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Objective: To evaluate the performance of multidetector computed tomographic angiography (MDCTA) in assessing the surgical resectability of pancreatic head adenocarcinoma., Methods: With institutional review board approval, radiographic, surgical, and pathological records of 203 consecutive patients with adenocarcinoma of the pancreatic head were analyzed retrospectively. Patients were imaged with MDCT scanners using our institution's CTA pancreatic protocol. Images were compared with surgical outcomes to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCTA in determining resectability., Results: Data were analyzed twice, once with equivocal findings on MDCTA assumed as resectable and again with equivocal cases assumed as unresectable. All equivocal cases were ultimately unresectable; when this was assumed, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were determined to be 100%, 71%, 85%,100% and 89%. Twelve patients deemed resectable by preoperative MDCTA were found to be unresectable on surgical exploration owing to vascular involvement (n = 4), liver metastases (n = 4), and peritoneal involvement (n = 4)., Conclusions: Multidetector CT angiography offers accurate and valuable preoperative assessment of surgical resectability of pancreatic ductal adenocarcinoma. Liver and peritoneal metastases and vascular invasion still remain important pitfalls in preoperative evaluation.

Objective: The clinical usefulness of routine, nonfocused helical CT was evaluated in diagnosing acute appendicitis or providing an alternative diagnosis in patients presenting to the emergency department with acute lower abdominal pain., Materials and Methods: We reviewed CT reports and clinical records of 650 consecutive adult patients who presented between January 1996 and December 2000 with right lower quadrant pain or lower abdominal pain and clinical findings suggestive of appendicitis. Helical CT was performed with oral contrast material in 610 cases (93.8%) and IV contrast in 572 cases (88.0%). Both vascular and enteric contrast media were administered in 544 cases (83.7%). Rectal contrast material was administered in 52 cases (8.0%). The abdomen was helically scanned from the dome of the diaphragm to the iliac crests with a collimation of 7 mm, from the iliac crests to the acetabular roof at a 5-mm collimation, from the acetabular roof to the symphysis pubis with a collimation of 5-10 mm. The surgical or clinical record was used for follow-up., Results: Of the 650 patients, 552 (84.9%) had adequate clinical follow-up. There were 137 true-positive, eight false-positive, five false-negative, and 402 true-negative cases. The sensitivity, specificity, and accuracy of nonfocused helical CT were 96.5%, 98.0%, 97.6%, respectively. The positive and negative predictive values were 94.5% and 98.8%, respectively. In patients without acute appendicitis, CT suggested an alternative diagnosis, which clinically explained the patient's acute abdominal pain in 266 patients (66.2%)., Conclusion: Nonfocused helical CT was highly accurate in diagnosing acute appendicitis or suggesting an alternative diagnosis in patients with acute lower abdominal pain or right lower quadrant pain.