Diagnosis and staging of pancreatic adenocarcinoma

Full text: Pancreatic cancer is one of the most fatal tumors. Successful surgical treatment depends on the ability and diagnostic accuracy of imaging techniques to detect small tumors and reliably characterize tumor resectability. Computed Tomography (CT) is the imaging modality most frequently used for the evaluation of patients with suspected pancreatic malignancy. The latest technical development has been the introduction of multislice helical CT. Multidetector technology and faster rotation times had a great impact on sensitivity and specificity. Maximal enhancement of the pancreatic parenchyma and peripancreatic vascular structures is important for the detection and staging of adenocarcinoma. Reformatted images may be obtained using a variety of advanced post processing techniques including maximum intensity projection that are very useful for the visualization of vascular structures. CT angiographic 3D-images may also improve staging and can be used to predict cases in which resection may be difficult resulting in appropriate patient management. If the CT scan is indeterminate, endoscopic ultrasonography can identify smaller lesions and further delineate vascular involvement particularly in pancreatic head. In certain cases Magnetic resonance imaging (MRI) may provide additional information. With recently developed examination techniques, the diagnosis of ductal adenocarcinoma on MRI has been improved. Detection of cancer is best performed by non-contrast T1-w fat-suppressed images and immediate post gadolinium images. Mangafodipir Trisodium, an organ-specific contrast agent, improves detection of small pancreatic masses and liver metastases. New evolving MR imaging techniques may improve even more image quality, thus enhancing the role of MRI as a problem solving method in pancreatic cancer