Portal venous invasion by pancreatobiliary carcinoma: diagnosis with intraportal endovascular US.

Abstract

To evaluate use of intraportal endovascular ultrasonography (IPEUS) in diagnosing portal venous invasion by pancreatobiliary carcinoma. IPEUS was performed in 26 consecutive patients with pancreatobiliary carcinoma. All patients underwent surgery. IPEUS was performed intraoperatively in 20 cases and preoperatively in six. The sonographic criterion for detection of portal venous invasion was obliteration of the echogenic band of the portal vein. The IPEUS results were compared with those of computed tomography (CT) and arterial portography. Vascular invasion was confirmed with use of resected specimens in seven patients and operative findings in five patients. For diagnosis of portal venous invasion, the sensitivity, specificity, and overall accuracy of IPEUS were all 100%; respective values were 92%, 64%, and 77% for angiography and 50%, 79%, and 65% for CT. IPEUS allows detection or exclusion of early invasion of the portal venous wall by pancreatobiliary carcinoma.