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Diagnosis and Staging of Pancreatic Cancer: Imaging Evaluations—Pancreatic Protocol CT and MRI, PET-CT

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Pancreatic Cancer: A Multidisciplinary Approach

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a lethal cancer and fourth leading cause of cancer mortality in the USA (Siegel et al., CA Cancer J Clin 70:7–30, 2020). Early diagnosis, accurate staging, and appropriate treatment are essential in management of patients with pancreatic cancer, which require a multidisciplinary approach. Imaging is crucial in detection and staging of pancreatic cancer. We will review the role and value of different imaging modalities in diagnosis, staging, and follow-up of pancreatic cancer.

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References

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

    PubMed  CAS  Google Scholar 

  2. Beer L, et al. Objective and subjective comparison of virtual monoenergetic vs. polychromatic images in patients with pancreatic ductal adenocarcinoma. Eur Radiol. 2019;29(7):3617–25.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bhosale P, et al. Quantitative and qualitative comparison of single-source dual-energy computed tomography and 120-kVp computed tomography for the assessment of pancreatic ductal adenocarcinoma. J Comput Assist Tomogr. 2015;39(6):907–13.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zamboni GA, et al. Single-energy low-voltage arterial phase MDCT scanning increases conspicuity of adenocarcinoma of the pancreas. Eur J Radiol. 2014;83(3):e113–7.

    Article  PubMed  Google Scholar 

  5. Macari M, 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.

    Article  PubMed  Google Scholar 

  6. Fletcher JG, et al. Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology. 2003;229(1):81–90.

    Article  PubMed  Google Scholar 

  7. Agarwal B, et al. Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol. 2004;99(5):844–50.

    Article  PubMed  Google Scholar 

  8. DeWitt J, et al. EUS-guided FNA of pancreatic metastases: a multicenter experience.[see comment]. Gastrointest Endosc. 2005;61(6):689–96.

    Article  PubMed  Google Scholar 

  9. Bronstein YL, et al. Detection of small pancreatic tumors with multiphasic helical CT. AJR Am J Roentgenol. 2004;182(3):619–23.

    Article  PubMed  Google Scholar 

  10. Prokesch RW, et al. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology. 2002;224(3):764–8.

    Article  PubMed  Google Scholar 

  11. Gangi S, et al. Time interval between abnormalities seen on CT and the clinical diagnosis of pancreatic cancer: retrospective review of CT scans obtained before diagnosis. AJR Am J Roentgenol. 2004;182(4):897–903.

    Article  PubMed  Google Scholar 

  12. Tajima Y, et al. Pancreatic carcinoma coexisting with chronic pancreatitis versus tumor-forming pancreatitis: diagnostic utility of the time-signal intensity curve from dynamic contrast-enhanced MR imaging. World J Gastroenterol. 2007;13(6):858–65.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kim T, et al. Pancreatic mass due to chronic pancreatitis: correlation of CT and MR imaging features with pathologic findings. AJR Am J Roentgenol. 2001;177(2):367–71.

    Article  PubMed  CAS  Google Scholar 

  14. Conwell DL, et al. American pancreatic association practice guidelines in chronic pancreatitis: evidence-based report on diagnostic guidelines. Pancreas. 2014;43(8):1143–62.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yadav AK, et al. Perfusion CT: can it predict the development of pancreatic necrosis in early stage of severe acute pancreatitis? Abdom Imaging. 2015;40(3):488–99.

    Article  PubMed  Google Scholar 

  16. Malka D, et al. Risk of pancreatic adenocarcinoma in chronic pancreatitis. Gut. 2002;51(6):849–52.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Perez-Johnston R, Sainani NI, Sahani DV. Imaging of chronic pancreatitis (including groove and autoimmune pancreatitis). Radiol Clin N Am. 2012;50(3):447–66.

