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Purpose: To evaluate the interval change of perivascular soft tissue (PVST) around the common hepatic and proximal superior mesenteric arteries arising after pancreaticoduodenectomy (PD) and to compare the difference between post operative change (benign PVST) and recurrence (malignant PVST). Materials and Methods: Serial multidetector CT (MDCT) studies in 44 patients who underwent PD for periampullary carcinomas were retrospectively reviewed (Group A). The incidence and interval change of PVST were evaluated and compared to control group (Group B, 21 patients with PD for benign diseases). Results: PVST was seen in all the 44 patients in Group A, and it was noted in 12 of 21 (57.1%) patients in Group B. Thirteen of 44 (29.5%) patients showed interval enlargement of PVST (malignant PVST), and 12 of 13 developed within 2 years after PD. There was higher incidence of malignant PVST in patients with lymph node metastasis (p < 0.01) and those with pancreas head carcinoma (p < 0.05). Conclusion: PVST is common after PD regardless of whether patients had malignant or benign diseases. PVST should be monitored for at least 2 years to distinguish recurrence from post operative change. Patients with lymph node metastasis and pancreas head carcinoma had a higher incidence of malignant PVST. [ABSTRACT FROM AUTHOR]