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Differential diagnosis between tumor-forming pancreatitis and pancreatic cancer by percutaneous transhepatic portography and selective direct pancreatic venography.

In 32 patients with tumor-forming pancreatitis and 109 patients with pancreatic cancer, the usefulness of percutaneous transhepatic portography (PTP) and selective pancreatic venography (SPV) for differential diagnosis of the two diseases was evaluated. The PTP images were type I in 53.1%, type II in 21.9%, type III in 12.5%, and type IV in 12.5% of the patients with tumor-forming pancreatitis and type I in 20.2%, type II in 23.9%, type III in 37.6%, and type IV in 18.3% of the patients with pancreatic cancer. Advanced images (type III or type IV) were observed in more than half the patients with pancreatic cancer. Mild images classified as type II were observed slightly more frequently in the patients with pancreatic cancer, but the differential diagnosis of the two diseases was difficult in patients showing type II PTP images. SPV findings were primarily hypervascularization (78.1%) and vasodilation (68.8%) in the patients with tumor-forming pancreatitis. Although encasement (smooth encasement) was noted in 31.3%, obstruction was found in only 3.1%. In the patients with pancreatic cancer, obstruction was observed in 85.3%, and encasement (irregular encasement) was noted in 78.9%. However, hypervascularization or vasodilatation was infrequent, and the tumor was characteristically imaged as a hypovascular area. PTP and SPV were considered to be useful for the differential diagnosis of tumor-forming pancreatitis and pancreatic cancer.