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Gastrointestinal ❯ Pancreas Mass

ProblemEvaluate pancreas for suspected pancreatic adenocarcinoma

The protocol for the detection of a suspected pancreas adenocarcinoma requires strict attention to protocol design. If not there is a good chance of missing a carcinoma when it is detectable. $0% of lesions under 2cm are routinely missed on CT. 

  1. Neutral oral contrast  (750-1000cc) is mandatory for good distension of the stomach and duodenum
  2. Dual phase acquisitions (arterial at 30 sec and venous at 70 sec) are mandatory for pancreas lesion detection and classification. Non contrast CT scans or delayed phase imaging (4-6 minutes post injection) are typically of no added value.
  3. Liver lesion detection is best seen on venous phase imaging but arterial phase may be helpful with lesion detection (perfusion changes) and classification (metastasis vs. hemangioma vs cyst)
  4. Arterial phase imaging is critical for arterial mapping especially of the celiac, SMA, hepatic artery and splenic artery
  5. Venous phase imaging is critical for venous mapping especially of the portal vein,  SMV and splenic vein
  6. Images must be analyzed with axial, MPR (coronal and sagittal) and 3D mapping (VRT, MIP, CR). More detail to follow on the specific of 3D imaging in pancreatic cancer

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