European Radiology

, Volume 17, Issue 3, pp 638–649 | Cite as

Pancreatic adenocarcinoma

  • Wolfgang Schima
  • Ahmed Ba-Ssalamah
  • Claus Kölblinger
  • Christiane Kulinna-Cosentini
  • Andreas Puespoek
  • Peter Götzinger
Hepatobiliary-Pancreas

Abstract

Adenocarcinoma is the most common malignant pancreatic tumor, affecting the head of the pancreas in 60–70% of cases. By the time of diagnosis, at least 80% of tumors are unresectable. Helical computed tomography (CT) is very effective in detecting and staging adenocarcinoma, with a sensitivity of up to 90% for detection and an accuracy of 80–90% for staging, but it has limitations in detecting small cancers. Moreover, it is not very accurate for determining nonresectability because small liver metastases, peritoneal carcinomatosis, and subtle signs of vascular infiltration may be missed. Multidetector-row CT (MDCT) has brought substantial improvements with its inherent ability to visualize vascular involvement in three dimensions. MDCT has been found to be at least equivalent to contrast-enhanced magnetic resonance imaging (MRI) for detecting adenocarcinoma. MRI can be used as a problem-solving tool in equivocal CT: MRI may help rule out pitfalls, such as inflammatory pseudotumor, focal lipomatosis, abscess, or cystic tumors. Mangafodipir-enhanced MRI reveals a very high tumor-pancreas contrast, which helps in diagnosing small cancers. Endosonography is, if available, also a very accurate tool for detecting small cancers, with a sensitivity of up to 98%. It is the technique of choice for image-guided biopsy if a histologic diagnosis is required for further therapy.

Keywords

Pancreas Tumor Adenocarcinoma MDCT MR imaging Gadolinium Mangafodipir trisodium 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Wolfgang Schima
    • 1
  • Ahmed Ba-Ssalamah
    • 1
  • Claus Kölblinger
    • 1
  • Christiane Kulinna-Cosentini
    • 1
  • Andreas Puespoek
    • 2
  • Peter Götzinger
    • 3
  1. 1.Department of RadiologyMedical University of ViennaViennaAustria
  2. 2.Department of Internal Medicine 4, Division of Gastroenterology and HepatologyMedical University of ViennaViennaAustria
  3. 3.Department of SurgeryMedical University of Vienna, AustriaViennaAustria

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