    Article  PubMed  Google Scholar 

  18. Worhunsky DJ, et al. Pancreatic neuroendocrine tumours: hypoenhancement on arterial phase computed tomography predicts biological aggressiveness. HPB (Oxford). 2014;16(4):304–11.

    Article  Google Scholar 

  19. Merkle EM, Bender GN, Brambs HJ. Imaging findings in pancreatic lymphoma: differential aspects. AJR Am J Roentgenol. 2000;174(3):671–5.

    Article  PubMed  CAS  Google Scholar 

  20. Allen PJ, 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 

  21. Saka B, et al. Pancreatic ductal adenocarcinoma is spread to the peripancreatic soft tissue in the majority of resected cases, rendering the AJCC T-stage protocol (7th edition) inapplicable and insignificant: a size-based staging system (pT1: </=2, pT2: >2-</=4, pT3: >4 cm) is more valid and clinically relevant. Ann Surg Oncol. 2016;23(6):2010–8.

    Article  PubMed  PubMed Central  Google Scholar 

  22. van Roessel S, et al. International validation of the eighth edition of the American joint committee on cancer (AJCC) TNM staging system in patients with resected pancreatic cancer. JAMA Surg. 2018;153(12):e183617.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Varadhachary GR, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13(8):1035–46.

    Article  PubMed  Google Scholar 

  24. Lu DS, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol. 1997;168(6):1439–43.

    Article  PubMed  CAS  Google Scholar 

  25. Wong JC, Lu DS. Staging of pancreatic adenocarcinoma by imaging studies. Clin Gastroenterol Hepatol. 2008;6(12):1301–8.

    Article  PubMed  Google Scholar 

  26. Al-Hawary MM, et al. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association. Gastroenterology. 2014;146(1):291–304.e1.

    Article  PubMed  Google Scholar 

  27. Katz MH, et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer. 2012;118(23):5749–56.

    Article  PubMed  Google Scholar 

  28. Boellaard R, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42(2):328–54.

    Article  PubMed  CAS  Google Scholar 

  29. Kim R, et al. PET/CT fusion scan prevents futile laparotomy in early stage pancreatic cancer. Clin Nucl Med. 2015;40(11):e501–5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ruan Z, et al. Multi-modality imaging features distinguish pancreatic carcinoma from mass-forming chronic pancreatitis of the pancreatic head. Oncol Lett. 2018;15(6):9735–44.

    PubMed  PubMed Central  Google Scholar 

  31. Toft J, et al. Imaging modalities in the diagnosis of pancreatic adenocarcinoma: a systematic review and meta-analysis of sensitivity, specificity and diagnostic accuracy. Eur J Radiol. 2017;92:17–23.

    Article  PubMed  Google Scholar 

  32. Kauhanen SP, 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 

  33. Yeh R, et al. The role of 18F-FDG PET/CT and PET/MRI in pancreatic ductal adenocarcinoma. Abdom Radiol (NY). 2018;43(2):415–34.

    Article  Google Scholar 

  34. Wang Z, et al. 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 

  35. Crippa S, et al. The role of (18)fluoro-deoxyglucose positron emission tomography/computed tomography in resectable pancreatic cancer. Dig Liver Dis. 2014;46(8):744–9.

    Article  PubMed  Google Scholar 

  36. Wang S, et al. The value of (18)F-FDG PET/CT and carbohydrate antigen 19-9 in predicting lymph node micrometastases of pancreatic cancer. Abdom Radiol (NY). 2019;44(12):4057–62.

    Article  Google Scholar 

  37. Zhu D, 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. Rayamajhi S, et al. Utility of (18) F-FDG PET/CT and CECT in conjunction with serum CA 19-9 for detecting recurrent pancreatic adenocarcinoma. Abdom Radiol (NY). 2018;43(2):505–13.

