Recurrent pancreatic adenocarcinoma: spiral CT evaluation following the Whipple procedure

Computed tomographic (CT) examination of patients who have undergone pancreaticoduodenectomy (Whipple procedure) for pancreatic adenocarcinoma is complex. The radiologist's assessment of the three surgically created anastomoses, as well as of subtle abnormalities that are the earliest signs of recurrent disease, is substantially aided by the volume acquisition capability of spiral CT and use of overlapping reconstruction intervals. Normal postoperative findings on spiral CT scans include ill-defined increased attenuation in the fat of the pancreatic bed and surrounding the superior mesenteric artery and pneumobilia. The most frequent sites of tumor recurrence are local disease in the pancreatic bed and metastases in the liver; concurrent local and liver disease may also be the initial manifestation of recurrent pancreatic adenocarcinoma. CA 19-9 is a tumor-associated antigen whose level is frequently elevated in patients with recurrent pancreatic cancer, and correlation of CT findings and the serum CA 19-9 level is helpful in differentiating between recurrent disease and postoperative changes. Correlation of CT appearances with clinical parameters, such as the type and position of surgically created anastomoses and knowledge of the radiation port in those patients receiving adjuvant radiation therapy, aids interpretation and helps one avoid false-positive diagnoses in the setting of complex anatomic and persistent postoperative changes inherent in this patient population.