Ritu Manoj Kakkar MBBS, Presenter: Nothing to Disclose

Sameer Surendra Soneji DMRD, Abstract Co-Author: Nothing to Disclose

Shrinivas Balaji Desai MD, Abstract Co-Author: Nothing to Disclose

To identify EPI in early pancreatic carcinoma locally confined to head and uncinate process and its clinical relevance.

32 patients (18:14=M:F) with early pancreatic carcinoma (T1 or T2) staged on CT were retrospectively reviewed for EPI by 2 experienced radiologists. The two major pathways of pancreatic innervation are plexus pancreaticus capitalis (PPC) 1 and 2. PPC 1 originates from the right celiac ganglion and courses posteriorly behind the portal vein while PPC 2 originates from the superior mesenteric artery plexus and extends to the uncinate process along the posteroinferior pancreaticoduodenal artery and the jejunal trunk. EPI was defined as confluent soft tissue attenuation, similar to that of primary tumor, extending along these plexuses.3 phase contrast enhanced CT was obtained on Discovery 750 GE VCT single source dual energy scanner with pancreas assessed in the parenchymal phase (20-40 secs). 1.25 mm thin slices were used for reconstruction of volumetric slabs at 20 degree to the coronal plane to evaluate EPI.

13/32 (40%) lesions were in the uncinate process and 19/32 (59%) in the head of pancreas. The uncinate process lesions were smaller (1.6-2.1cms) out of which 12/13 (92%) were T1 and 1/13 (8%) were T2. Head lesions were comparatively larger (1.5-2.9 cms) with 6/19 (32%) T1 and 13/19 (68%) T2 lesions. 30/32 (94%) patients had EPI. 17/19 (89%) head lesions showed EPI invasion with 8/17 (47%) involving only PPC 1 and 9/17 (53%) involving PPC 1 and 2. 2/19 (11%) head lesions did not show EPI and both were T1 lesions (1.5 & 1.7 cms). All 13 uncinate process lesions showed EPI and solely involved the PPC 2

All T2 and majority of T1 head and uncinate process tumors showed EPI. Head lesions involved either PPC 1 or both depending upon size, while uncinate process masses solely involved PPC 2. Small FOV (12cms) 3D MDCT is needed to visualize small peripancreatic vessels and ascertain EPI.

EPI can be associated with higher positive surgical margins (R1 resection) hence poor prognosis & recurrence. Effort should be made to identify EPI in CT staging of pancreatic cancer. 

Kakkar, R, Soneji, S, Desai, S, CT Evaluation of Extrapancreatic Perineural Invasion (EPI) in Carcinoma of Head and Uncinate Process.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013541.html