Objective: To evaluate prospectively the efficacy of ultrasonography (US), helical computed tomography (HCT), endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) in the assessment of vascular invasion and lymph node metastasis in pancreatic carcinoma.

Methods: Consecutive 68 patients with pancreatic carcinoma were studied. Results of each imaging techniques regarding vascular invasion and lymph node metastasis were compared with the surgical and pathological findings.

Results: (1) US findings were confirmed moderately in accordance with surgical and pathological results in the evaluation of inferior cava vein, splenic artery and vein invasion of pancreatic carcinoma. HCT findings of evaluating superior mesenteric vein, portal vein, splenic vein were confirmed greatly in accordance with surgical and pathological results. The results of evaluating superior mesenteric artery, inferior cava vein, splenic artery, common hepatic artery, proper hepatic artery, celiac trunk, abdominal aorta were confirmed moderately in accordance with surgical and pathological results. MRI findings of evaluating superior mesenteric artery and vein, portal artery and vein were moderately in accordance with surgical and pathological results. EUS findings of evaluating splenic vein were confirmed greatly in accordance with surgical and pathological results, and moderately in accordance with surgical and pathological results in the evaluation of superior mesenteric vein. (2) EUS had the highest sensitivity (75.0%), accuracy (87.5%), and negative predictive values (91.7%) in the evaluation of lymph node metastasis. The sensitivity of HCT and MRI were 37.5% and 35.3%, which were significantly lower than that of EUS. The sensitivity of US was 18.7%, which was the lowest of all. In addition, the multivariate logistic regression analysis confirmed that EUS had an independent predictive value (OR: 34.50, 95%CI: 6.54 - 182.09).

Conclusion: Helical CT should be considered the most precise technique to evaluate vascular invasion. EUS had an independent predictive value with respect to tumor metastasis to regional lymph nodes.