Solid Pancreatic Masses

Part of the Medical Radiology book series (MEDRAD)


There is a wide variety of solid neoplasms that affect the pancreas. The vast majority of them will be ductal adenocarcinoma and neuroendocrine tumors. MSCT has significantly increased both the detection and improved preoperative staging of pancreatic adenocarcinoma. Volume acquisitions facilitate the creation of high-quality 3D images that provide superior depiction of peripancreatic extension of disease allowing appropriate therapeutic decision making; however pancreas specific multiphase MSCT protocols are required to achieve these results. Additionally, multiphase MSCT has increased the detection of small neuroendocrine tumors. Finally, although there are several much more unusual pancreatic tumors, both primary and secondary that may be infrequently encountered in clinical practice, a more detailed discussion of metastases to the pancreas and non-neoplastic focal pancreatic masses is offered.


Pancreatic Cancer Chronic Pancreatitis Pancreatic Adenocarcinoma National Comprehensive Cancer Network Main Pancreatic Duct 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ahn SS, Kim MJ et al (2009) Indicative findings of pancreatic cancer in prediagnostic CT. Eur Radiol 19(10):2448–2455PubMedCrossRefGoogle Scholar
  2. Ariyama J, Suyama M et al (1998) Imaging of small pancreatic ductal adenocarcinoma. Pancreas 16(3):396–401PubMedCrossRefGoogle Scholar
  3. Balthazar EJ (2005) Pancreatitis associated with pancreatic carcinoma. Preoperative diagnosis: role of CT imaging in detection and evaluation. Pancreatology 5(4–5):330–344PubMedCrossRefGoogle Scholar
  4. Berland LL, Lawson TL et al (1981) Computed tomography of the normal and abnormal pancreatic duct: correlation with pancreatic ductography. Radiology 141(3):715–724PubMedGoogle Scholar
  5. Bilimoria KY, Bentrem DJ et al (2007) Validation of the 6th edition AJCC pancreatic cancer staging system: report from the national cancer database. Cancer 110(4):738–744PubMedCrossRefGoogle Scholar
  6. Byrd SB, Compton CC et al (eds) (2010) AJCC cancer staging manual, Springer, New YorkGoogle Scholar
  7. Callery MP, Chang KJ et al (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16(7):1727–1733PubMedCrossRefGoogle Scholar
  8. Clark CJ, Traverso LW (2010) Positive peritoneal lavage cytology is a predictor of worse survival in locally advanced pancreatic cancer. Am J Surg 199(5):657–662PubMedCrossRefGoogle Scholar
  9. Dalrymple NC, Prasad SR et al (2007) Price of isotropy in multidetector CT. Radiographics 27(1):49–62PubMedCrossRefGoogle Scholar
  10. Deshmukh SD, Willmann JK et al (2010) Pathways of extrapancreatic perineural invasion by pancreatic adenocarcinoma: evaluation with 3D volume-rendered MDCT imaging. Am J Roentgenol 194(3):668–674CrossRefGoogle Scholar
  11. Fidler JL, Fletcher JG et al (2003) Preoperative detection of pancreatic insulinomas on multiphasic helical CT. Am J Roentgenol 181(3):775–780Google Scholar
  12. Fishman EK, Horton KM (2001) Imaging pancreatic cancer: the role of multidetector CT with three-dimensional CT angiography. Pancreatology 1(6):610–624PubMedCrossRefGoogle Scholar
  13. Fletcher JG, Wiersema MJ et al (2003) Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 229(1):81–90PubMedCrossRefGoogle Scholar
  14. Fukushima H, Itoh S et al (2006) Diagnostic value of curved multiplanar reformatted images in multislice CT for the detection of resectable pancreatic ductal adenocarcinoma. Eur Radiol 16(8):1709–1718PubMedCrossRefGoogle Scholar
  15. Gangi S, Fletcher JG et al (2004) Time interval between abnormalities seen on CT and the clinical diagnosis of pancreatic cancer: retrospective review of CT scans obtained before diagnosis. Am J Roentgenol 182(4):897–903Google Scholar
  16. Gerstenmaier JF, Malone DE (2011) Mass lesions in chronic pancreatitis: benign or malignant? An “evidence-based practice” approach. Abdom Imaging 36(5):569--577Google Scholar
  17. Ghavamian R, Klein KA et al (2000) Renal cell carcinoma metastatic to the pancreas: clinical and radiological features. Mayo Clin Proc 75(6):581–585PubMedCrossRefGoogle Scholar
  18. Hommeyer SC, Freeny PC et al (1995) Carcinoma of the head of the pancreas: evaluation of the pancreaticoduodenal veins with dynamic CT–potential for improved accuracy in staging. Radiology 196(1):233–238PubMedGoogle Scholar
  19. Hough TJ, Raptopoulos V et al (1999) Teardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas. Am J Roentgenol 173(6):1509–1512Google Scholar
