰腺癌多层螺旋CT（MSCT）影像表现与临床病理因素及肿瘤血管生成的关系。资料与方法搜集36例经手术病理证实为胰腺导管细胞癌患者的癌肿组织石蜡切片进行特殊免疫组织化学染色。36例患者术前均行MSCT多期动态增强扫描。采用Loyer的CT诊断标准,对受侵胰周血管进行CT分级,并以横断面图像结合多平面重组（MPR）图像,评价肿瘤对周围组织器官的侵犯情况。评价CT像上胰腺癌血管侵犯、胰周侵犯与肿瘤部位、淋巴转移、肝脏转移、UICC分期、病理分级、微血管密度（MVD）、血管内皮生成因子（VEGF）、VEGF—C、金属蛋白酶（MMP）MMP-2、MMP-9的关系。结果对于胰周血管侵犯,统计结果示UICC分期（P＜0．001）,病理分级（P=0．02）,MVD（P＜0．023）,VEGF（P=0．01）,VEGF-C（P=0．016）,MMP-2（P=0．041）有统计学意义。对于胰外侵犯,统计学结果示淋巴转移（P=0．031）,肝脏转移（P=0．025）,UICC分期（P＜0．001）,MVD（P＜0．001）,VEGF（P=0．02）,MMP-2（P=0．01）,MMP-9（P=0．003）有统计学意义。进一步非参数统计显示胰外侵犯,血管侵犯与未侵犯组的平均UICC分期差异均有统计学意义（P＜0．001）,但对于平均病理分级,则差异均无统计学意义（P=0．275,P=1．00）。结论CT影像上胰外侵犯、血管侵犯的表现与肿瘤UICC分期、血管生成关系密切,与肿瘤病理分级无直接联系。血管侵犯和淋巴转移、肝转移并没有明显的相关性,但胰外侵犯和转移密切相关。     

MRI对胰腺癌胰周血管侵犯的手术可切除性评价

目的对胰腺癌胰周血管侵犯判断的最佳序列进行评价,并探讨MRI判断胰腺癌胰周血管侵犯的敏感性、特异性及准确性。资料与方法搜集22例经手术病理证实的胰腺癌病例,所有患者均行平扫的SET1WI、FSE T2WI、SE T1WI＋FS序列扫描,同时行动态增强GRE（DCE FMPSPGR）序列的三期扫描。对该22例患者术前胰周血管侵犯情况进行回顾性分析：（1）按照肿瘤对周围血管侵犯的程度,采用0～3级的等级法进行术前盲法评分,统计血管侵犯及无侵犯的支数,并同手术结果对照。分析0～3各级别对于血管侵犯与否判断其敏感性。（2）统计SE T1WI及DCE FMPSPGR两序列分别及结合起来评价胰周血管侵犯敏感性、特异性、阳性预测值、阴性预测值及准确性。结果22例患者7段共154支血管中,术中发现51支有侵犯,103支无侵犯。其中WE T1WI术前诊断45支受侵．109支无侵犯,漏诊6支,误诊3支。DCEFMPSPCR诊断43支受侵．111支正常,漏诊8支,误诊2支。WE T1WI和DCE FMPSPGR分别及两者相结合判断血管受侵的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为：88．2％、97％、93．8％、94．3％、94．2％;84．3％、98．0％、95．5％、92．7％、93．5％;92．1％、98．0％、95．9％、96．2％、96．1％。结论MRI判断胰周血管侵犯的敏感性为92．1％,特异性为98．0％,诊断准确性96．1％。以SE T1WI和DCE FMPSPGR两序列较优,两者结合起来可以提高判断的准确性。     

