This pictorial shows in a schematic way the most important CT,
MRI and EUS findings in the local staging of cephalic pancreatic adenocarcinoma.
Analyzing resecability criteria,
we focused on the involvement of the retroportal lamina (retroportal fat tissue).
Pancreatic ductal adenocarcinoma is the most frequent type of pancreatic cancer.
It has a very poor prognosis,
which is mainly due to a late clinical presentation and the limited effects of chemotherapy.
Surgical resection still remains the only potentially curative treatment.
80% of patients present with an advanced,
unresectable disease .
CT is the gold standard for staging patients with pancreatic adenocarcinoma allowing a correct assessment of the neoplastic mass,
the vascular involvement,
the margin involvement and therefore the resectability criteria .
Findings and procedure details
Because of the poor prognosis,
pancreatic adenocarcinoma has been described and studied since years.
A detailed imaging schema for the TNM-classification has been modified,
adapted and finally proposed in order to achieve better standardization in the therapeutic approach.
The diagnostic CT-parameters of resectability are well known and in common use of radiologists,
who describe the tumor.
Parameters of evaluation of resectability at CT.
Tissue obliteration: gross macro infiltration.
Alteration of the tissue density (ROI in the region of interest): spread,
In this pictorial we did not focus on the different therapy options like neoadjuvant chemotherapy regimes or new surgery possibilities.
The focus lied on the diagnostic imaging criteria of the cephalic ductal pancreatic adenocarcinoma,
especially the evaluation of the retroportal fat tissue.
Our purpose is to familiarize radiologists with other potential pathways of perineural,
extrapancreatic and peripancreatic fat tissue invasion,
which is an important criteria for resectability but also a prognostic factor for recurrence of the disease.
P and Lowenfels,
AB: "Epidemiology of pancreatic cancer: an overview." Nature reviews.
Gastroenterology & hepatology,
et al.: "Pancreatic cancer." Lancet,
IR and Anderson,
MA: "Pancreatic Solid and Cystic Neoplasms: Diagnostic Evaluation and Intervention." Radiologic clinics of North America,
et al.: "Selection criteria in resectable pancreatic cancer: a biological and morphological approach." World journal of gastroenterology,