  20. Ichikawa T, Sou H et al (2001) Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 221(1):107–116PubMedCrossRefGoogle Scholar
  21. Ichikawa T, Erturk SM et al (2006) MDCT of pancreatic adenocarcinoma: optimal imaging phases and multiplanar reformatted imaging. Am J Roentgenol 187(6):1513–1520CrossRefGoogle Scholar
  22. Imamura M, Asahi S et al (2002) Minute pancreatic carcinoma with initial symptom of acute pancreatitis. J Hepatobiliary Pancreat Surg 9(5):632–636PubMedCrossRefGoogle Scholar
  23. Ishikawa O, Ohigashi H et al (1992) Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Ann Surg 215(3):231–236PubMedCrossRefGoogle Scholar
  24. Itoh S, Ikeda M et al (2003) Assessment of the pancreatic and intrapancreatic bile ducts using 0.5-mm collimation and multiplanar reformatted images in multislice CT. Eur Radiol 13(2):277–285PubMedGoogle Scholar
  25. Jemal A, Murray T et al (2005) Cancer statistics, 2005. CA Cancer J Clin 55(1):10–30PubMedCrossRefGoogle Scholar
  26. Jemal A, Siegel R et al (2010) Cancer statistics, 2010. CA Cancer J Clin 60(5):277–300PubMedCrossRefGoogle Scholar
  27. Jimenez RE, Fernandez-del Castillo C (2010) Tumors of the pancreas. Sleisenger and Fordtran’s gastrointestinal and liver disease. Feldman M, Friedman LS, Brandt LJ (eds) Philadelphia 2:1017–1027 ElsevierGoogle Scholar
  28. Kalra MK, Maher MM et al (2003) State-of-the-art imaging of pancreatic neoplasm. Br J Radiol 76(912):857–865PubMedCrossRefGoogle Scholar
  29. Kaneko OF, Lee DM et al (2010) Performance of multidetector computed tomographic angiography in determining surgical resectability of pancreatic head adenocarcinoma. J Comput Assist Tomogr 34(5):732–738PubMedCrossRefGoogle Scholar
  30. Kim SH, Lee JM et al (2008) Intrapancreatic accessory spleen: findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol 9(2):162–174PubMedCrossRefGoogle Scholar
  31. Kim JH, Park SH et al (2010) Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology 257(1):87–96PubMedCrossRefGoogle Scholar
  32. Lammer J, Herlinger H et al (1985) Pseudotumorous pancreatitis. Gastrointest Radiol 10(1):59–67PubMedCrossRefGoogle Scholar
  33. Lee DS, Jeffrey RB et al (2009) Islet-cell tumors of the pancreas: spectrum of MDCT findings. A pictorial essay. Applied Radiology 38(11):10–28Google Scholar
  34. Liu Y, Song Q et al (2009) The value of multidetector-row CT in the preoperative detection of pancreatic insulinomas. Radiol Med 114(8):1232–1238PubMedCrossRefGoogle Scholar
  35. Lu DS, Reber HA et al (1997) Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. Am J Roentgenol 168(6):1439–1443Google Scholar
  36. Macari M, Spieler B et al (2010) Dual-source dual-energy MDCT of pancreatic adenocarcinoma: initial observations with data generated at 80 kVp and at simulated weighted-average 120 kVp. Am J Roentgenol 194(1):W27–W32CrossRefGoogle Scholar
  37. Manak E, Merkel S et al (2009) Resectability of pancreatic adenocarcinoma: assessment using multidetector-row computed tomography with multiplanar reformations. Abdom Imaging 34(1):75–80PubMedCrossRefGoogle Scholar
  38. McMahon PM, Halpern EF et al (2001) Pancreatic cancer: cost-effectiveness of imaging technologies for assessing resectability. Radiology 221(1):93–106PubMedCrossRefGoogle Scholar
  39. McNulty NJ, Francis IR et al (2001) Multi–detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 220(1):97–102PubMedGoogle Scholar
  40. Megibow AJ, Francis IR (2003) Unusual pancreatic neoplasms: imaging. Imaging of the Pancreas: cystic and rare tumors. In: Procacci C, Megibow AJ (eds) Springer, Heidelberg, pp 249–267Google Scholar
  41. Mochizuki K, Gabata T et al (2010) MDCT findings of extrapancreatic nerve plexus invasion by pancreas head carcinoma: correlation with en bloc pathological specimens and diagnostic accuracy. Eur Radiol 20(7):1757–1767PubMedCrossRefGoogle Scholar
  42. Morgan DE, Waggoner CN et al (2010) Resectability of pancreatic adenocarcinoma in patients with locally advanced disease downstaged by preoperative therapy: a challenge for MDCT. Am J Roentgenol 194(3):615–622CrossRefGoogle Scholar
  43. Moussa A, Mitry E et al (2004) Pancreatic metastases: a multicentric study of 22 patients. Gastroenterol Clin Biol 28(10 Pt 1):872–876Google Scholar
  44. O’Malley ME, Boland GW et al (1999) Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT. Am J Roentgenol 173(6):1513–1518Google Scholar
