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Imaging Diagnosis of Pancreatic Cancer: CT and MRI

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Abstract

Pancreatic cancer (PC) remains one of the deadliest cancers worldwide, with a poor survival rate. Although complete surgical resection remains the only potential curative therapy for pancreatic cancer, less than 20% of the patients newly diagnosed with pancreatic cancer undergo surgical resection with a curative intent. This is mainly due to the lack of early symptoms and the tendency of pancreatic adenocarcinoma to invade adjacent structures or to metastasize at an early stage. Imaging studies play a critical role for evaluation of the extent of disease and staging, which is of great importance to make adequate selection for surgical candidate. Currently, the diagnosis of PC relies on computed tomography (CT) and/or magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP), or biopsy, or fine-needle aspiration (FNA) using endoscopic ultrasound (EUS). Although MDCT currently has a major role in the evaluation of PC, multiparametric MRI with diffusion-weighted imaging and MRCP allows a comprehensive analysis of the morphological changes of the pancreatic parenchyma as well as the pancreatic duct and can be used as a problem-solving tool. Positron emission tomography (PET) techniques could be used in special conditions in which CT and EUS are not completely diagnostic. It is essential for clinicians to understand the advantages and disadvantages of the various pancreatic imaging modalities in order to be able to make optimal treatment management decisions.

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References

  1. Hariharan D, Saied A, Kocher HM. Analysis of mortality rates for pancreatic cancer across the world. HPB (Oxford). 2008;10(1):58–62.

    Article  CAS  Google Scholar 

  2. Hidalgo M. Pancreatic cancer. N Engl J Med. 2010;362(17):1605–17.

    Article  CAS  PubMed  Google Scholar 

  3. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30.

    Article  PubMed  Google Scholar 

  4. Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology. 2014;270(1):248–60.

    Article  PubMed  Google Scholar 

  5. Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. Lancet. 2004;363(9414):1049–57.

    Article  CAS  PubMed  Google Scholar 

  6. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58(2):71–96.

    Article  PubMed  Google Scholar 

  7. Peparini N, Chirletti P. Mesopancreas: a boundless structure, namely R1 risk in pancreaticoduodenectomy for pancreatic head carcinoma. Eur J Surg Oncol. 2013;39(12):1303–8.

    Article  CAS  PubMed  Google Scholar 

  8. Mathur A, Ross SB, Luberice K, Kurian T, Vice M, Toomey P, et al. Margin status impacts survival after pancreaticoduodenectomy but negative margins should not be pursued. Am Surg. 2014;80(4):353–60.

    PubMed  Google Scholar 

  9. Tamm EP, Balachandran A, Bhosale PR, Katz MH, Fleming JB, Lee JH, et al. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin N Am. 2012;50(3):407–28.

    Article  PubMed  Google Scholar 

  10. Fusaroli P, Kypraios D, Caletti G, Eloubeidi MA. Pancreatico-biliary endoscopic ultrasound: a systematic review of the levels of evidence, performance and outcomes. World J Gastroenterol. 2012;18(32):4243–56.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sahani DV, Bonaffini PA, Catalano OA, Guimaraes AR, Blake MA. State-of-the-art PET/CT of the pancreas: current role and emerging indications. Radiographics. 2012;32(4):1133–58. discussion 58–60

    Article  PubMed  Google Scholar 

  12. Shrikhande SV, Barreto SG, Goel M, Arya S. Multimodality imaging of pancreatic ductal adenocarcinoma: a review of the literature. HPB (Oxford). 2012;14(10):658–68.

    Article  Google Scholar 

  13. Miura F, Takada T, Amano H, Yoshida M, Furui S, Takeshita K. Diagnosis of pancreatic cancer. HPB (Oxford). 2006;8(5):337–42.

    Article  Google Scholar 

  14. Raman SP, Horton KM, Fishman EK. Multimodality imaging of pancreatic cancer-computed tomography, magnetic resonance imaging, and positron emission tomography. Cancer J. 2012;18(6):511–22.

    Article  PubMed  Google Scholar 

  15. Dibble EH, Karantanis D, Mercier G, Peller PJ, Kachnic LA, Subramaniam RM. PET/CT of cancer patients: part 1, pancreatic neoplasms. AJR Am J Roentgenol. 2012;199(5):952–67.