    Article  Google Scholar 

  39. Ly JN, Miller FH. MR imaging of the pancreas: a practical approach. Radiol Clin N Am. 2002;40(6):1289–306.

    Article  PubMed  Google Scholar 

  40. Miller FH, Rini NJ, Keppke AL. MRI of adenocarcinoma of the pancreas. AJR Am J Roentgenol. 2006;187(4):W365–74.

    Article  PubMed  Google Scholar 

  41. Obuz F, et al. Pancreatic adenocarcinoma: detection and staging with dynamic MR imaging. Eur J Radiol. 2001;38(2):146–50.

    Article  PubMed  CAS  Google Scholar 

  42. Manfredi R, et al. Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulation. Radiology. 2000;214(3):849–55.

    Article  PubMed  CAS  Google Scholar 

  43. Balthazar EJ. Pancreatitis associated with pancreatic carcinoma. Preoperative diagnosis: role of CT imaging in detection and evaluation. Pancreatology. 2005;5(4–5):330–44.

    Article  PubMed  CAS  Google Scholar 

  44. Jenkins JP, et al. Quantitative tissue characterisation in pancreatic disease using magnetic resonance imaging. Br J Radiol. 1987;60(712):333–41.

    Article  PubMed  CAS  Google Scholar 

  45. Ichikawa T, et al. Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology. 2001;221(1):107–16.

    Article  PubMed  CAS  Google Scholar 

  46. Siddiqi AJ, Miller F. Chronic pancreatitis: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR. 2007;28(5):384–94.

    Article  PubMed  Google Scholar 

  47. Lopez Hanninen E, et al. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography. Radiology. 2002;224(1):34–41.

    Article  PubMed  Google Scholar 

  48. Fayad LM, Mitchell DG. Magnetic resonance imaging of pancreatic adenocarcinoma. Int J Gastrointest Cancer. 2001;30(1–2):19–25.

    Article  PubMed  CAS  Google Scholar 

  49. Adamek HE, et al. Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study. Lancet. 2000;356(9225):190–3.

    Article  PubMed  CAS  Google Scholar 

  50. Matsuki M, et al. Diffusion-weighed MR imaging of pancreatic carcinoma. Abdom Imaging. 2007;32(4):481–3.

    Article  PubMed  CAS  Google Scholar 

  51. Kim JK, et al. Focal pancreatic mass: distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo MRI. J Magn Reson Imaging. 2007;26(2):313–22.

    Article  PubMed  Google Scholar 

  52. Schima W, et al. Pancreatic adenocarcinoma. Eur Radiol. 2007;17(3):638–49.

    Article  PubMed  Google Scholar 

  53. Danet IM, et al. Liver metastases from pancreatic adenocarcinoma: MR imaging characteristics. J Magn Reson Imaging. 2003;18(2):181–8.

    Article  PubMed  Google Scholar 

  54. Pamuklar E, Semelka RC. MR imaging of the pancreas. Magn Reson Imaging Clin N Am. 2005;13(2):313–30.

    Article  PubMed  Google Scholar 

  55. Horvat N, et al. Subclinical focal cholangitis mimicking liver metastasis in asymptomatic patients with history of pancreatic ductal adenocarcinoma and biliary tree intervention. Cancer Imaging. 2017;17(1):21.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Scialpi M, et al. Imaging evaluation of post pancreatic surgery. Eur J Radiol. 2005;53(3):417–24.

    Article  PubMed  Google Scholar 

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Correspondence to Sanaz Javadi .

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Javadi, S., Wong, V., Ibarra Rovira, J.J., Bhosale, P., Tamm, E. (2022). Diagnosis and Staging of Pancreatic Cancer: Imaging Evaluations—Pancreatic Protocol CT and MRI, PET-CT. In: Bhutani, M.S., Katz, M.H., Maitra, A., Herman, J.M., Wolff, R.A. (eds) Pancreatic Cancer: A Multidisciplinary Approach. Springer, Cham. https://doi.org/10.1007/978-3-031-05724-3_5

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  • DOI: https://doi.org/10.1007/978-3-031-05724-3_5

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