  45. Powell AC, Hajdu CH et al (2008) Nonfunctioning pancreatic endocrine neoplasm presenting as asymptomatic, isolated pancreatic duct stricture: a case report and review of the literature. Am Surg 74(2):168–171PubMedGoogle Scholar
  46. Procacci C, Carbognin G et al (2001) Nonfunctioning endocrine tumors of the pancreas: possibilities of spiral CT characterization. Eur Radiol 11(7):1175–1183PubMedCrossRefGoogle Scholar
  47. Prokesch RW, Chow LC et al (2002a) Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 224(3):764–768PubMedCrossRefGoogle Scholar
  48. Prokesch RW, Chow LC et al (2002b) Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience. Radiology 225(3):759–765PubMedCrossRefGoogle Scholar
  49. Raimondi S, Maisonneuve P et al (2009) Epidemiology of pancreatic cancer: an overview. Nat Rev Gastroenterol Hepatol 6(12):699–708PubMedCrossRefGoogle Scholar
  50. Roche CJ, Hughes ML et al (2003) CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas. Am J Roentgenol 180(2):475–480Google Scholar
  51. Sai M, Mori H et al (2010) Peripancreatic lymphatic invasion by pancreatic carcinoma: evaluation with multi-detector row CT. Abdom Imaging 35(2):154–162PubMedCrossRefGoogle Scholar
  52. Salles A, Nino-Murcia M et al (2007) CT of pancreas: minimum intensity projections. Abdom Imaging 27: 27Google Scholar
  53. Schueller G, Schima W et al (2006) Multidetector CT of pancreas: effects of contrast material flow rate and individualized scan delay on enhancement of pancreas and tumor contrast. Radiology 241(2):441–448PubMedCrossRefGoogle Scholar
  54. Shi C, Siegelman SS et al (2010) Pancreatic duct stenosis secondary to small endocrine neoplasms: a manifestation of serotonin production? Radiology 257(1):107–114PubMedCrossRefGoogle Scholar
  55. Simianu VV, Zyromski NJ et al (2010) Pancreatic cancer: progress made. Acta Oncol 49(4): 407–417Google Scholar
  56. Solcia E, Capella C et al (eds) (1997) Tumors of the Pancreas. AFIP atlas of tumor pathology. Washington, DC, Armed Forces Institute of PathologyGoogle Scholar
  57. Stabile BE, Morrow DJ et al (1984) The gastrinoma triangle: operative implications. Am J Surg 147(1):25–31PubMedCrossRefGoogle Scholar
  58. Stephens DH (1997) CT of pancreatic neoplasms. Part I: adenocarcinoma. Curr Probl Diagn Radiol 26(2):59–80PubMedGoogle Scholar
  59. Takahashi N, Fletcher JG et al (2009) Autoimmune pancreatitis: differentiation from pancreatic carcinoma and normal pancreas on the basis of enhancement characteristics at dual-phase CT. Am J Roentgenol 193(2):479–484CrossRefGoogle Scholar
  60. Tanaka S, Nakao M et al (2010) Slight dilatation of the main pancreatic duct and presence of pancreatic cysts as predictive signs of pancreatic cancer: a prospective study. Radiology 254(3):965–972PubMedCrossRefGoogle Scholar
  61. Tempero M, Brand R (2008) Pancreatic Cancer. Cecil Medicine Goldman L, Ausiello D (eds). Philadelphia, Elsevier, pp 1479–1482Google Scholar
  62. Tempero MA, Arnoletti JP et al (2010) Pancreatic adenocarcinoma. J Natl Compr Canc Netw 8(9):972–1017PubMedGoogle Scholar
  63. Uehara H, Tatsumi K et al (2009) Scraping cytology with a guidewire for pancreatic-ductal strictures. Gastrointest Endosc 70(1):52–59PubMedCrossRefGoogle Scholar
  64. Wong JC, Lu DS (2008) Staging of pancreatic adenocarcinoma by imaging studies. Clin Gastroenterol Hepatol 6(12):1301–1308PubMedCrossRefGoogle Scholar
  65. Yamada Y, Mori H et al (2000) CT assessment of the inferior peripancreatic veins: clinical significance. Am J Roentgenol 174(3):677–684Google Scholar
  66. Yeo CJ, Cameron JL et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226(3):248–57, discussion 257–260Google Scholar
  67. Yoon SH, Lee JM et al (2010) Small (<=20 mm) Pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology 2011:15Google Scholar
  68. Yoon SH, Lee JM et al (2011) Small (<=20 mm) Pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology 259(2):442–452PubMedCrossRefGoogle Scholar
  69. Zamboni GA, Kruskal JB et al (2007) Pancreatic adenocarcinoma: value of multidetector CT angiography in preoperative evaluation. Radiology 245(3):770–778PubMedCrossRefGoogle Scholar
  70. Zhao WY, Luo M et al (2009) Computed tomography in diagnosing vascular invasion in pancreatic and periampullary cancers: a systematic review and meta-analysis. Hepatobiliary Pancreat Dis Int 8(5):457–464PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.NYU-Langone Medical CenterNew YorkUSA

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