    Article  PubMed  Google Scholar 

  16. Lee ES, Lee JM. Imaging diagnosis of pancreatic cancer: a state-of-the-art review. World J Gastroenterol. 2014;20(24):7864–77.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Maringhini A, Ciambra M, Raimondo M, Baccelliere P, Grasso R, Dardanoni G, et al. Clinical presentation and ultrasonography in the diagnosis of pancreatic cancer. Pancreas. 1993;8(2):146–50.

    Article  CAS  PubMed  Google Scholar 

  18. Karlson BM, Ekbom A, Lindgren PG, Kallskog V, Rastad J. Abdominal US for diagnosis of pancreatic tumor: prospective cohort analysis. Radiology. 1999;213(1):107–11.

    Article  CAS  PubMed  Google Scholar 

  19. Rickes S, Unkrodt K, Neye H, Ocran KW, Wermke W. Differentiation of pancreatic tumours by conventional ultrasound, unenhanced and echo-enhanced power Doppler sonography. Scand J Gastroenterol. 2002;37(11):1313–20.

    Article  CAS  PubMed  Google Scholar 

  20. Conrad C, Fernandez-Del Castillo C. Preoperative evaluation and management of the pancreatic head mass. J Surg Oncol. 2013;107(1):23–32.

    Article  PubMed  Google Scholar 

  21. Schima W, Ba-Ssalamah A, Kolblinger C, Kulinna-Cosentini C, Puespoek A, Gotzinger P. Pancreatic adenocarcinoma. Eur Radiol. 2007;17(3):638–49.

    Article  PubMed  Google Scholar 

  22. Zakharova OP, Karmazanovsky GG, Egorov VI. Pancreatic adenocarcinoma: outstanding problems. World J Gastrointest Surg. 2012;4(5):104–13.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Zamboni GA, Kruskal JB, Vollmer CM, Baptista J, Callery MP, Raptopoulos VD. Pancreatic adenocarcinoma: value of multidetector CT angiography in preoperative evaluation. Radiology. 2007;245(3):770–8.

    Article  PubMed  Google Scholar 

  24. Brennan DD, Zamboni GA, Raptopoulos VD, Kruskal JB. Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT. Radiographics. 2007;27(6):1653–66.

    Article  PubMed  Google Scholar 

  25. Lepanto L, Arzoumanian Y, Gianfelice D, Perreault P, Dagenais M, Lapointe R, et al. Helical CT with CT angiography in assessing periampullary neoplasms: identification of vascular invasion. Radiology. 2002;222(2):347–52.

    Article  PubMed  Google Scholar 

  26. Zhao WY, Luo M, Sun YW, Xu Q, Chen W, Zhao G, et al. Computed tomography in diagnosing vascular invasion in pancreatic and periampullary cancers: a systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int. 2009;8(5):457–64.

    PubMed  Google Scholar 

  27. Li H, Zeng MS, Zhou KR, Jin DY, Lou WH. Pancreatic adenocarcinoma: signs of vascular invasion determined by multi-detector row CT. Br J Radiol. 2006;79(947):880–7.

    Article  CAS  PubMed  Google Scholar 

  28. Vargas R, Nino-Murcia M, Trueblood W, Jeffrey Jr RB. MDCT in Pancreatic adenocarcinoma: prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations. AJR Am J Roentgenol. 2004;182(2):419–25.

    Article  PubMed  Google Scholar 

  29. Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol. 1997;168(6):1439–43.

    Article  CAS  PubMed  Google Scholar 

  30. Manak E, Merkel S, Klein P, Papadopoulos T, Bautz WA, Baum U. Resectability of pancreatic adenocarcinoma: assessment using multidetector-row computed tomography with multiplanar reformations. Abdom Imaging. 2009;34(1):75–80.

    Article  PubMed  Google Scholar 

  31. Gusmini S, Nicoletti R, Martinenghi C, Del Maschio A. Vascular involvement in periampullary tumors: MDCT, EUS, and CDU. Abdom Imaging. 2009;34(4):514–22.

    Article  CAS  PubMed  Google Scholar 

  32. Tempero MA, Malafa MP, Behrman SW, Benson 3rd AB, Casper ES, Chiorean EG, et al. Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw. 2014;12(8):1083–93.