多层螺旋CT血管造影对胰腺癌侵犯胰周血管的判断

目的:探讨多层螺旋CT血管造影对胰腺癌侵犯胰周血管的判断及其意义。方法:使用Toshiba Aquilion 16层螺旋CT对胰腺癌患者扫描后,进行动脉期和门脉期胰周主要血管CTA三维成像。以三维图像为主,对胰周血管是否受累进行判别及评价,并与手术对照。结果:其中手术病人42例,CTA显示血管受侵28例,术中所见血管受侵29例。CTA判断血管受侵敏感性为96.43%,特异性为85.71%,χ2=0.333,P=0.564>0.05,胰周血管是否受侵术前CTA判断与手术判断在统计学上没有差异。结论:术前CTA判断胰腺癌的胰周血管是否受侵对手术具有前瞻性指导意义。     

抑脂三维动态增强磁共振血管成像对胰腺癌胰周血管侵犯的手术可切除性评价

目的 探讨抑脂三维动态增强磁共振血管成像(3D DCE-MRA)判断胰腺癌胰周血管侵犯的敏感性与特异性,并评价其临床价值.方法 收集临床怀疑胰腺癌病例65例,依据增强扫描方法的不同分为A、B 2组.对A、B组中经手术及病理证实的22例和21例胰腺癌患者,统计SE T1WI、DCE FMPSPGR、3D DCE-MRA及横断面MRI(包括SE T1WI+延迟期DCE FMPSPGR)图像上血管累及条数,同手术病理结果相对照,并计算各自对胰腺癌胰周血管侵犯判断的敏感性、特异性、阳性预测值及阴性预测值,并行统计学检验.结果 在胰腺癌侵犯胰周血管的评价中,3D DCE-MRA的敏感性和特异性分别为85.7%、97.1%.MRA+MRI同MRI之间在判断血管可切除性上有统计学差异.MRA+MRI与SE T1WI+DCE FMPSPGR相比,在胰周血管受侵的判断上,前者优于后者,但无统计学差异.结论 3D DCE-MRA在胰腺癌侵犯胰周血管的手术可切除性评价中具较重要临床价值,结合横断面图像可进一步提高判断的准确率.     

MSCT影像表现及肿瘤血管生成对胰腺癌预后价值的探讨

目的:研究MSCT影像表现及肿瘤血管生成对判断胰腺癌预后的价值。方法:回顾性分析36例经手术证实的胰腺癌患者的CT影像表现(肿瘤胰外侵犯,胰周血管侵犯)、临床病理因素,并采用免疫组化方法检测测量肿瘤微血管密度(MVD)、血管内皮生长因子(VEGF)和金属蛋白酶(MMP)表达水平,与患者的预后进行相关性分析。36例患者术前均行MSCT检查和CT血管成像、多平面重组(MPR)等图像后处理。结果:COX回归分析发现胰腺癌患者的临床分期、病理分级、CT影像表现(胰外侵犯,血管侵犯)、MMP-2表达水平与患者的预后有相关性(P<0.05),其中以CT图像上有胰外侵犯和血管侵犯的相对风险度最高(18.18,6.173)。结论:胰腺癌胰外侵犯、胰周血管侵犯的CT影像表现是预后的独立影响因素,而MVD、VEGF、MMP-9对胰腺癌预后评价无显著性意义。     

螺旋CT对胰腺癌的诊断及术前评估

主要从胰腺癌病灶本身及邻近受累器官的CT表现、胰周血管受侵、胰周淋巴结及远处转移灶的CT表现等几方面总结了螺旋CT在胰腺癌的诊断及术前评估中所发挥的重要作用.其中着重强调了螺旋CT对判定胰腺癌可切除性的指导意义,并详细介绍了螺旋CT对胰周血管重建的研究.     

