Skip to main content
SpringerLink
Log in

PET/CT in Pancreatic Neoplasms

  • Chapter
  • First Online:
Imaging Diagnostics in Pancreatic Cancer

Part of the book series: Clinical Gastroenterology ((CG))

  • 392 Accesses

Abstract

Optimal treatment for pancreatic adenocarcinoma which is associated with high morbidity and mortality consists of surgery with neoadjuvant or adjuvant chemoradiotherapy. Owing to the high glucose uptake by pancreatic cancer cells, 18F-FDG PET/CT can contribute to staging and therapeutic decision making, preventing futile surgeries in patients with distant metastases. 18F-FDG PET/CT has been shown to offer prognostic information and is a good tool for treatment response assessment particularly in patients with equivocal findings on CT or MRI.

68Gallium-DOTATATE PET/CT is the preferred imaging modality for staging patients with well-differentiated pancreatic neuroendocrine tumors. Therapy with 177Lu-DOTATATE offers survival benefit to patients with metastatic neuroendocrine tumors, unresponsive to other therapeutic measures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Mostafa ME, Erbarut-Seven I, Pehlivanoglu B, Adsay V. Pathologic classification of “pancreatic cancers”: current concepts and challenges. Chin Clin Oncol. 2017;6(6):59.

    Article  PubMed  Google Scholar 

  2. Klimstra DS. Nonductal neoplasms of the pancreas. Mod Pathol. 2007;20(Suppl 1):S94–112.

    Article  PubMed  Google Scholar 

  3. McGuigan A, Kelly P, Turkington RC, Jones C, Coleman HG, McCain RS. Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2018;24(43):4846–61.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Carrato A, Falcone A, Ducreux M, Valle JW, Parnaby A, Djazouli K, et al. A systematic review of the burden of pancreatic cancer in Europe: real-world impact on survival, quality of life and costs. J Gastrointest Cancer. 2015;46(3):201–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Tempero MA. NCCN guidelines updates: pancreatic cancer. J Natl Compr Canc Netw. 2019;17(5.5):603–5.

    CAS  PubMed  Google Scholar 

  6. Santhosh S, Mittal BR, Rana SS, Srinivasan R, Bhattacharya A, Das A, et al. Metabolic signatures of malignant and non-malignant mass-forming lesions in the periampulla and pancreas in FDG PET/CT scan: an atlas with pathologic correlation. Abdom Imaging. 2015;40(5):1285–315.

    Article  PubMed  Google Scholar 

  7. Expert Panel on Gastrointestinal I, Qayyum A, Tamm EP, Kamel IR, Allen PJ, Arif-Tiwari H, et al. ACR appropriateness criteria((R)) staging of pancreatic ductal adenocarcinoma. J Am Coll Radiol. 2017;14(11S):S560–S9.

    Google Scholar 

  8. Basu S, Hess S, Nielsen Braad PE, Olsen BB, Inglev S, Hoilund-Carlsen PF. The basic principles of FDG-PET/CT imaging. PET Clin. 2014;9(4):355–70. v

    Article  PubMed  Google Scholar 

  9. Vaziri-Gohar A, Zarei M, Brody JR, Winter JM. Corrigendum: metabolic dependencies in pancreatic cancer. Front Oncol. 2018;8:672.

    Article  PubMed  Google Scholar 

  10. Best LM, Rawji V, Pereira SP, Davidson BR, Gurusamy KS. Imaging modalities for characterising focal pancreatic lesions. Cochrane Database Syst Rev. 2017;4:CD010213.

    PubMed  Google Scholar 

  11. Kauhanen SP, Komar G, Seppanen MP, Dean KI, Minn HR, Kajander SA, et al. A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg. 2009;250(6):957–63.

    Article  PubMed  Google Scholar 

  12. Schick V, Franzius C, Beyna T, Oei ML, Schnekenburger J, Weckesser M, et al. Diagnostic impact of 18F-FDG PET-CT evaluating solid pancreatic lesions versus endosonography, endoscopic retrograde cholangio-pancreatography with intraductal ultrasonography and abdominal ultrasound. Eur J Nucl Med Mol Imaging. 2008;35(10):1775–85.