    Article  CAS  Google Scholar 

  33. Koyama K, Okamura T, Kawabe J, Nakata B, Chung KH, Ochi H, et al. Diagnostic usefulness of FDG PET for pancreatic mass lesions. Ann Nucl Med. 2001;15(3):217–24.

    Article  CAS  PubMed  Google Scholar 

  34. Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology. 2004;231(2):305–32.

    Article  PubMed  Google Scholar 

  35. von Schulthess GK, Steinert HC, Hany TF. Integrated PET/CT: current applications and future directions. Radiology. 2006;238(2):405–22.

    Article  Google Scholar 

  36. Kinney T. Evidence-based imaging of pancreatic malignancies. Surg Clin North Am. 2010;90(2):235–49.

    Article  PubMed  Google Scholar 

  37. Varadarajulu S, Eloubeidi MA. The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer. Surg Clin North Am. 2010;90(2):251–63.

    Article  PubMed  Google Scholar 

  38. Iglesias-Garcia J, Dominguez-Munoz E, Lozano-Leon A, Abdulkader I, Larino-Noia J, Antunez J, et al. Impact of endoscopic ultrasound-guided fine needle biopsy for diagnosis of pancreatic masses. World J Gastroenterol. 2007;13(2):289–93.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Puli SR, Bechtold ML, Buxbaum JL, Eloubeidi MA. How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass?: a meta-analysis and systematic review. Pancreas. 2013;42(1):20–6.

    Article  PubMed  Google Scholar 

  40. Fusaroli P, Spada A, Mancino MG, Caletti G. Contrast harmonic echo-endoscopic ultrasound improves accuracy in diagnosis of solid pancreatic masses. Clin Gastroenterol Hepatol: Off Clin Pract J Am Gastroenterol Assoc. 2010;8(7):629–34 e1–2.

    Google Scholar 

  41. Giovannini M, Thomas B, Erwan B, Christian P, Fabrice C, Benjamin E, et al. Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses: a multicenter study. World J Gastroenterol: WJG. 2009;15(13):1587–93.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lee TH, Cha SW, Cho YD. EUS elastography: advances in diagnostic EUS of the pancreas. Korean J Radiol: Off J Korean Radiol Soc. 2012;13(Suppl 1):S12–6.

    Article  Google Scholar 

  43. Iglesias-Garcia J, Larino-Noia J, Abdulkader I, Forteza J, Dominguez-Munoz JE. EUS elastography for the characterization of solid pancreatic masses. Gastrointest Endosc. 2009;70(6):1101–8.

    Article  PubMed  Google Scholar 

  44. Giovannini M, Hookey LC, Bories E, Pesenti C, Monges G, Delpero JR. Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients. Endoscopy. 2006;38(4):344–8.

    Article  CAS  PubMed  Google Scholar 

  45. Balachandran A, Bhosale PR, Charnsangavej C, Tamm EP. Imaging of pancreatic neoplasms. Surg Oncol Clin N Am. 2014;23(4):751–88.

    Article  PubMed  Google Scholar 

  46. Tummala P, Junaidi O, Agarwal B. Imaging of pancreatic cancer: an overview. J Gastrointest Oncol. 2011;2(3):168–74.

    PubMed  PubMed Central  Google Scholar 

  47. Goshima S, Kanematsu M, Kondo H, Yokoyama R, Miyoshi T, Kato H, et al. Pancreas: optimal scan delay for contrast-enhanced multi-detector row CT. Radiology. 2006;241(1):167–74.

    Article  PubMed  Google Scholar 

  48. Kondo H, Kanematsu M, Goshima S, Miyoshi T, Shiratori Y, Onozuka M, et al. MDCT of the pancreas: optimizing scanning delay with a bolus-tracking technique for pancreatic, peripancreatic vascular, and hepatic contrast enhancement. AJR Am J Roentgenol. 2007;188(3):751–6.

    Article  PubMed  Google Scholar 

  49. Tamm EP, Balachandran A, Bhosale P, Szklaruk J. Update on 3D and multiplanar MDCT in the assessment of biliary and pancreatic pathology. Abdom Imaging. 2009;34(1):64–74.

