Abstract
Pancreatic cancer accounts for the third most common cause of all cancer-related deaths. The 5-year survival rate ranges from 3%, in patients with metastatic disease, to 37%, in patients with localized tumor without regional disease. Therefore, staging is critical for the management of pancreatic cancer, as surgery is the only curative option. While management of pancreatic cancer requires multidisciplinary approach, imaging plays a critical role in appropriate stratification of patients. This chapter discusses CT imaging, the primary modality for staging.
Sensitivity of detecting pancreatic cancer can be optimized up to 92% by acquiring various phases of contrast enhancement. Typically acquired phases include pre-contrast images, arterial/pancreatic parenchymal phase at 35–45 seconds, and portal venous/hepatic parenchymal phase at 60–70 seconds.
The National Comprehensive Cancer Network (NCCN) stratifies pancreatic cancer into three categories: resectable, borderline resectable, and unresectable. Pancreatic tumor is considered resectable when there is no evidence of tumor contact with peripancreatic vasculature. Tumor abutting ≤1800 of the peripancreatic arteries is considered borderline resectable. Peripancreatic venous encasement or venous abutment, with intact proximal and distal venous anatomy for vascular bypass, is also considered borderline resectable. Locally advanced tumor with ≥1800 encasement of the peripancreatic arteries and unreconstructible SMV/PV are considered unresectable. Other factors that affect TNM staging, such as hepatic metastasis, lymphadenopathy, local tumor extension to the adjacent organs, and malignant ascites, should also be considered.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Siegal RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34.
American Cancer Society. Cancer Facts & Figures 2020. Atlanta: American Cancer Society; 2020.
www.cancer.org/cancer/pancreatic-cacer/detection-diagnosis-staging/survival-rates.html. Accessed 2020-03-30.
Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. JNCCN. 2017;15(8):1029–61.
www.cancer.net/cancer-types/pancreatic-cancer/statistics. Accessed 1/26/2020.
Zins M, Matos C, Cassinotto C. Pancreatic adenocarcinoma staging in the era of preoperative chemotherapy and radiation therapy. Radiology. 2018;287:374–90.
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Pancreatic Adenocarcinoma. Version 1.2020 - November 26, 2019. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed 1 Apr 2020.
Final Update Summary: Pancreatic Cancer. US Preventive Services Task Force. July 2015. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/pancreatic-cancer-screening.
Megibow A, Zhou X, Rotterdam H, et al. Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability-report of the radiology diagnostic oncology group. Radiology. 1995;195:327–32.
Bronstein YL, Loyer E, Kaur H, et al. Detection of small pancreatic tumors with multiphasic helical CT. Am J Roent. 2004;182:619–23.
Feldman MK, Gandhi NS. Imaging evaluation of pancreatic cancer. Surg Clin N Am. 2016;96:1235–56.
McNulty NJ, Francis IR, Platt JF, et al. Multi-detector helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology. 2001;220:97–102.
Tublin M, Tessler F, Cheng S, et al. Effect of injection rate of contrast medium on pancreatic and hepatic helical CT. Radiology. 1999;210:97–101.
Ichikawa T, Erturk SM, Sou H, et al. MDCT of pancreatic adenocarcinoma: optimal imaging phases and multiplanar reformatted imaging. AJR. 2006;187:1513–20.
Goshima S, Kanematsu M, Kondo H, et al. Pancreas: optimal scan delay of contrast-enhanced multi-detector Ros CT. Radiology. 2006;241:167–74.
Kondo H, Kanematsu M, Goshima S, et al. MDCT of the pancreas: optimizing scanning delay with a bolus-tracking technique for pancreatic Peripancreatic vascular, and hepatic contrast enhancement. AJR. 2007;188:751–6.
Yoon SH, Lee JM, Cho JY, et al. Small ( 20 mm) pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology. 2011;259(2):442–52.
Ahualli J. The double duct sign. Radiology. 2007;224:314–5.
Mortele KJ, Rocha TC, Streeter JL, et al. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics. 2006;26(3):715–31.
Yeh BM, Liu PS, Soto JA, et al. MR imaging and CT of the biliary tract. Radiographics. 2009;29:1669–4688.
Vitellas KM, Keogan MT, Spritzer CE, et al. MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. Radiographics. 2000;20:939–57.
Ahn SS, Kim MJ, Choi JY, et al. Indicative findings of pancreatic cancer in prediagnostic CT. Eur Radiol. 2009;19(10):2448–55.
Prokesch RW, Chow LC, Beaulieu CF, et al. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology. 2002;224:764–8.
Ishigami K, Yoshimitsu K, Irie H, et al. Diagnostic value of the delayed phase image for Iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography. EJR. 2009;69(1):139–46.
Kim JH, Park SH, Yu ES 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.
Zamboni GA, Kruskal JB, Vollmer CM, et al. Pancreatic adenocarcinoma: value of multidetector CT angiography in preoperative evaluation. Radiology. 2007;245(3):770–8.
