Type:
Educational Exhibit
Keywords:
Neoplasia, Diagnostic procedure, MR, CT, Pancreas, Oncology, Abdomen
Authors:
J. Saenz Banuelos, P. Lopez Sala, N. Alberdi, I. Fuertes Fernandez, C. Malafarina, C. Sainz Gomez; PAMPLONA/ES
DOI:
10.26044/ecr2019/C-1372
Background
Pancreatic carcinoma is the second most frequent digestive tumour [1-4].
Pancreatic ductal adenocarcinoma (PDAC),
originated from the exocrine pancreas,
is the most frequent histological type of pancreatic carcinoma and represents 95% of these neoplasms [5,6].
It is the fourth cause of oncologic death in developed countries [6,7].
At the time of the diagnosis,
40-50% of the cases have metastases,
and about 40% of the patients suffer from a locally advanced disease,
in which surgery is not indicated [8].
Nowadays,
complete surgical resection is the only potentially curative treatment of these tumours.
However,
only initial stages benefit from surgery,
which means only 10-20% of the patients [8-10].
Including all stages of the disease,
the average survival at 5 years is 5-6% [11].
In patients with clinical suspicion of pancreatic neoplasia (jaundice,
weight loss,
abdominal pain...) and/or dilatation of the main pancreatic duct and/or biliary duct,
it is important to perform an initial imaging study specifically focused on the pancreatic evaluation [12].
The period of time between diagnostic,
staging CT and surgical intervention has to be as short as possible if the tumour is resectable (available literature suggests less than 25 days) [13].
In case of the finding in multidetector computerized tomography (MDCT) of a pancreatic lesion with typical signs of neoplasia and clear resectability criteria,
surgery is recommended without the need for pathological confirmation to avoid therapeutic delays.
Although the technique of choice is the MDCT,
it is worth highlighting the role in this field of MRI,
which has shown similar sensitivity and specificity in the staging of PDAC [3,14] and may even be superior in the detection of small liver and peritoneal metastases [15].
In addition,
MRI helps in the differential diagnosis of PDAC with other pancreatic lesions.