螺旋CT对胰腺癌的诊断及术前评估

主要从胰腺癌病灶本身及邻近受累器官的CT表现、胰周血管受侵、胰周淋巴结及远处转移灶的CT表现等几方面总结了螺旋CT在胰腺癌的诊断及术前评估中所发挥的重要作用。其中着重强调了螺旋CT对判定胰腺癌可切除性的指导意义，并详细介绍了螺旋CT对胰周血管重建的研究。     

胰腺癌侵犯胰周主要血管的CT表现分析

目 的分析多层螺旋CT(MSCT)胰腺检查，胰腺癌侵及胰周主要动、静脉的不同CT表现特征。方法 MSCT诊断胰腺癌68例患者中，33例行手术治疗(其中12例行胰十二指肠切除术，21例剖腹探查发现不可切除)，病理结果均证实为胰腺导管细胞癌。术中由手术者仔细探查胰周主要血管[肠系膜上动脉(SMA)、腹腔干(CA)、肝动脉(HA)、肠系膜上静脉(SMV)及门静脉主干(PV)]。结果 165支受检血管中，手术探查发现103支血管未受侵犯，其余62支血管受侵，MSCT术前检查，8．1％(5／62)受侵血管误判为未受侵犯(假阴性)。其余受侵的胰周主要动、静脉(57支)具有不同的CT表现特征：胰周主要动脉受侵时，均被肿瘤包绕大于管周的1／2或完全包埋于肿瘤中。胰周主要静脉受侵时，部分静脉血管被肿瘤包绕小于管周的1／2：SMV为4支(4／17)，PV为2支(2／13)，但同时均出现管壁受浸润或管腔狭窄或管腔形态改变；胰周静脉受侵犯时出现管腔狭窄或闭塞的机会较胰周动脉大：SMV为11支(11／17)，PV为12支(12／13)，而CA为3支(3／8)，HA为4支(4／7)，SMA为4支(4／12)；胰周静脉受侵犯时管壁呈浸润性改变的比例较胰周动脉高：SMV为11支(11／17)，PV为7支(7／13)，而CA为3支(3／8)，HA为2支(2／7)，SMA为6支(6／12)。结论 胰周动、静脉受侵及时，其CT表现具有不同特征。     

Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion

OBJECTIVE: To establish preliminarily the different diagnostic criteria for peripancreatic arterial and venous invasion in pancreatic carcinoma by comparing their multidetector-row computed tomography (MDCT) appearances with surgical exploration. METHODS: Among 101 patients with pancreatic carcinoma examined by MDCT, 54 candidates accepting surgery were preoperatively evaluated for vascular invasion based on CT signs (A-E): arterial embedment in tumor or venous obliteration; tumor involvement exceeding one-half of the circumference of the vessel; vessel wall irregularity; vessel caliber stenosis; teardrop superior mesenteric vein (SMV). The peripancreatic major vessels (n = 224) were examined carefully by surgeons during the operation. RESULTS: During surgical exploration, 78 vessels were found to be invaded. With sign A (B, C, or D) as the CT criterion for peripancreatic vascular invasion, the sensitivity of arterial and venous invasion was 66% (97%, 45%, or 41%) and 14% (49%, 63%, or 55%), respectively; the specificity of absence of arterial and venous invasion was 100% (91%, 99%, or 100%) and 100% (all 100%). In this study, there were 3 SMVs appearing teardrop (sign E), which were all confirmed to be invaded. CONCLUSIONS: It is recommended that the CT diagnostic criteria for arterial and venous invasion should be dealt with differently. The criteria of arterial invasion are the presence of sign A or the combination of sign B with one of signs C and D. The criteria of venous invasion are the presence of one of the following signs: sign A, sign B, sign C, sign D, and sign E.     

