Application and progress of medical imaging in total mesopancreas excision for pancreatic head carcinoma

Figure 1 Radiological depiction of the mesopancreas in computed tomography. A: The dotted line outlines the boundary of the mesopancreas, a region identified as the retro pancreatic retro portal tissue; B: The inferior boundary of the mesopancreas is 2 cm below the origin of superior mesenteric artery. PV: Portal vein; SMA: Superior mesenteric artery; LRV: Left renal vein; IVC: Inferior vena cava; AA: Aorta artery; CT: Celiac trunk.

Figure 2 Key steps of total mesopancreas excision. A: Dissection of the right semi-circumference of the superior mesenteric artery and celiac trunk; B: Clearance of the retropancreatic retroportal space (mesopancreas triangular). PV: Portal vein; SV: Splenic vein; SMV: Superior mesenteric vein; SMA: Superior mesenteric artery; IPDA: Inferior pancreaticoduodenal arteries; IVC: Inferior vena cava; LRV: Left renal vein; AA: Aorta artery; CBD: Common bile duct.

Figure 3 Typical CT features of pancreatic head carcinoma in a 73-year-old male patient. A: On noncontrast CT imaging a slightly low-density mass (arrow) in the pancreatic head area was identified; B–D: On contrast CT images, the tumor shows an avascular tumor with a lower density than normal pancreatic parenchyma on arterial phase (B), venous phase (C), and delay phase (D). CT: Computed tomography.

Figure 4 Typical magnetic resonance features of pancreatic head carcinoma in a 57-year-old female patient. A–C: Swollen pancreatic head (arrow) with slightly higher signal on T2-weighted imaging (WI) (A) and diffusion-weighted imaging (B), and low signal on T1WI (C) was detected; D: Notes that the dilation of pancreatic duct (arow head) and double duct sign on magnetic resonance cholangiopancreatography; E–H: After administration of contrast agent, the tumor shows a progressive enhancement pattern similar to computed tomography on early arterial phase (E), late arterial phase (F), venous phase (G), and delay phase (H).