    Article  PubMed  Google Scholar 

  50. Salles A, Nino-Murcia M, Jeffrey Jr RB. CT of pancreas: minimum intensity projections. Abdom Imaging. 2008;33(2):207–13.

    Article  PubMed  Google Scholar 

  51. Sun HY, Kim SH, Kim MA, Lee JY, Han JK, Choi BI. CT imaging spectrum of pancreatic serous tumors: based on new pathologic classification. Eur J Radiol. 2010;75(2):e45–55.

    Article  PubMed  Google Scholar 

  52. Scialpi M, Piscioli I, Magli M, D'Andrea A. Split-bolus spectral multidetector CT of the pancreas: problem solving in the detection of “isoattenuating” pancreatic cancer? Radiology. 2014;270(3):936–7.

    Article  PubMed  Google Scholar 

  53. Brook OR, Gourtsoyianni S, Brook A, Siewert B, Kent T, Raptopoulos V. Split-bolus spectral multidetector CT of the pancreas: assessment of radiation dose and tumor conspicuity. Radiology. 2013;269(1):139–48.

    Article  PubMed  Google Scholar 

  54. Tamm EP, Bhosale PR, Vikram R, de Almeida Marcal LP, Balachandran A. Imaging of pancreatic ductal adenocarcinoma: state of the art. World J Radiol. 2013;5(3):98–105.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Kim HC, Yang DM, Jin W, Ryu CW, Ryu JK, Park SI, et al. Multiplanar reformations and minimum intensity projections using multi-detector row CT for assessing anomalies and disorders of the pancreaticobiliary tree. World J Gastroenterol. 2007;13(31):4177–84.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Prokesch RW, Chow LC, Beaulieu CF, Nino-Murcia M, Mindelzun RE, Bammer R, et al. Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience. Radiology. 2002;225(3):759–65.

    Article  PubMed  Google Scholar 

  57. Raptopoulos V, Prassopoulos P, Chuttani R, McNicholas MM, McKee JD, Kressel HY. Multiplanar CT pancreatography and distal cholangiography with minimum intensity projections. Radiology. 1998;207(2):317–24.

    Article  CAS  PubMed  Google Scholar 

  58. Prokesch RW, Chow LC, Beaulieu CF, Bammer R, Jeffrey Jr RB. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology. 2002;224(3):764–8.

    Article  PubMed  Google Scholar 

  59. Yoon SH, Lee JM, Cho JY, Lee KB, Kim JE, Moon SK, et al. Small (</= 20 mm) pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology. 2011;259(2):442–52.

    Article  PubMed  Google Scholar 

  60. Chu AJ, Lee JM, Lee YJ, Moon SK, Han JK, Choi BI. Dual-source, dual-energy multidetector CT for the evaluation of pancreatic tumours. Br J Radiol. 2012;85(1018):e891–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Heye T, Nelson RC, Ho LM, Marin D, Boll DT. Dual-energy CT applications in the abdomen. AJR Am J Roentgenol. 2012;199(5 Suppl):S64–70.

    Article  PubMed  Google Scholar 

  62. Marin D, Nelson RC, Barnhart H, Schindera ST, Ho LM, Jaffe TA, et al. Detection of pancreatic tumors, image quality, and radiation dose during the pancreatic parenchymal phase: effect of a low-tube-voltage, high-tube-current CT technique – preliminary results. Radiology. 2010;256(2):450–9.

    Article  PubMed  Google Scholar 

  63. Graser A, Johnson TR, Chandarana H, Macari M. Dual energy CT: preliminary observations and potential clinical applications in the abdomen. Eur Radiol. 2009;19(1):13–23.

    Article  PubMed  Google Scholar 

  64. Macari M, Spieler B, Kim D, Graser A, Megibow AJ, Babb J, et al. Dual-source dual-energy MDCT of pancreatic adenocarcinoma: initial observations with data generated at 80 kVp and at simulated weighted-average 120 kVp. AJR Am J Roentgenol. 2010;194(1):W27–32.

    Article  PubMed  Google Scholar 

  65. Silva AC, Lawder HJ, Hara A, Kujak J, Pavlicek W. Innovations in CT dose reduction strategy: application of the adaptive statistical iterative reconstruction algorithm. AJR Am J Roentgenol. 2010;194(1):191–9.