Ichikawa T, Haradome H, Hachiya J, Nitatori T, Ohtomo K, Kinoshita T, et al. Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging. Radiology. 1997;202:655–62.
Al-Hawary MM, Francis IR, Chari ST, 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.
Hong SB, Lee SS, Kim JH, et al. Pancreatic cancer CT: prediction of resectability according to NCCN criteria. Radiology. 2018;289:710–8.
Morgan DE, Waggoner CN, Canon CL et al. Resectability of pancreatic adenocarcinoma in patients with locally advanced disease downstaged by preoperative.
Cassinotto C, Cortade J, Belleannee G, 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.
Cassinotto C, Mouries A, Lafourcade JP, et al. Locally advanced pancreatic adenocarcinoma: reassessment of response with CT after neoadjuvant chemotherapy and radiation therapy. Radiology. 2014;273(1):108–16.
Deshmukh SD, Willmann JK, Jeffrey RB. Pathways of extrapancreatic perineural invasion by pancreatic adenocarcinoma: evaluation with 3D volume-rendered MDCT imaging. AJR. 2010;194:668–74.
Sai M, Mori H, Kiyonaga M, et al. Peripancreatic lymphatic invasion by pancreatic carcinoma: evaluation with multi-detector CT. Abdom Imaging. 2010;35:154–62.
Zuo HD, Tang W, Zhang XM, et al. CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (part II): imaging of pancreatic carcinoma nerve invasion. World J Radiol. 2012;4(1):13–20.
Chang ST, Jerffrey RB, Patel BN, et al. Preoperative multidetector CT diagnosis of extrapancreatic perineural or duodenal invasion is associated with reduced postoperative survival after pancreaticoduodenectomy for pancreatic adenocarcinoma: preliminary experience and implications for patient care. Radiology. 2016;281(3):816–25.
Alabousi M, McInnes MD, Salameh JP et al. MRI vs. CT for the detection of liver metastases in patients with pancreatic carcinoma: a comparative diagnostic test accuracy systematic review and meta-analysis. J MRI. 2020.
Motosugi U, Ichikawa T, Morisaka H, 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.
Valls C, Andia E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. AJR Am J Roentgenol. 2002;178:821–6.
Marion-Audibert AM, Vullierme MP, Ronot M, et al. Routine MRI with DWI sequences to detect liver metastases in patients with potentially resectable pancreatic ductal carcinoma and normal liver CT: a prospective multicenter study. AJR. 2018;211:W217–25.
Bipat S, van Leeuwen MS, Comans EFI, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis-meta-analysis. Radiology. 2005;237:123–31.
Kinkel D, Lu Y, Both M, et al. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology. 2002;224:748–56.
Thomassen I, Lemmens VE, Nienhuijs SW, et al. Incidence, prognosis and possible treatment strategies of peritoneal carcinomatosis of pancreatic origin: a population-based study. Pancreas. 2013;42(1):72–5.
Roche CJ, Hughes ML, Garvey CJ, et al. CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas. AJR Am J Roentgenol. 2003;180(2):475–80.
Macari M, Spieler B, Kim D, 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.
Marin D, Boll D, Mileto A, et al. State of the art: dual-energy CT of the abdomen. Radiology. 2014;271(2):327–42.
Klauss M, Stiller W, Pahn G, et al. Dual-energy perfusion-CT of pancreatic adenocarcinoma. Eur J Radiol. 2013;82(2):208–14.
George E, Wortman JR, Fulwadhva UP, et al. Dual energy CT applications in pancreatic pathologies. Br J Radiol. 2017;90(20170411):1–13.
Chu AJ, Lee JM, Lee YJ, et al. Dual-source, dual-energy multidetector CT for the evaluation of pancreatic tumours. Br J Radiol. 2012;85:891–8.
Marin D, Nelson RC, Barnhart H, 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;256:450–9.
Levy AD, Shaw JC, Sobin LH. Secondary tumors and tumorlike lesions of the peritoneal cavity: imaging features with pathologic correlation. Radiographics. 2009;29:347–73.
Tempero M. NCCN guidelines updates: pancreatic cancer. JNCCN.org 2019; 17:5.5:603–605.
Brennan DD, Zamboni GA, Raptopoulos VD, et al. Comprehensive preoperative assessment of pancreatic adenocarcinoma with 64-section volumetric CT. Radiographics. 2007;27:1655–66.
Almeida RR, Lo GC, Patino M, Bizzo B, Canellas R, Sahani D. Advances in pancreatic CT imaging. AJR. 2018;211:52–66.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Lee, R.P., Jin, D., Han, T. (2021). Multi-detector CT Scan. In: Anand, N., Darwin, P. (eds) Imaging Diagnostics in Pancreatic Cancer. Clinical Gastroenterology. Humana, Cham. https://doi.org/10.1007/978-3-030-69940-6_1
Download citation
DOI: https://doi.org/10.1007/978-3-030-69940-6_1
Published:
Publisher Name: Humana, Cham
Print ISBN: 978-3-030-69939-0
Online ISBN: 978-3-030-69940-6
eBook Packages: MedicineMedicine (R0)