    Article  PubMed  Google Scholar 

  13. Jha P, Bijan B. PET/CT for pancreatic malignancy: potential and pitfalls. J Nucl Med Technol. 2015;43(2):92–7.

    Article  PubMed  Google Scholar 

  14. van Kouwen MC, Jansen JB, van Goor H, de Castro S, Oyen WJ, Drenth JP. FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis. Eur J Nucl Med Mol Imaging. 2005;32(4):399–404.

    Article  PubMed  Google Scholar 

  15. Dong A, Dong H, Zhang L, Zuo C. Hypermetabolic lesions of the pancreas on FDG PET/CT. Clin Nucl Med. 2013;38(9):e354–66.

    Article  PubMed  Google Scholar 

  16. Nguyen VX, Nguyen CC, Nguyen BD. (1)(8)F-FDG PET/CT imaging of the pancreas: spectrum of diseases. JOP. 2011;12(6):557–66.

    PubMed  Google Scholar 

  17. Matsumoto I, Shirakawa S, Shinzeki M, Asari S, Goto T, Ajiki T, et al. 18-Fluorodeoxyglucose positron emission tomography does not aid in diagnosis of pancreatic ductal adenocarcinoma. Clin Gastroenterol Hepatol. 2013;11(6):712–8.

    Article  PubMed  Google Scholar 

  18. Bakker GJ, Vanbellinghen MC, Scheithauer TP, Verchere CB, Stroes ES, Timmers N, et al. Pancreatic 18F-FDG uptake is increased in type 2 diabetes patients compared to non-diabetic controls. PLoS One. 2019;14(3):e0213202.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Zhang J, Jia G, Zuo C, Jia N, Wang H. (18)F- FDG PET/CT helps differentiate autoimmune pancreatitis from pancreatic cancer. BMC Cancer. 2017;17(1):695.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Cheng MF, Guo YL, Yen RF, Chen YC, Ko CL, Tien YW, et al. Clinical utility of FDG PET/CT in patients with autoimmune pancreatitis: a case-control study. Sci Rep. 2018;8(1):3651.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Santhosh S, Mittal BR, Bhasin D, Rana SS, Bhattacharya A, Srinivasan R, et al. Dual-phase 18F-FDG PET/CT imaging in the characterization of pancreatic lesions: does it offer prognostic information? Nucl Med Commun. 2014;35(10):1018–25.

    Article  PubMed  Google Scholar 

  22. Buchs NC, Buhler L, Bucher P, Willi JP, Frossard JL, Roth AD, et al. Value of contrast-enhanced 18F-fluorodeoxyglucose positron emission tomography/computed tomography in detection and presurgical assessment of pancreatic cancer: a prospective study. J Gastroenterol Hepatol. 2011;26(4):657–62.

    Article  PubMed  Google Scholar 

  23. Allen PJ, Kuk D, Castillo CF, Basturk O, Wolfgang CL, Cameron JL, et al. Multi-institutional validation study of the American Joint Commission on Cancer (8th Edition) changes for T and N staging in patients with pancreatic adenocarcinoma. Ann Surg. 2017;265(1):185–91.

    Article  PubMed  Google Scholar 

  24. Strobel O, Neoptolemos J, Jager D, Buchler MW. Optimizing the outcomes of pancreatic cancer surgery. Nat Rev Clin Oncol. 2019;16(1):11–26.

    Article  CAS  PubMed  Google Scholar 

  25. NCCN guidelines for pancreatic cancer. 2018.

    Google Scholar 

  26. Joo I, Lee JM, Lee DH, Lee ES, Paeng JC, Lee SJ, et al. Preoperative assessment of pancreatic cancer with FDG PET/MR imaging versus FDG PET/CT plus contrast-enhanced multidetector CT: a prospective preliminary study. Radiology. 2017;282(1):149–59.