Pancreatic adenocarcinoma: signs of vascular invasion determined by multi-detector row CT

The purpose of this study was to analyse multi-detector row CT (MDCT) signs of peripancreatic arterial and venous invasion in pancreatic carcinoma. Among 101 patients with pancreatic carcinoma examined by MDCT, 54 candidates for surgery were pre-operatively evaluated for vascular invasion based on MDCT signs. The peripancreatic major vessels (including superior mesenteric artery, coeliac artery, common hepatic artery, superior mesenteric vein and portal vein) were examined carefully by surgeons during the operation. At surgical exploration, 78 of 224 vessels were invaded by tumour. The invaded peripancreatic major arteries (n = 29) and veins (n = 49) presented different MDCT signs: 43% of invaded veins (18/42, except for 7 occluded veins) were surrounded by tumour less than 50% of the vessel circumference compared with 97% (28/29) of the invaded arteries, which were surrounded by tumour more than 50% of the vessel circumference or were embedded in tumour (p<0.001). 69% (34/49) of the invaded veins had vascular stenosis or obliteration, compared with 41% (12/29) of the invaded arteries (p<0.05). Irregularity of the vein wall, 74% (31/42, except for 7 occluded veins); occurred more often than that of the artery wall, 45% (13/29) (p<0.05). In conclusion, the MDCT signs of peripancreatic arterial and venous invasion have different characteristics, which should be considered in pre-operative evaluation.     

Local extension of pancreatic carcinoma: assessment with thin-section helical CT versus with breath-hold fast MR imaging--ROC analysis.

PURPOSE: To compare contrast material-enhanced thin-section helical CT with breath-hold contrast-enhanced MR imaging for sensitivity in the detection of pancreatic adenocarcinoma and for accuracy in local tumor staging. MATERIALS AND METHODS: Fifty-seven patients (37 men, 20 women aged 42-28 years) suspected of having pancreatic adenocarcinoma were examined. The final diagnosis was confirmed at surgery to be pancreatic cancer in 31 patients; the other 26 patients were deemed not to have pancreatic cancer. All patients underwent both CT and MR imaging (turbo spin-echo and fast low-angle shot) studies. Image quality and pancreatic enhancement were subjectively evaluated. All CT scans and MR images were assessed by two independent observers by using a five-point scale for the detection of tumor and of invasion into the peripancreatic tissue, portal vein, and/or peripancreatic artery. Receiver operating characteristic curves for CT and MR imaging were analyzed. RESULTS: At visual analysis, pancreatic enhancement at CT and at MR imaging was comparable, but depiction of vessels was superior at helical CT. Detectability of tumor was comparable. Helical CT was significantly superior to MR imaging in diagnostic imaging of invasion into the peripancreatic tissue, portal vein, and/or peripancreatic artery (P < .01). CONCLUSION: Thin-section dynamic CT is more sensitive than MR imaging for detection of peripancreatic and vascular invasion in patients with pancreatic cancer.     

Pancreatic-phase versus portal vein-phase helical CT of the pancreas: optimal temporal window for evaluation of pancreatic adenocarcinoma

OBJECTIVE: Our objective was to use helical CT to compare the enhancement attenuation values of pancreatic adenocarcinoma, adjacent normal pancreas, and critical vascular structures during the pancreatic phase and portal vein phase. SUBJECTS AND METHODS: Forty-one patients with pathologically proven pancreatic adenocarcinoma underwent dual-phase thin-section dynamic helical CT using a pancreatic-phase and portal vein-phase protocol. The scan delay after initiation of the contrast bolus was 40 sec for the pancreatic phase and 70 sec for the portal vein phase. Attenuation values after i.v. contrast administration were calculated during both phases of scanning for normal pancreas, pancreatic tumor, celiac axis, superior mesenteric artery, superior mesenteric vein, splenic vein, and portal vein. Quantitative values were assessed using regions of interest. RESULTS: Mean differences of enhancement between tumor and normal pancreas were significantly greater in the pancreatic phase (57 H) than the portal vein phase (35 H) (p = .0001). Enhancement values of all the critical vascular structures were also significantly greater in the pancreatic phase than the portal vein phase (p < .001). CONCLUSION: With dynamic thin-section helical CT, pancreatic-phase scanning provides greater differences in contrast enhancement between normal pancreas and pancreatic tumor and between pancreatic tumors and surrounding critical vascular structures than does portal vein-phase scanning.     

