Imaging Diagnosis and Staging of Pancreatic Cancer: Which Methods are Essential and What Information Should they Provide?
Megan H. Lee, Elliot K. Fishman
Imaging is critical to the diagnosis and staging of pancreatic cancer. Multiple modalities are available, such as computed tomography (CT), magnetic resonance imaging including magnetic resonance cholangiopancreatography (MRCP), and ultrasound. CT is the preferred modality for pancreatic adenocarcinoma, the most common pancreatic malignancy. Multiphase CT, including arterial and portal venous phases, is critical for the accurate staging of vascular involvement. Pancreatic adenocarcinoma is most commonly a hypoenhancing mass relative to normal pancreatic parenchyma. Identifying vascular involvement is important in staging pancreatic adenocarcinoma. Vascular involvement renders the patient ineligible for primary pancreaticoduodenectomy without neoadjuvant chemotherapy or chemoradiation. CT generally tends to underestimate resectability due to a similar CT appearance of locally invasive pancreatic adenocarcinoma and surrounding fibrosis. Pancreatic lesions, such as mucinous cystic neoplasms, serous cystadenoma, and intraductal papillary mucinous neoplasms, can be evaluated on CT, though MRI often adds additional information via fluid-sensitive sequences and MRCP.