Value of Multidetector Computed Tomography for Assessing Mesopancreas Invasion in Pancreatic Head Ductal Adenocarcinoma: Correlation with Histopathology
Main Article Content
Abstract
Objective
To evaluate the value of multidetector computed tomography (MDCT) in assessing mesopancreatic invasion in patients with pancreatic head cancer, using postoperative histopathology as the reference standard.
Materials and Methods
A retrospective cross-sectional descriptive study was conducted on 59 patients with pancreatic head pancreatic ductal adenocarcinoma who underwent surgical resection at Bach Mai Hospital between January 2021 and December 2025. All patients underwent preoperative MDCT to assess resectability according to the NCCN criteria, the degree of mesopancreatic infiltration, and mesopancreatic attenuation. Two radiologists independently reviewed the CT images, and the final imaging findings were established by consensus. Imaging findings were correlated with postoperative histopathological results. Statistical analyses were performed using IBM SPSS Statistics version 20.0.
Results
The mean age of the study population was 61.9 ± 9.8 years, with males accounting for 54.2%. Histopathological examination demonstrated mesopancreatic invasion in 35 of 59 cases (59.3%). According to the NCCN classification, 79.7% of tumors were resectable and 20.3% were borderline resectable. On MDCT, mesopancreatic infiltration was classified as absent in 35.6% of cases, fibrotic infiltration in 32.2%, and solid infiltration in 32.2%.
Using postoperative histopathology as the reference standard, the presence of mesopancreatic infiltration on MDCT yielded a sensitivity of 80.0%, specificity of 58.3%, and accuracy of 71.2% for predicting mesopancreatic invasion. When solid infiltration on MDCT was considered a positive criterion, the corresponding sensitivity, specificity, and accuracy were 48.6%, 91.7%, and 66.1%, respectively.
Mesopancreatic attenuation on MDCT demonstrated predictive value for mesopancreatic invasion, with an area under the receiver operating characteristic curve (AUC) of 0.718 (95% CI: 0.589–0.847; p = 0.005), indicating moderate discriminative ability. The optimal cutoff value determined by the Youden index was 10 HU, yielding a sensitivity of 60.0% and a specificity of 83.3%.
Conclusion
MDCT demonstrates moderate performance in predicting mesopancreatic invasion in patients with pancreatic head pancreatic ductal adenocarcinoma. Solid mesopancreatic infiltration is a highly specific imaging sign of histopathological mesopancreatic invasion. Mesopancreatic attenuation is a useful imaging parameter for the preoperative prediction of mesopancreatic invasion.
Keywords
Pancreatic head pancreatic ductal adenocarcinoma, mesopancreas, multidetector computed tomography, mesopancreatic invasion
Article Details
References
doi:10.1056/NEJMra1404198
2. Khiêm NT, Hội NH, Sơn TH, et al. Tổng quan về mạc treo tụy và ứng dụng phẫu thuật. VIETNAM JOURNAL
OF SURGERY AND ENDOLAPAROSURGERY. 2024;(Số 02-Tập 14). Accessed June 14, 2026. https://vjsel.
vn/tong-quan-ve-mac-treo-tuy-va-ung-dung-phau-thuat
3. Gockel I, Domeyer M, Wolloscheck T, Konerding MA, Junginger T. Resection of the mesopancreas (RMP): a new
surgical classification of a known anatomical space. World J Surg Oncol. 2007;5:44. doi:10.1186/1477-7819-5-44
4. Wellner UF, Krauss T, Csanadi A, et al. Mesopancreatic Stromal Clearance Defines Curative Resection of
Pancreatic Head Cancer and Can Be Predicted Preoperatively by Radiologic Parameters: A Retrospective
Study. Medicine (Baltimore). 2016;95(3):e2529. doi:10.1097/MD.0000000000002529
5. Ishida M, Fujii T, Kishiwada M, et al. Japanese classification of pancreatic carcinoma by the Japan Pancreas
Society: Eighth edition. J Hepatobiliary Pancreat Sci. 2024;31(11):755-768. doi:10.1002/jhbp.12056
6. Nagakawa Y, Yi SQ, Takishita C, et al. Precise anatomical resection based on structures of nerve and fibrous
tissue around the superior mesenteric artery for mesopancreas dissection in pancreaticoduodenectomy for
pancreatic cancer. J Hepatobiliary Pancreat Sci. 2020;27(6):342-351. doi:10.1002/jhbp.725
7. Adham M, Singhirunnusorn J. Surgical technique and results of total mesopancreas excision (TMpE) in
pancreatic tumors. Eur J Surg Oncol. 2012;38(4):340-345. doi:10.1016/j.ejso.2011.12.015
8. NCCN 2025 Guidelines for Pancreatic Cancer | PDF | Pancreatic Cancer | Therapy. Scribd. Accessed July
24, 2026. https://www.scribd.com/document/891796167/NCCN-2025
9. Safi SA, Haeberle L, Heuveldop S, et al. Pre-Operative MDCT Staging Predicts Mesopancreatic Fat
Infiltration—A Novel Marker for Neoadjuvant Treatment? Cancers (Basel). 2021;13(17):4361. doi:10.3390/
cancers13174361
10. Navez J, Pezzulo M, Bouchart C, et al. The radiological morphology of mesopancreas: A new variable to
predict a positive vascular margin after pancreatoduodenectomy for pancreatic ductal adenocarcinoma?
JCO. 2024;42(3_suppl):615-615. doi:10.1200/JCO.2024.42.3_suppl.615
11. Standardizing computed tomographic assessment of the mesopancreas in pancreatic cancer patients |
springermedizin.de. Accessed June 14, 2026. https://www.springermedizin.de/standardizing-computedtomographic-
assessment-of-the-mesopancrea/52270928
12. Safi SA, Haeberle L, Fluegen G, et al. Mesopancreatic excision for pancreatic ductal adenocarcinoma improves
local disease control and survival. Pancreatology. 2021;21(4):787-795. doi:10.1016/j.pan.2021.02.024