    Article  PubMed  Google Scholar 

  27. Asagi A, Ohta K, Nasu J, Tanada M, Nadano S, Nishimura R, et al. Utility of contrast-enhanced FDG-PET/CT in the clinical management of pancreatic cancer: impact on diagnosis, staging, evaluation of treatment response, and detection of recurrence. Pancreas. 2013;42(1):11–9.

    Article  PubMed  Google Scholar 

  28. Wang XY, Yang F, Jin C, Fu DL. Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer. World J Gastroenterol. 2014;20(42):15580–9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Yachida S, Iacobuzio-Donahue CA. The pathology and genetics of metastatic pancreatic cancer. Arch Pathol Lab Med. 2009;133(3):413–22.

    Article  PubMed  Google Scholar 

  30. Wang Z, Chen JQ, Liu JL, Qin XG, Huang Y. FDG-PET in diagnosis, staging and prognosis of pancreatic carcinoma: a meta-analysis. World J Gastroenterol. 2013;19(29):4808–17.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Strobel K, Heinrich S, Bhure U, Soyka J, Veit-Haibach P, Pestalozzi BC, et al. Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the resectability of pancreatic cancer. J Nucl Med. 2008;49(9):1408–13.

    Article  PubMed  Google Scholar 

  32. Ghaneh P, Hanson R, Titman A, Lancaster G, Plumpton C, Lloyd-Williams H, et al. PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer. Health Technol Assess. 2018;22(7):1–114.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Moletta L, Bissoli S, Fantin A, Passuello N, Valmasoni M, Sperti C. PET/CT incidental detection of second tumor in patients investigated for pancreatic neoplasms. BMC Cancer. 2018;18(1):531.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mellon EA, Jin WH, Frakes JM, Centeno BA, Strom TJ, Springett GM, et al. Predictors and survival for pathologic tumor response grade in borderline resectable and locally advanced pancreatic cancer treated with induction chemotherapy and neoadjuvant stereotactic body radiotherapy. Acta Oncol. 2017;56(3):391–7.

    Article  CAS  PubMed  Google Scholar 

  35. Akita H, Takahashi H, Ohigashi H, Tomokuni A, Kobayashi S, Sugimura K, et al. FDG-PET predicts treatment efficacy and surgical outcome of pre-operative chemoradiation therapy for resectable and borderline resectable pancreatic cancer. Eur J Surg Oncol. 2017;43(6):1061–7.

    Article  CAS  PubMed  Google Scholar 

  36. Li XX, Liu NB, Zhu L, Yuan XK, Yang CW, Ren P, et al. Consequences of additional use of contrast-enhanced (18)F-FDG PET/CT in target volume delineation and dose distribution for pancreatic cancer. Br J Radiol. 2015;88(1051):20140590.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Zhu D, Wang L, Zhang H, Chen J, Wang Y, Byanju S, et al. Prognostic value of 18F-FDG-PET/CT parameters in patients with pancreatic carcinoma: A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(33):e7813.

    Article  Google Scholar 

  38. Chirindel A, Alluri KC, Chaudhry MA, Wahl RL, Pawlik TM, Herman JM, et al. Prognostic value of FDG PET/CT-derived parameters in pancreatic adenocarcinoma at initial PET/CT staging. AJR Am J Roentgenol. 2015;204(5):1093–9.

    Article  PubMed  Google Scholar 

  39. Sperti C, Pasquali C, Chierichetti F, Ferronato A, Decet G, Pedrazzoli S. 18-Fluorodeoxyglucose positron emission tomography in predicting survival of patients with pancreatic carcinoma. J Gastrointest Surg. 2003;7(8):953–9; discussion 9-60.

    Article  PubMed  Google Scholar 

  40. Pergolini I, Crippa S, Salgarello M, Belfiori G, Partelli S, Ruffo G, et al. SUVmax after (18)fluoro-deoxyglucose positron emission tomography/computed tomography: A tool to define treatment strategies in pancreatic cancer. Dig Liver Dis. 2018;50(1):84–90.

