Imaging of Pancreatic Adenocarcinoma

  • Haydee Ojeda-Fournier
  • K. Ann Choe
Part of the M. D. Anderson Solid Tumor Oncology Series book series (MDA)

Imaging plays a crucial role in the diagnosis, staging, and follow-up of pancreatic adenocarcinoma. In addition to identifying the primary tumor, the goals of imaging in pancreatic cancer include assessment of local and regional invasion, evaluation of lymph nodes and vascular structures, and evaluation for possible metastatic disease. Furthermore, imaging assessment identifies those patients who are candidates for resection—the only known therapy associated with longterm survival—and spares others from unnecessary surgical intervention. There is no indication for plain film evaluation and limited value in using ultrasonography (US) in the evaluation of pancreatic cancer. Because of its invasive nature, angiography has fallen out of favor in the evaluation of pancreatic adenocarcinoma. Cross-sectional imaging, including computed tomography (CT) and MRI, however, meet the stated goals in the assessment of pancreatic cancer. Magnetic resonance cholangiopancreatography (MRCP) can also add valuable information in specific cases. Other important modalities that utilize imaging include EUS, endoscopic retrograde pancreatography (ERCP), and PET are discussed elsewhere in this text.


Pancreatic Cancer Chronic Pancreatitis Pancreatic Duct Superior Mesenteric Artery Pancreatic Adenocarcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Taylor AM, Roberts SA, Manson JM. 2001, Experience with laparoscopic ultrasonography for defining tumour resectability in carcinoma of the pancreatic head and periampullary region. Brit J of Surg 88(8):1077–1083CrossRefGoogle Scholar
  2. 2.
    Long EE et al. 2005, Computed tomography, endoscopic, laparoscopic, and intra-operative sonography for assessing resectability of pancreatic cancer. Surg Onc 14(2):105–113CrossRefGoogle Scholar
  3. 3.
    Oshikawa O et al. 2002, Dynamic sonography of pancreatic tumors: comparison with dynamic CT. AJR. Am J of Roentgenology 178 (5):1133–1137Google Scholar
  4. 4.
    Bipat S et al. 2005, Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis. J of Comp Asst Tomog 29(4):438–445CrossRefGoogle Scholar
  5. 5.
    Kaneko T et al. 2002, Power Doppler ultrasonography for the assessment of vascular invasion by pancreatic cancer. Pancreatology: Off J of the Intl Assoc of Pancreatology(IAP) 2(1):61–68Google Scholar
  6. 6.
    Clarke DL et al. 2003, Preoperative imaging of pancreatic cancer: a management-oriented approach. J of the Am Coll of Surg 196(1):119–129.CrossRefGoogle Scholar
  7. 7.
    Katz MH et al. 2005, An evidence-based approach to the diagnosis and staging of pancreatic cancer. Pancreatology: Off J of the Intl Assoc of Pancreatology (IAP) 5(6):576–590Google Scholar
  8. 8.
    Soriano A et al. 2004, Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomo-graphy, magnetic resonance imaging, and angiography. Am J of Gastroenterology 99 (3):492–501CrossRefGoogle Scholar
  9. 9.
    Tamm E, Charnsangavej C, Szklaruk J 2001, Advanced 3-D imaging for the evaluation of pancreatic cancer with multidetector CT. Intl J of Gastro Cancer 30(1-2):65–71.CrossRefGoogle Scholar
  10. 10.
    Prokesch RW et al. 2002, Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience. Radiology 225(3):759–765.CrossRefPubMedGoogle Scholar
  11. 11.
    Smith SL, Rajan PS 2004, Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT. Clin Radiol 59(1):26–38CrossRefPubMedGoogle Scholar
  12. 12.
    Imbriaco M et al. 2002, Dual-phase versus single-phase helical CT to detect and assess resectability of pancreatic carcinoma. Am J of Roentgenology (AJR) 178(6):1473–1479Google Scholar
  13. 13.
    Fletcher JG et al. 2003, Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology 229(1):81–90CrossRefPubMedGoogle Scholar
  14. 14.
    Valls C et al. 2002, Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery Am J of Roentgenology (AJR) 178: p. (4) 821 – 6.Google Scholar
  15. 15.
    Bronstein YL et al. 2004, Detection of small pancreatic tumors with multiphasic helical CT. AJR. Am J of Roentgenology (AJR) 182(3):619–623Google Scholar
  16. 16.
    Imbriaco M et al. 2005, Value of the single-phase technique in MDCT assessment of pancreatic tumors. Am J of Roentgenology (AJR) 184(4):1111–1117Google Scholar
  17. 17.
    Balci NC, Semelka RC 2001, Radiologic diagnosis and staging of pancreatic ductal adenocarcinoma. Euro J of Radiol 38(2):105–112CrossRefGoogle Scholar
  18. 18.
    Tamm E, Charnsangavej C 2001, Pancreatic cancer: current concepts in imaging for diagnosis and staging. Cancer J 7(4):298–311PubMedGoogle Scholar
  19. 19.
    Leung T-K et al. 2005, Difficulty with diagnosis of malignant pancreatic neoplasms coexisting with chronic pancreatitis. World J of Gastroent (WJG) 11(32):5075–5078Google Scholar
  20. 20.
    O’Malley ME et al. 1999, Adenocarcinoma of the head of the pancreas: Determination of surgical unresectability with thin-section pancreatic-phase helical CT. Am J of Roentgenology (AJR) 173:1513–1518Google Scholar
  21. 21.
    Obuz F et al. 2001, Pancreatic adenocarcinoma: detection and staging with dynamic MR imaging. Eur J of Radiol 38(2):146–150CrossRefGoogle Scholar
  22. 22.
    Lu DSK et al. 1997, Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. Am J of Roentgenology (AJR) 168:1439–1443Google Scholar
  23. 23.
    Exocrine pancreas. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual, 6th ed. New York, NY: Springer, 2002:157–164Google Scholar
  24. 24.
    Zeman RK et al. 1997, TNM Staging of Pancreatic Carcinoma Using Helical CT. Am J of Roentgenology (AJR) 169:459–464Google Scholar
  25. 25.
    Fayad LM, Mitchell DG 2001, Magnetic resonance imaging of pancreatic adenocarcinoma. Int J of Gastroint Cancer 30(1-2):19–25CrossRefGoogle Scholar
  26. 26.
    Lopez Hanninen E et al. 2002, Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography. Radiology 224 (1): 34–41CrossRefPubMedGoogle Scholar
  27. 27.
    Ramsay D et al. 2004, I dentification and staging of pancreatic tumours using computed tomography, endoscopic ultrasound and mangafodipir trisodium-enhanced magnetic resonance imaging. Australasian Radiol 48(2):154–161CrossRefGoogle Scholar
  28. 28.
    Schima W et al. 2002, Diagnosis and staging of pancreatic cancer: comparison of mangafodipir trisodium-enhanced MR imaging and contrast-enhanced helical hydro-CT. Am J of Roentgenology (AJR) 179(3):717–24Google Scholar
  29. 29.
    Fischer U et al. 2002, Preoperative local MRI-staging of patients with a suspected pancreatic mass. Euro Radiol 12(2):296–303CrossRefGoogle Scholar
  30. 30.
    Ichikawa T et al. 2001, Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 221(1):107–116CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Haydee Ojeda-Fournier
    • 1
  • K. Ann Choe
    • 2
  1. 1.San Diego and Moores Cancer CenterUniversity of CaliforniaLa JollaUSA
  2. 2.University of Cincinnati College of MedicineCincinnatiUSA

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