胰腺癌胰周淋巴结转移分布特征的螺旋CT表现

目的:胰腺癌胰周淋巴结转移的分布特征及螺旋CT影像表现。方法:搜集经手术病理诊断为原发性胰腺癌45例,所有病例均经手术病理或影像标准诊断有胰周淋巴结转移。根据本组45例病例CT所反映的肿大淋巴结的分布情况,将胰周淋巴结分为8组。设定淋巴结的短径≥1.0cm为淋巴结转移阳性的影像表现。统计阳性淋巴结的出现率,重点观察淋巴结转移的部位、大小、数目、形态、密度、强化情况。结果:本组45例胰腺癌中,共计89个部位观察到淋巴结转移胰周转移淋巴结以腹腔动脉干组46.7%(21例),肠系膜根部组46.7%(21例),腹主动脉周围组35.6%(16例)为最多,胃周11.1%(5例)及脾动脉-脾门组13.3%(6例)最少。结论:胰腺癌转移所致肿大淋巴结主要分布在腹腔干、肠系膜根部以及腹主动脉周围。螺旋CT扫描检查可以较准确显示胰腺癌胰周淋巴结的转移情况。     

CT assessment of the inferior peripancreatic veins: clinical significance

OBJECTIVE: The purpose of this study was to evaluate and clarify the clinical significance of CT scans of the inferior peripancreatic veins. MATERIALS AND METHODS: Forty-three patients with suspected pancreatic disease underwent three-phase helical CT (collimation, 5 mm; reconstruction, 2.5 mm; scan delay, 30, 60, and 150 sec). The frequency of visualization on CT of the anterior and posterior inferior pancreaticoduodenal veins, inferior pancreaticoduodenal vein, and first jejunal trunk was assessed and correlated with angiographic and pathologic findings. RESULTS: The frequency of visualization of normal inferior peripancreatic veins in patients (n = 22) with a normal portomesenteric vein was 36% for the anteroinferior pancreaticoduodenal vein, 36% for the posteroinferior pancreaticoduodenal vein, 59% for the inferior pancreaticoduodenal vein, and 100% for the first jejunal trunk. The smaller inferior peripancreatic veins were frequently not visualized when normal. In patients (n = 13) with pancreatic carcinoma involving the portosuperior mesenteric vein, all of the inferior peripancreatic veins were dilated and easily recognizable. When the tumor did not involve the portosuperior mesenteric vein but did involve the anteroinferior pancreaticoduodenal, posteroinferior pancreaticoduodenal, and inferior pancreaticoduodenal veins (n = 8), some of the other peripancreatic veins (first jejunal trunk, anterior and posterior superior pancreaticoduodenal veins, and gastrocolic trunk) were dilated. Dilatation indicated tumor extension to the third portion of the duodenum. In patients (n = 7) with involvement of the inferior pancreaticoduodenal vein, the first jejunal trunk, or both without the involvement of the portosuperior mesenteric vein, dilatation of the other peripancreatic veins (anteroinferior pancreaticoduodenal vein, posteroinferior pancreaticoduodenal vein, anterosuperior pancreaticoduodenal vein, posterosuperior pancreaticoduodenal vein, and gastrocolic trunk) indicated tumor invasion of only the second portion of the extrapancreatic nerve plexus (n = 4) and tumor invasion of both the second portion of the extrapancreatic nerve and the mesenteric root (n = 3). CONCLUSION: Dilatation of peripancreatic veins with nonvisualization of inferior peripancreatic veins suggests tumor invasion of peripancreatic tissue.     