    Article  PubMed  Google Scholar 

  41. Myssayev A, Myssayev A, Ideguchi R, Eguchi S, Adachi T, Sumida Y, et al. Usefulness of FDG PET/CT derived parameters in prediction of histopathological finding during the surgery in patients with pancreatic adenocarcinoma. PLoS One. 2019;14(1):e0210178.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Ruf J, Lopez Hanninen E, Oettle H, Plotkin M, Pelzer U, Stroszczynski C, et al. Detection of recurrent pancreatic cancer: comparison of FDG-PET with CT/MRI. Pancreatology. 2005;5(2–3):266–72.

    Article  PubMed  Google Scholar 

  43. Sperti C, Pasquali C, Bissoli S, Chierichetti F, Liessi G, Pedrazzoli S. Tumor relapse after pancreatic cancer resection is detected earlier by 18-FDG PET than by CT. J Gastrointest Surg. 2010;14(1):131–40.

    Article  PubMed  Google Scholar 

  44. Jung W, Jang JY, Kang MJ, Chang YR, Shin YC, Chang J, et al. The clinical usefulness of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) in follow-up of curatively resected pancreatic cancer patients. HPB (Oxford). 2016;18(1):57–64.

    Article  Google Scholar 

  45. Sheikhbahaei S, Mena E, Marcus C, Wray R, Taghipour M, Subramaniam RM. 18F-FDG PET/CT: therapy response assessment interpretation (Hopkins Criteria) and survival outcomes in lung cancer patients. J Nucl Med. 2016;57(6):855–60.

    Article  CAS  PubMed  Google Scholar 

  46. Sheikhbahaei S, Wray R, Young B, Mena E, Taghipour M, Rahmim A, et al. 18F-FDG-PET/CT therapy assessment of locally advanced pancreatic adenocarcinoma: impact on management and utilization of quantitative parameters for patient survival prediction. Nucl Med Commun. 2016;37(3):231–8.

    Article  CAS  PubMed  Google Scholar 

  47. Kittaka H, Takahashi H, Ohigashi H, Gotoh K, Yamada T, Tomita Y, et al. Role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in predicting the pathologic response to preoperative chemoradiation therapy in patients with resectable T3 pancreatic cancer. World J Surg. 2013;37(1):169–78.

    Article  PubMed  Google Scholar 

  48. Hyun SH, Kim HS, Choi SH, Choi DW, Lee JK, Lee KH, et al. Intratumoral heterogeneity of (18)F-FDG uptake predicts survival in patients with pancreatic ductal adenocarcinoma. Eur J Nucl Med Mol Imaging. 2016;43(8):1461–8.

    Article  CAS  PubMed  Google Scholar 

  49. Herrmann K, Erkan M, Dobritz M, Schuster T, Siveke JT, Beer AJ, et al. Comparison of 3′-deoxy-3′-[(1)(8)F]fluorothymidine positron emission tomography (FLT PET) and FDG PET/CT for the detection and characterization of pancreatic tumours. Eur J Nucl Med Mol Imaging. 2012;39(5):846–51.

    Article  CAS  PubMed  Google Scholar 

  50. Wieder H, Beer AJ, Siveke J, Schuster T, Buck AK, Herrmann K, et al. (18)F-fluorothymidine PET for predicting survival in patients with resectable pancreatic cancer. Oncotarget. 2018;9(11):10128–34.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Challapalli A, Barwick T, Pearson RA, Merchant S, Mauri F, Howell EC, et al. 3'-Deoxy-3'-(1)(8)F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer. Eur J Nucl Med Mol Imaging. 2015;42(6):831–40.

