Selected images from contrast-enhanced CT in patients with locally advanced adenocarcinoma of the pancreas. A high-quality contrast-enhanced CT scan (arterial phase in Panels A–C and portal venous phase in Panels D–F) is required for optimal staging of pancreas cancer. Panel A demonstrates the typical features of adenocarcinoma of the pancreas on arterial phase axial CT scans (dotted outline) with tumor encasement of the superior mesenteric artery (white arrow). Note the dilatation of the common bile duct (red arrow). Panels B (magnified coronal) and C (sagittal) show reconstruction of CT images into additional orthogonal planes with exquisite details to confirm the unresectable nature of the tumor due to vascular encasement. Panel Ddemonstrates the typical features of adenocarcinoma of the pancreas on portal venous phase axial CT scans in a different subject. The dotted line outlines a pancreas cancer lesion in the pancreatic head, which is encasing the portal splenic confluence (dotted outline). Panels E (white arrow) and F show the pinched appearance of the portal splenic confluence by tumor abutment and invasion of the superior mesenteric vein (white arrow) on coronal and sagittal views. Note the presence of a stent in the common bile duct (red arrow) to help relieve biliary obstruction caused by the tumor. CA, celiac axis; SMA, superior mesenteric artery.
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