Magnetic resonance imaging of pancreatic adenocarcinoma

  • Laura M. Fayad
  • Donald G. Mitchell
Review Article


Background. Magnetic resonance imaging (MRI) should be considered essential to the presurgical evaluation of pancreatic adenocarcinoma, to accurately detect resectable lesions and to spare patients with non-resectable tumors the morbidity, mortality, and expense of unnecessary surgery. This article is a review of the MRI characteristics of pancreatic adenocarcinoma, the features that determine its resectability, and the optimal MR sequences needed for its effective evaluation. The role of MRI imaging is contrasted with other imaging and invasive modalities for the diagnosis and staging of pancreatic adenocarcinoma.

Key Words

Imaging study pancreatic cancer pancreatic carcinoma neoplasm chronic pancreatitis main pancreatic duct 


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  1. 1.
    Arslan A, Buanes T, Geitung JT. Pancreatic carcinoma: MR, MR angiography and dynamic helical CT in the evaluation of vascular invasion. Eur J Radiol 2001;38(2):151–159.PubMedCrossRefGoogle Scholar
  2. 2.
    Hawes RH, Xiong Q, Waxman I, et al. A multispecialty approach to the diagnosis and management of pancreatic cancer. Am J Gastroenterol 2000;95(1):17–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Nitecki SS, Sarr MG, Colby TV, Van Heerden JA. Long-term survival after resection for ductal adenocarcinoma of the pancras: Is it really improving? Ann Surg 1994;221:59–66.CrossRefGoogle Scholar
  4. 4.
    Ariyama J, Suyama M, Satoh K, Sai J. Imaging of Small Pancreatic Ductal Adenocarcinoma. Pancreas 1998;16(3):396–401.PubMedCrossRefGoogle Scholar
  5. 5.
    Kern S, Hruban R, Hollingsworth MA, et al. A White Paper: The Product of a Pancreas Cancer Think Tank. San Francisco, CA. 2000.Google Scholar
  6. 6.
    Chung YS. The detection of human pancreatic cancer associated antigen in the serum of cancer patients. Cancer 1987;60:1636–1643.PubMedCrossRefGoogle Scholar
  7. 7.
    Semelka RC, Kroeker MA, Shoenut JP, et al. Pancreatic disease: Prospective comparison of CT. ERCP and 1.5 Tesla MR imaging with dynamic gadolinium enhancement and fat suppression. Radiology 1991;181:785–791.PubMedGoogle Scholar
  8. 8.
    Irie H, Honda H, Kaneko K, et al. Comparison of helical CT and MR imaging in detecting and staging small pancreatic adenocarcinoma. Abdom Imaging 1997;22:429–433.PubMedCrossRefGoogle Scholar
  9. 9.
    Ralls PW, Halls J, Renner I, et al. Endoscopic retrograde cholangiopancreaticography (ERCP) and pancreatic disease. Radiology 1980;134:347–352.PubMedGoogle Scholar
  10. 10.
    McFarland EG, Kaufman JA, Saini S, et al. Preoperative staging of cancer of the pancreas: Value of MR angiography versus conventional angiography in detecting portal venous invasion. Am J Roentgenol 1996;166:37–43.Google Scholar
  11. 11.
    Bottger TC, Boddin J, Duber C, et al. Diagnosing and staging of pancreatic carcinoma—what is necessary? Oncol 1998;55:122–129.CrossRefGoogle Scholar
  12. 12.
    Bluemke DA, Fishman EK. CT and MR evaluation of pancreatic cancer. Surg Oncol Clin N Am 1998;7:103–124.PubMedGoogle Scholar
  13. 13.
    Diehl SJ, Lehmann KJ, Sadick M, et al. Pancreatic cancer: Value of dual-phase helical CT in assessing resectability. Radiology 1998;206:373–378.PubMedGoogle Scholar
  14. 14.
    Ichikawa T, Haradome H, Hachiya J, et al. Pancreatic ductal adenocarcinoma: Preoperative assessment with helical CT versus dynamic MR imaging. Radiology 1997;202:655–662.PubMedGoogle Scholar
  15. 15.
    Sheridan MB, Ward J, Guthrie JA, et al. Dynamic contrastenhanced MR imaging and dual-phase helical CT in the preoperative assessment of suspected pancreatic cancer: A comparative study with receiver operating characteristic analysis. Am J Roentgenol 1999;173:483–590.Google Scholar
  16. 16.
    Gabata T, Masui S, Kadoya M, et al. Small pancreatic adenocarcinomas: Efficacy of MR imaging with fat suppression and gadolinium enhancement. Radiology 1994;193:683–688.PubMedGoogle Scholar