    Article  PubMed  Google Scholar 

  66. O'Neill E, Hammond N, Miller FH. MR imaging of the pancreas. Radiol Clin N Am. 2014;52(4):757–77.

    Article  PubMed  Google Scholar 

  67. Park HS, Lee JM, Choi HK, Hong SH, Han JK, Choi BI. Preoperative evaluation of pancreatic cancer: comparison of gadolinium-enhanced dynamic MRI with MR cholangiopancreatography versus MDCT. J Magn Reson Imaging. 2009;30(3):586–95.

    Article  PubMed  Google Scholar 

  68. Sandrasegaran K, Lin C, Akisik FM, Tann M. State-of-the-art pancreatic MRI. AJR Am J Roentgenol. 2010;195(1):42–53.

    Article  PubMed  Google Scholar 

  69. Wang Y, Miller FH, Chen ZE, Merrick L, Mortele KJ, Hoff FL, et al. Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographics. 2011;31(3):E47–64.

    Article  PubMed  Google Scholar 

  70. Song SJ, Lee JM, Kim YJ, Kim SH, Lee JY, Han JK, et al. Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. J Magn Reson Imaging. 2007;26(1):86–93.

    Article  PubMed  Google Scholar 

  71. Koh DM, Lee JM, Bittencourt LK, Blackledge M, Collins DJ. Body diffusion-weighted mr imaging in oncology: imaging at 3 T. Magn Reson Imaging Clin N Am. 2016;24(1):31–44.

    Article  PubMed  Google Scholar 

  72. Kim H, Lee JM, Yoon JH, Jang JY, Kim SW, Ryu JK, et al. Reduced field-of-view diffusion-weighted magnetic resonance imaging of the pancreas: comparison with conventional single-shot echo-planar imaging. Korean J Radiol. 2015;16(6):1216–25.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Wang Y, Chen ZE, Nikolaidis P, McCarthy RJ, Merrick L, Sternick LA, et al. Diffusion-weighted magnetic resonance imaging of pancreatic adenocarcinomas: association with histopathology and tumor grade. J Magn Reson Imaging. 2011;33(1):136–42.

    Article  CAS  PubMed  Google Scholar 

  74. Lavdas E, Vlychou M, Arikidis N, Kapsalaki E, Roka V, Arvanitis DL, et al. How reliable is MRCP with an SS-FSE sequence at 3.0 T: comparison between SS-FSE BH and 3D-FSE BH ASSET sequences. Clin Imaging. 2013;37(4):697–703.

    Article  PubMed  Google Scholar 

  75. Kim JE, Lee JM, Kim SH, Baek JH, Moon SK, Yu IS, et al. Differentiation of intraductal growing-type cholangiocarcinomas from nodular-type cholangiocarcinomas at biliary MR imaging with MR cholangiography. Radiology. 2010;257(2):364–72.

    Article  PubMed  Google Scholar 

  76. Ryoo I, Lee JM, Chung YE, Park HS, Kim SH, Han JK, et al. Gadobutrol-enhanced, three-dimensional, dynamic MR imaging with MR cholangiography for the preoperative evaluation of bile duct cancer. Investig Radiol. 2010;45(4):217–24.

    Article  Google Scholar 

  77. Motosugi U, Ichikawa T, Morisaka H, Sou H, Muhi A, Kimura K, et al. Detection of pancreatic carcinoma and liver metastases with gadoxetic acid-enhanced MR imaging: comparison with contrast-enhanced multi-detector row CT. Radiology. 2011;260(2):446–53.

    Article  PubMed  Google Scholar 

  78. Francis IR. Pancreatic adenocarcinoma: diagnosis and staging using multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Cancer Imaging. 2007;7(Spec NoA):S160–5.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Kim JH, Park SH, Yu ES, Kim MH, Kim J, Byun JH, et al. Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology. 2010;257(1):87–96.

    Article  PubMed  Google Scholar 

  80. Blouhos K, Boulas KA, Tsalis K, Hatzigeorgiadis A. The isoattenuating pancreatic adenocarcinoma: review of the literature and critical analysis. Surg Oncol. 2015;24(4):322–8.

    Article  CAS  PubMed  Google Scholar 

  81. Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16(7):1727–33.