    Article  CAS  PubMed  Google Scholar 

  52. Russell J, Pillarsetty N, Kramer RM, Romesser PB, Desai P, Haimovitz-Friedman A, et al. In vitro and in vivo comparison of gemcitabine and the gemcitabine analog 1-(2′-deoxy-2′-fluoroarabinofuranosyl) cytosine (FAC) in human orthotopic and genetically modified mouse pancreatic cancer models. Mol Imaging Biol. 2017;19(6):885–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Segard T, Robins PD, Yusoff IF, Ee H, Morandeau L, Campbell EM, et al. Detection of hypoxia with 18F-fluoromisonidazole (18F-FMISO) PET/CT in suspected or proven pancreatic cancer. Clin Nucl Med. 2013;38(1):1–6.

    Article  PubMed  Google Scholar 

  54. Klaassen R, Bennink RJ, van Tienhoven G, Bijlsma MF, Besselink MG, van Berge Henegouwen MI, et al. Feasibility and repeatability of PET with the hypoxia tracer [(18)F]HX4 in oesophageal and pancreatic cancer. Radiother Oncol. 2015;116(1):94–9.

    Article  PubMed  Google Scholar 

  55. Lewis A, Li D, Williams J, Singh G. Pancreatic neuroendocrine tumors: state-of-the-art diagnosis and management. Oncology (Williston Park). 2017;31(10):e1–e12.

    Google Scholar 

  56. Hope TA, Bergsland EK, Bozkurt MF, Graham M, Heaney AP, Herrmann K, et al. Appropriate use criteria for somatostatin receptor PET imaging in neuroendocrine tumors. J Nucl Med. 2018;59(1):66–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Griffith RW, McDonald E, Emmonds L, Gerhold J, Cohn AL, Liu E. Efficacy and limitations of 68-gallium DOTATATE PET/CT for neuroendocrine tumors: clinical experience following FDA approval. HPB. 2018;20:S91–S2.

    Article  Google Scholar 

  58. Tirosh A, Papadakis GZ, Millo C, Sadowski SM, Herscovitch P, Pacak K, et al. Association between neuroendocrine tumors biomarkers and primary tumor site and disease type based on total (68)Ga-DOTATATE-Avid tumor volume measurements. Eur J Endocrinol. 2017;176(5):575–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Tirosh A, Papadakis GZ, Millo C, Hammoud D, Sadowski SM, Herscovitch P, et al. Prognostic utility of total (68)Ga-DOTATATE-Avid tumor volume in patients with neuroendocrine tumors. Gastroenterology. 2018;154(4):998–1008. e1.

    Article  PubMed  Google Scholar 

  60. Ilhan H, Fendler WP, Cyran CC, Spitzweg C, Auernhammer CJ, Gildehaus FJ, et al. Impact of (68)Ga-DOTATATE PET/CT on the surgical management of primary neuroendocrine tumors of the pancreas or ileum. Ann Surg Oncol. 2015;22(1):164–71.

    Article  PubMed  Google Scholar 

  61. Ezziddin S, Khalaf F, Vanezi M, Haslerud T, Mayer K, Al Zreiqat A, et al. Outcome of peptide receptor radionuclide therapy with 177Lu-octreotate in advanced grade 1/2 pancreatic neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2014;41(5):925–33.

    Article  CAS  PubMed  Google Scholar 

  62. Zandee WT, Brabander T, Blazevic A, Kam BLR, Teunissen JJM, Feelders RA, et al. Symptomatic and radiological response to 177Lu-DOTATATE for the treatment of functioning pancreatic neuroendocrine tumors. J Clin Endocrinol Metab. 2019;104(4):1336–44.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Asha Kandathil & Rathan M. Subramaniam

  2. Dean’s Office, University of Otago Medical School, Dunedin, New Zealand

    Rathan M. Subramaniam

Authors
  1. Asha Kandathil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rathan M. Subramaniam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Asha Kandathil .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Norwalk Hospital, Nuvance Health, Norwalk, CT, USA

    Naveen Anand

  2. Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA

    Peter Darwin

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kandathil, A., Subramaniam, R.M. (2021). PET/CT in Pancreatic Neoplasms. 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_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-69940-6_5

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-69939-0

  • Online ISBN: 978-3-030-69940-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation