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Molecular imaging of pancreatic neoplasms

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Abstract

Purpose

Pancreatic ductal adenocarcinomas (PDACs) derive from the exocrine pancreas and account for the majority of pancreatic tumors (95%). It is the seventh leading cause of cancer-related deaths and shows one of the worst prognoses in oncology with a 5-year survival rate of 9%. Pancreatic neuroendocrine tumors (pNETs) derive from the endocrine part of the pancreas. Well-differentiated pNETs are characterized by slow tumor growth and good life expectancy. In all pancreatic tumor entities, imaging plays a key role. Hybrid imaging modalities (PET/CT and PET/MRI) combine functional and structural data and may reflect a more accurate assessment of disease spread which directs subsequent treatment planning and patient management.

Methods

A comprehensive search strategy was used based on PubMed and SCOPUS databases from 1999 to date.

Results

FDG PET/CT in PDAC shows high sensitivity and specificity in evaluation of T- and M-staging but lesser sensitivity of N-staging. In restaging, metabolic changes occur earlier than morphological changes in tumor size and can be assessed by molecular imaging which can act as a predictor of prognosis. 68Ga-labeled somatostatin analogs (SSAs) are the gold standard in imaging of well-differentiated pNETs. In poorly differentiated pNETs, FDG is the radiotracer of choice. PET/MRI may have added value due to higher soft-tissue contrast. However, more prospective studies comparing PET/CT and PET/MRI systems are needed.

Conclusion

FDG PET/CT plays a key role in PDAC in staging, restaging as well as disease monitoring during follow-up. Functional imaging with 68Ga-labeled SSA is the gold standard in imaging of well-differentiated pNETs.

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This is a review article and all reviewed studies are referenced.

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Authors and Affiliations

  1. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, CA, USA

    H. Duan, L. Baratto & A. Iagaru

  2. Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy

    R. Laudicella, F. Stracuzzi & S. Baldari

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HD carried out literature search, literature review, content planning, wrote and edited manuscript. RL carried out literature search, literature review, content planning, wrote and edited manuscript. FS carried out literature search, literature review. SB contributed to content planning and editing. LB carried out literature search, literature review, content planning, edited manuscript. AI helped in content planning and edited manuscript.

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Duan, H., Baratto, L., Laudicella, R. et al. Molecular imaging of pancreatic neoplasms. Clin Transl Imaging 9, 141–151 (2021). https://doi.org/10.1007/s40336-020-00408-7

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