    Article  PubMed  Google Scholar 

  82. Fukukura Y, Takumi K, Kamimura K, Shindo T, Kumagae Y, Tateyama A, et al. Pancreatic adenocarcinoma: variability of diffusion-weighted MR imaging findings. Radiology. 2012;263:732–40.

    Article  PubMed  Google Scholar 

  83. Ly JN, Miller FH. MR imaging of the pancreas: a practical approach. Radiol Clin N Am. 2002;40(6):1289–306.

    Article  PubMed  Google Scholar 

  84. Low RN, Sebrechts CP, Barone RM, Muller W. Diffusion-weighted MRI of peritoneal tumors: comparison with conventional MRI and surgical and histopathologic findings – a feasibility study. AJR Am J Roentgenol. 2009;193(2):461–70.

    Article  PubMed  Google Scholar 

  85. Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13(8):1035–46.

    Article  PubMed  Google Scholar 

  86. Wong JC, Lu DS. Staging of pancreatic adenocarcinoma by imaging studies. Clin Gastroenterol Hepatol. 2008;6(12):1301–8.

    Article  PubMed  Google Scholar 

  87. Brugel M, Link TM, Rummeny EJ, Lange P, Theisen J, Dobritz M. Assessment of vascular invasion in pancreatic head cancer with multislice spiral CT: value of multiplanar reconstructions. Eur Radiol. 2004;14(7):1188–95.

    Article  PubMed  Google Scholar 

  88. Li H, Zeng MS, Zhou KR, Jin DY, Lou WH. Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion. J Comput Assist Tomogr. 2005;29(2):170–5.

    Article  PubMed  Google Scholar 

  89. Chen FM, Ni JM, Zhang ZY, Zhang L, Li B, Jiang CJ. Presurgical evaluation of pancreatic cancer: a comprehensive imaging comparison of CT versus MRI. AJR Am J Roentgenol. 2016;206(3):526–35.

    Article  PubMed  Google Scholar 

  90. Holzapfel K, Reiser-Erkan C, Fingerle AA, Erkan M, Eiber MJ, Rummeny EJ, et al. Comparison of diffusion-weighted MR imaging and multidetector-row CT in the detection of liver metastases in patients operated for pancreatic cancer. Abdom Imaging. 2011;36(2):179–84.

    Article  PubMed  Google Scholar 

  91. Kauhanen SP, Komar G, Seppanen MP, Dean KI, Minn HR, Kajander SA, et al. A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg. 2009;250(6):957–63.

    Article  PubMed  Google Scholar 

  92. Edge SBBD, Compton CG, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  93. Saka B, Balci S, Basturk O, Bagci P, Postlewait LM, Maithel S, et al. Pancreatic ductal adenocarcinoma is spread to the peripancreatic soft tissue in the majority of resected cases, rendering the AJCC T-stage protocol (7th edition) inapplicable and insignificant: a size-based staging system (pT1: </=2, pT2: >2-</=4, pT3: >4 cm) is more valid and clinically relevant. Ann Surg Oncol. 2016;23:2010–8.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Park H, An S, Eo SH, Song KB, Park JH, Kim KP, et al. Survival effect of tumor size and extrapancreatic extension in surgically resected pancreatic cancer: proposal for improved T classification. Hum Pathol. 2014;45(11):2341–6.

    Article  PubMed  Google Scholar 

  95. Fuhrman GM, Leach SD, Staley CA, Cusack JC, Charnsangavej C, Cleary KR, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreat Tumor Study Group Ann Surg. 1996;223(2):154–62.

    CAS  Google Scholar 

  96. Katz MH, Marsh R, Herman JM, Shi Q, Collison E, Venook AP, et al. Borderline resectable pancreatic cancer: need for standardization and methods for optimal clinical trial design. Ann Surg Oncol. 2013;20(8):2787–95.

    Article  PubMed  Google Scholar 

  97. Brook OR, Brook A, Vollmer CM, Kent TS, Sanchez N, Pedrosa I. Structured reporting of multiphasic CT for pancreatic cancer: potential effect on staging and surgical planning. Radiology. 2015;274(2):464–72.

    Article  PubMed  Google Scholar 

  98. Catalano C, Laghi A, Fraioli F, Pediconi F, Napoli A, Danti M, et al. Pancreatic carcinoma: the role of high-resolution multislice spiral CT in the diagnosis and assessment of resectability. Eur Radiol. 2003;13(1):149–56.

