The superior mesenteric artery fat plane: Is obliteration pathognomonic of pancreatic carcinoma? |
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| Authors: | D G Mitchell M C Hill R Cooper E Bury S Brick P Lane C Magal R Roberts |
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| Institution: | 1. Department of Radiology, SUNY Downstate Medical Center, Brooklyn, New York;2. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland;3. Department of Radiology, Weill Cornell Medical College, New York, New York;4. Departments of Ophthalmology, Neurology, Physiology, and Pharmacology, SUNY Downstate Medical Center, Brooklyn, New York;5. Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia;1. GE and Digestive Oncology Department, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium;2. GE Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium;3. Oncology Department, Saint-Joseph Community Health Center, Liège, Belgium;4. Oncology Department – University Hospital Antwerp, Edegem, Belgium;5. GE Department, INDC Entité Jolimontoise, Haine-St-Paul, Belgium;6. Oncology Department, Cliniques et Maternité Ste Elisabeth, Namur, Belgium;7. GE Department – Ghent University Hospital, Ghent, Belgium;8. Oncology Department, Centre Hospitalier Universitaire A. Paré, Mons, Belgium;9. Data Center, Institut J. Bordet, Brussels, Belgium;1. Spine Surgery Department, Hôpitaux Universitaires de Strasbourg, Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France;2. Faculty of Medicine, Midwifery and Health Sciences, Université of Strasbourg, 4, rue Kirschleger, 67085 Strasbourg Cedex, France;3. Public Health Department, Hôpitaux Universitaires de Strasbourg, 1, place de l’hôpital, B.P. 426, 67091 Strasbourg Cedex, France;1. Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA;2. Program in Immunology, Division of Medical Sciences, Harvard Medical School, Boston, MA 02115, USA;3. Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520, USA;4. The Salk Institute for Biological Studies, La Jolla, CA 92037, USA;5. Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA |
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| Abstract: | Obliteration of the fat plane surrounding the superior mesenteric artery has been described as characteristic of pancreatic carcinoma. To determine the specificity of this and other computed tomography findings in the pancreas and peripancreatic region, scans of 86 patients were reviewed without clinical history. Diagnoses included pancreatitis (26 patients); pancreatic adenocarcinoma (14 patients); lymphoma (17 patients); metastatic nonpancreatic carcinoma (14 patients); and normal findings (15 patients). Confluent adenopathy could not be reliably differentiated from a pancreatic mass except when adenopathy separated the common bile duct from the duodenum. Retrocrural adenopathy was unusual with pancreatic carcinoma. The fat plane surrounding the superior mesenteric artery was obliterated with pancreatic carcinoma (36%), nonpancreatic carcinoma (29%), and lymphoma (24%), but not with pancreatitis, although perivascular edema was seen in 19%. Evaluation of the celiac axis was less rewarding. Obliteration of the superior mesenteric artery fat plane is a sign of malignancy, but it is not specific for pancreatic carcinoma. We propose that the superior mesenteric artery origin be considered within a paraaortic space, separate from the anterior pararenal space. This explains its characteristic lack of involvement by pancreatitis. |
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