多层螺旋CT对胰源性门静脉高压的诊断价值

目的探讨多层螺旋CT腹部增强扫描在诊断胰源性门静脉高压(PSPH)中的价值。方法对15例临床疑诊胰腺体尾部病变累及门静脉系统的患者的增强CT资料进行回顾性研究,观察门静脉系统形态改变,并测量胃冠状静脉、门静脉、脾静脉、肠系膜上静脉内径。结果急慢性胰腺炎及胰腺癌侵犯或压迫脾静脉,血液向门静脉回流受阻,致其远端显影不佳,近端血管扩张以及侧支循环形成最终导致胰源性门静脉高压症。结论多排螺旋CT可连续观察侧支循环走行,清晰显示病变与邻近结构关系,为胰源性门脉高压患者提供血管形态、病因诊断等多方面有价值信息,并为临床诊断和治疗提供客观的影像学依据。     

Significance of color Doppler ultrasonography in the assessment of pancreatic carcinoma vascular invasion

BACKGROUND/AIM: It is highly appreciated to provide exact data on vascular invasion of pancreatic carcinoma relying as much as possible on non-invasive diagnostic procedures. Color Doppler ultrasonography has been proven as an efficient method for clinical staging of pancreatic carcinoma essential for therapeutic decisions. The aim of this study was to provide an analysis of the sensitivity and specificity for color Doppler ultrasonography in patients suffering from pancreatic carcinoma. METHODS: We performed color Doppler ultrasonography examination in 43 patients with pancreatic carcinoma prior to the surgery. The findings of ultrasonography on neoplasm vascular invasion were correlated to the findings obtained during the subsequent surgical procedures. An estimation of neoplastic invasion of certain blood vessels including portal vein, celiac trunk, and superior mesenteric artery and vein is critical for decision making regarding surgical treatment. The patients with metastases of pancreatic carcinoma were excluded from the study. RESULTS. Comparing color Doppler and the surgical findings we estimated the sensitivity for detection of neoplastic vascular invasion ranging from 79-93%, whereas the specificity range was from 83-93%. CONCLUSION: Color Doppler ultrasonography is a sufficiently sensitive and specific method for evaluation of vascular invasion in pancreatic carcinoma patients. Since color Doppler ultrasonography is a non-invasive, radiation free, and inexpensive diagnostic tool, considering also the results of this and similar studies we could strongly recommend its use for an initial presurgical evaluation of vascular invasion in pancreatic carcinoma patients.     

CT criteria for venous invasion in patients with pancreatic head carcinoma

The purpose of the study was to evaluate CT criteria for venous invasion in patients with potentially resectable carcinoma of the pancreatic head, with surgical and histopathological correlation. In 113 patients evaluated with spiral CT for suspected pancreatic head carcinoma, several CT criteria for venous invasion were scored prospectively for the portal vein (PV) and the superior mesenteric vein (SMV): length of tumour contact with PV/SMV (0 mm, < 5 mm, > 5 mm); circumferential involvement of the vein (0 degree, 0-90 degrees, 90-180 degrees, > 180 degrees); degree of stenosis; irregularity of the vessel margin; and tumour convexity towards vessel. 65 patients underwent surgery. Pancreatic head carcinoma was proven and pathology of the vascular margin was obtained in 50 of these patients. CT findings for single and combined criteria were correlated with pathology in these 50 patients, 30 of whom showed venous ingrowth. Invasion was found in all cases with SMV narrowing (n = 7), PV contour involvement > 90 degrees (n = 6), PV narrowing (n = 5) and PV wall irregularity (n = 3). The vascular ingrowth rate was 88% (15/17) for tumour concavity towards the PV or SMV. Poor predictors of ingrowth were length of tumour contact with PV > 5 mm (78% ingrowth, 14/18) and contour involvement of the SMV > 90 degrees (83% ingrowth, 10/12). Absence of vascular ingrowth could not be predicted in 100%. In conclusion, CT criteria can predict a high risk of invasion in potentially resectable tumours. Narrowing of the SMV and the PV seems the most reliable criterion, as well as circumferential involvement of the PV > 90 degrees. The best combination of criteria was tumour concavity with circumferential involvement > 90 degrees (sensitivity 60% and positive predictive value 90%).