    PubMed  Google Scholar 

  99. Grenacher L, Klauss M, Dukic L, Delorme S, Knaebel HP, Dux M, et al. Diagnosis and staging of pancreatic carcinoma: MRI versus multislice-CT – a prospective study. RöFo. 2004;176(11):1624–33.

    CAS  PubMed  Google Scholar 

  100. Koelblinger C, Ba-Ssalamah A, Goetzinger P, Puchner S, Weber M, Sahora K, et al. Gadobenate dimeglumine-enhanced 3.0-T MR imaging versus multiphasic 64-detector row CT: prospective evaluation in patients suspected of having pancreatic cancer. Radiology. 2011;259(3):757–66.

    Article  PubMed  Google Scholar 

  101. Lee JK, Kim AY, Kim PN, Lee MG, Ha HK. Prediction of vascular involvement and resectability by multidetector-row CT versus MR imaging with MR angiography in patients who underwent surgery for resection of pancreatic ductal adenocarcinoma. Eur J Radiol. 2010;73(2):310–6.

    Article  PubMed  Google Scholar 

  102. Schima W, Fugger R. Evaluation of focal pancreatic masses: comparison of mangafodipir-enhanced MR imaging and contrast-enhanced helical CT. Eur Radiol. 2002;12(12):2998–3008.

    PubMed  Google Scholar 

  103. Cassinotto C, Cortade J, Belleannee G, Lapuyade B, Terrebonne E, Vendrely V, et al. An evaluation of the accuracy of CT when determining resectability of pancreatic head adenocarcinoma after neoadjuvant treatment. Eur J Radiol. 2013;82(4):589–93.

    Article  PubMed  Google Scholar 

  104. Kim YE, Park MS, Hong HS, Kang CM, Choi JY, Lim JS, et al. Effects of neoadjuvant combined chemotherapy and radiation therapy on the CT evaluation of resectability and staging in patients with pancreatic head cancer. Radiology. 2009;250(3):758–65.

    Article  PubMed  Google Scholar 

  105. Morgan DE, Waggoner CN, Canon CL, Lockhart ME, Fineberg NS, Posey 3rd JA, et al. Resectability of pancreatic adenocarcinoma in patients with locally advanced disease downstaged by preoperative therapy: a challenge for MDCT. AJR Am J Roentgenol. 2010;194(3):615–22.

    Article  PubMed  Google Scholar 

  106. Tamm EP, Loyer EM, Faria S, Raut CP, Evans DB, Wolff RA, et al. Staging of pancreatic cancer with multidetector CT in the setting of preoperative chemoradiation therapy. Abdom Imaging. 2006;31(5):568–74.

    Article  CAS  PubMed  Google Scholar 

  107. Cassinotto C, Mouries A, Lafourcade JP, Terrebonne E, Belleannee G, Blanc JF, et al. Locally advanced pancreatic adenocarcinoma: reassessment of response with CT after neoadjuvant chemotherapy and radiation therapy. Radiology. 2014;273(1):108–16.

    Article  PubMed  Google Scholar 

  108. Torigian DA, Zaidi H, Kwee TC, Saboury B, Udupa JK, Cho ZH, et al. PET/MR imaging: technical aspects and potential clinical applications. Radiology. 2013;267(1):26–44.

    Article  PubMed  Google Scholar 

  109. Yoo HJ, Lee JS, Lee JM. Integrated whole body MR/PET: where are we? Korean J Radiol. 2015;16(1):32–49.

    Article  PubMed  PubMed Central  Google Scholar 

  110. Chen BB, Tien YW, Chang MC, Cheng MF, Chang YT, Wu CH, et al. PET/MRI in pancreatic and periampullary cancer: correlating diffusion-weighted imaging, MR spectroscopy and glucose metabolic activity with clinical stage and prognosis. Eur J Nucl Med Mol Imaging. 2016;43:1753–64.

    Article  PubMed  Google Scholar 

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Lee, J.M., Yoon, J.H. (2017). Imaging Diagnosis of Pancreatic Cancer: CT and MRI. In: Kim, SW., Yamaue, H. (eds) Pancreatic Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47181-4_7

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