  17. 17.
    Vellet AD, Romano W, Bach DB, et al. Adenocarcinoma of the pancreatic ducts: Comparative evaluation with CT and MR imaging at 1.5 T. Radiology 1992;183:87–95.PubMedGoogle Scholar
  18. 18.
    Outwater EK, Mitchell DG. MR imaging techniques for evaluation of the pancreas. Top Magn Reson Imag 1996;8:248–264.Google Scholar
  19. 19.
    Semelka RC, Ascher SM. MRI of the pancreas state of the art. Radiology 1993;188:593–602.PubMedGoogle Scholar
  20. 20.
    Semelka RC, Kelekis NL, Ascher SM. Pancreas, in: MRI of the Abdomen and Pelvis (Semelka RC, Ascher SM, Reinhold C, Eds.), Wiley-Liss, New York, 1997; pp. 187–238.Google Scholar
  21. 21.
    Balci NC, Semelka RC. Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma. Eur J Radiol 2001;38(2):105–112.PubMedCrossRefGoogle Scholar
  22. 22.
    Tsuda T, Mochizuki T, Kikuchi K, et al. Late-phase enhancement of the upstream portion of pancreatic adenocarcinoma on dual-phase helical CT. Abdom Imaging 2001;26:635–639.PubMedCrossRefGoogle Scholar
  23. 23.
    Johnson PT, Outwater EK. Pancreatic carcinoma versus chronic pancreatitis: dynamic MR imaging. Radiology 1999;212:213–218.PubMedGoogle Scholar
  24. 24.
    Karawasa E, Goldberg HI, Moss AA, et al. CT pancreatogram in carcinoma of the pancreas and chronic panereatitis. Radiology 1983;148:489–493.Google Scholar
  25. 25.
    Elmas N, Yorulmaz I, Oran I, et al. A new criterion in differentiation of pancreatitis and pancreatic carcinoma: Artery-to-vein ratio using the superior mesenteric vessels. Abdom Imaging 1996;21:331–333.PubMedCrossRefGoogle Scholar
  26. 26.
    Ichikawa T, Sou H, Araki T, et al. Duct-penetrating sign at MRCP: Usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 2001;221:107–116.PubMedCrossRefGoogle Scholar
  27. 27.
    Kettritz U, Semelka RC. Contrast-enhanced MR imaging of the pancreas. MRI Clin N Am 1996;4:87–100.Google Scholar
  28. 28.
    Mayo-Smith WW, Schima W, Saini S, et al. Pancreatic enhancement and pulse sequence analysis using low-dose mangafodipir trisodium. Am J Roentgenol 1998;170(3):649–652.Google Scholar
  29. 29.
    Reiber A, Tomczak R, Nussle K, et al. MRI with mangafodipir trisodium in the detection of pancreatic tumours: Comparison with helical CT. Br J Radiology 2000;73(875): 1165–1169.Google Scholar
  30. 30.
    Nishiharu T, Yamashita Y, Abe Y, et al. Local extension of pancreatic carcinoma: Assessment with thin-section helical CT versus with breath-hold fast MR imaging-ROC analysis. Radiology 1999;212:445–452.PubMedGoogle Scholar
  31. 31.
    Stark DD, Wittenberg J, Butch RJ, Ferrucci JT. Hepatic metastases: Randomized, controlled comparison of detection with MR imaging and CT. Radiology 1987;165:399–406.PubMedGoogle Scholar
  32. 32.
    Semelka RC, Worawottanakul S, Kelekis NL, et al. Liver lesion detection and characterization comparison of single phase spiral CT and current MR techniques. J Magn Reson Imag 1997;7:1040–1047.CrossRefGoogle Scholar
  33. 33.
    Federle M, Chezmar J, Ribin DL, et al. Efficacy and safety of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: Results of the U.S. multicenter phase III clinical trials. Efficacy of early imaging. J Magn Reson Imag 2000;12:689–701.CrossRefGoogle Scholar
  34. 34.
    Choi CK, Liu GC, Chen LT, et al. MRI demonstration of peritoneal implants. Abdom Imaging 1994;19:95–101.CrossRefGoogle Scholar
  35. 35.
    Mitchell DG, Semelka CR. The pancreas and spleen. in: Magnetic Resonance Imaging of the Body (Higgins CB, Hricak H, Helms CA, Eds.). Lippincott-Raven, Philadelphia, PA, 1997; pp. 639–665.Google Scholar

Copyright information

© Humana Press Inc 2001

Authors and Affiliations

  • Laura M. Fayad
    • 1
  • Donald G. Mitchell
    • 1
  1. 1.Division of Magnetic Resonance ImagingThomas Jefferson University HospitalPhiladelphia

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