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Pancreatic Adenocarcinoma and Other Pancreatic Malignancies

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Functional Imaging in Oncology

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Abstract

Pancreatic adenocarcinoma is a highly lethal disease, mainly due to late diagnosis. Imaging is essential to correctly stage pancreatic adenocarcinoma and define resectable tumors. CT and MRI are more commonly used to detect, characterize, and stage pancreatic carcinoma based on morphological features and enhancement patterns. With the advent of new molecular targeted therapies, there is a growing interest in the imaging assessment of early response to therapy. Therefore, there is growing interest in exploring the capabilities of new functional imaging techniques in the assessment of pancreatic cancer. In this manner, 18FDG PET-CT has been mainly used for initial M-staging, treatment planning with radiation therapy, and the early evaluation of treatment response to chemotherapy and radiotherapy. Diffusion-weighted imaging has shown high sensitivity and specificity for pancreatic cancer detection. Moreover, diffusion-weighted imaging is also able to accurately differentiate pancreatic carcinoma from benign lesions and has been proposed for prediction of treatment response. Pancreatic carcinoma shows high permeability and reduced blood flow in DCE-MRI, CT perfusion, and CEUS. Vascular characteristics of pancreatic carcinoma studies by these imaging techniques may have a role in characterization of pancreatic lesion, therapy monitoring, and prediction of response to treatment. In addition, functional imaging techniques have also been used to differentiate nonneoplastic cystic lesions from neoplastic cysts and in the case of neuroendocrine tumors for detection, characterization, distant staging, recurrence depiction after treatment, and treatment selection for possible radionuclide-based treatment.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC60 :

Initial area under the concentration curve in 60

CEUS:

Contrast-enhanced ultrasound

C peak :

Peak tissue gadolinium concentration

CT:

Computed tomography

D:

Tissue diffusivity

DCE-MRI:

Dynamic contrast-enhanced-MRI

DOTANOC:

68Ga-DOTA-NaI-octreotide

DWI:

Diffusion-weighted imaging

ERCP:

Endoscopic retrograde cholangiopancreatography

EUS:

Endoscopic ultrasound

f :

Perfusion fraction

18FDG:

18-Fluorodeoxyglucose

IPMNs:

Intraductal papillary mucinous neoplasms

IVIM:

Intravoxel incoherent motion

K trans :

Volume transfer coefficient

Kep:

Rate constant

MCNs:

Mucinous cystic neoplasms

MRI:

Magnetic resonance imaging

M-staging:

Metastatic staging

NEC:

Neuroendocrine carcinoma

NETs:

Neuroendocrine tumors

N-staging:

Nodal staging

OctreoScan:

111In-labelled octreotide

PET:

Positron emission tomography

RCC:

Renal cell carcinoma

SMI:

Somatostatin receptor imaging

SUVmax :

Maximum standardized uptake value

THRIVE:

T1-weighted high-resolution isotropic volume excitation

TIC:

Time-intensity curve

T-staging:

Local staging

US:

Ultrasound

v e :

Volume of distribution

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Authors and Affiliations

  1. Health Time Group, Jaén, Spain

    Antonio Luna MD (Chief of MRI)

  2. Department of Radiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA

    Antonio Luna MD (Chief of MRI)

  3. Body Section, Clinica Las Nieves, SERCOSA, Health Time Group, Jaén, Spain

    Lidia Alcalá-Mata MD

  4. Body Section, Centro de Diagnóstico Enrique Rossi, Buenos Aires, Argentina

    Mariano Volpacchio

  5. MRI Section, Clínica Las Nieves, SERCOSA, Health Time Group, Jaén, Spain

    José Pablo Martínez- Barbero MD

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  1. Antonio Luna MD
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  2. Lidia Alcalá-Mata MD
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  3. Mariano Volpacchio
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  4. José Pablo Martínez- Barbero MD
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Correspondence to Antonio Luna MD .

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Editors and Affiliations

  1. Health Time Group, Jaén, Spain

    Antonio Luna

  2. Clinica Girona Hospital Sta. Caterina, Gerona, Spain

    Joan C. Vilanova

  3. CDPI and IRM, Botafongo - Rio de Janeiro/RJ, Brazil

    L. Celso Hygino Da Cruz Jr.

  4. Centro de Diagnóstico Dr. Enrique Rossi, Buenos Aires, Argentina

    Santiago E. Rossi

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Luna, A., Alcalá-Mata, L., Volpacchio, M., Barbero, J.P.M. (2014). Pancreatic Adenocarcinoma and Other Pancreatic Malignancies. In: Luna, A., Vilanova, J., Hygino Da Cruz Jr., L., Rossi, S. (eds) Functional Imaging in Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40582-2_21

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