Type:
Educational Exhibit
Keywords:
Metastases, Cancer, Diagnostic procedure, Decision analysis, MR, CT, Pancreas, Oncology, Abdomen
Authors:
T. Tvarijonas1, G. Rudaitytė2, I. Zaboriene1, K. Zviniene1; 1Kaunas/LT, 2Gelgaudiškis/LT
DOI:
10.26044/ecr2019/C-3255
Background
Pancreatic ductal adenocarcinoma (PDAC) is one of the most malignant cancer forms.
It is fourth most common cause of cancer death worldwide,
with a poor overall 5-year survival rate of only 4 %,
reasonably earning the name “silent killer”.
The treatment depends upon tumour resectability at presentation,
therefore,
radiological imaging is crucial in the management of the disease [2-3].
Currently,
multi-detector computed tomography (MDCT) is the most commonly used,
best-validated imaging modality for the diagnosis and staging of pancreatic cancer.
Modern contrast-enhanced magnetic resonance imaging (MRI) has been demonstrated to be equivalent to MDCT in detection and staging of pancreatic cancer.
Preoperative imaging is important to define patients as having resectable disease,
borderline resectable disease,
locally advanced disease (unresectable) and metastatic disease (unresectable).
It is important to assess and describe the factors relevant to staging,
such as: local extent of tumor,
vascular involvement,
lymph node involvement and distant metastases.
To facilitate this,
standardized reporting templates for PDAC have been created [1].
These templates provide superior evaluation of pancreatic cancer,
facilitate surgical planning,
increase surgeons confidence about tumor resectability.
The estimated sensitivity of MDCT for the detection of pancreatic adenocarcinoma,
reported in the literature,
is around 90-97% ,
whereas sensitivity for detecting small lesions (≤1.5cm in size) is only around 67% [4-5].
The typical appearance of PDAC on MDCT is an ill-defined hypodense mass,
compared to surrounding parenchymal tissue.
However,
11-27% of PDAC are isodense to surrounding pancreatic parenchyma and are occult on CT images,
particularly small ones [1].
In these cases,
secondary signs of pancreatic lesion,
such as abrupt cutoff of the main pancreatic duct (MPD) with upstream dilation,
mass effect,
and pancreatic contour irregularity may be present [6].
Approximately 10% of PDAC’s do not appear as focal masses,
but as diffuse gland enlargement [7].
In such cases there is a doubt whether only CT is enough? Or the disease is really only locally advanced and finally is it possible that incidentally found “just” the cystic lesion could hide something more.