Cristian Coroian MD, MBA, Presenter: Nothing to Disclose

Brian Anthony Bianco DO, MBA, Abstract Co-Author: Nothing to Disclose

Wilbur B. Bowne MD, Abstract Co-Author: Nothing to Disclose

Alexander Edward Trebelev MD, Abstract Co-Author: Nothing to Disclose

To present the emerging technique of high resolution intravascular ultrasound (IVUS) evaluation of arterial invasion by cancer. We demonstrate the ability to interogate the three layers of the hepatic, superior mesenteric, splenic, and gastroduodenal arteries (including adventitia, media, and intima) with sub-millimiter resolution. By using IVUS, we more accurately stage hepatobiliary and pancreatic cancer in patients where dynamic computed tomography (CT) demonstrates cancer encasement or mass effect on an artery.  

A 6 Fr sheath is used to gain access and navigate a wire into the target vessel. The IVUS probe is then advanced while recording Chroma flow gray scale images through the arterial segment of interest. Start and end scan location is determined by fluoroscopic roadmap. Patients with pancreatic cancer and hepatobiliary cancer are selected. As part of cancer staging, dynamic CT imaging is performed. In patients where the tumor mass encases or causes mass effect on the hepatic artery, superior mesenteric artery, splenic artery, or gastroduodenal artery, high frequency IVUS is performed (as described above) to evaluate invasion of the vascular adventitia, media, and intima. Pathological findings are correlated with IVUS images. Traditional methods of indirectly suggesting invasion by assessing vascular encasement or mass effect of a tumor on a vessel by dynamic CT are compared with IVUS results to determine sensitivy and specificity. Dynamic CT curved reformatted images are then correlated with IVUS images to determine exact location and integrity of the artery layers. The sub-millimiter spacial resolution of IVUS allows for grayscale anatomic identification and accurate determination of tumor invasion.

We present cases of cholangiocarcinoma and pancreatic cancer showcasing the accuracy of IVUS in resolving dynamic CT suspected vascular invasion with the highest spatial resolution. 100% accuracy is attained with no periprocedural complication.

High frequency IVUS is technically feasible in the splanchnic arteries. IVUS is an emerging technique in the staging of cancer, and in our experience, provides 100% accuracy in determining arterial vascular invasion.

High frequency IVUS is an emerging technique in staging of cholangiocarcinoma and pancreatic cancer, and in our experience, provides 100% accuracy in determining arterial vascular invasion.  

Coroian, C, Bianco, B, Bowne, W, Trebelev, A, High Resolution Imaging with High Frequency Intravascular Ultrasound Improves Sensitivity in Cancer Staging when Vascular Encasement or Mass Effect is Suspected on Dynamic Computed Tomography: Special Cases in Hepatobiliary and Pancreatic Cancer.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13020963.html