Keywords:
Neoplasia, Metastases, Cancer, Diagnostic procedure, Contrast agent-intravenous, MR, CT, Pancreas, Oncology, Abdomen
Authors:
G. Berrada, K. Charef, Z. Abbad El Andaloussi, H. El Mrabet, H. LHAJOUI, S. El Manjra, S. lezar, M. P. F. Essodegui, K. Elkhadir; Casablanca/MA
DOI:
10.26044/ecr2019/C-3680
Conclusion
Pancreatic cancer is a highly lethal malignancy which is increasing in incidence and mortality.
Pancreatic ductal adenocarcinoma,
the most aggressive form,
accounts for 85-95% of all pancreatic malignancies.
The prognosis remains grim,
with a 5-year survival rate of about 5%,
related to advanced stage at diagnosis,
with metastases and growth beyond the confines of the pancreas,
and to early spread along the perineural pathways,
a feature that results in a high early recurrence rate.
Currently,
the only potentially curative therapy for pancreatic carcinoma is complete surgical resection.
However,
this therapy is limited to patients whose tumors can be resected with negative pathologic margins (R0 resection) and do not have metastatic disease.
Unfortunately,
53% of patients have distant metastatic disease at the time of diagnosis and only 15-20% of patients have potentially resectable disease at the time of diagnosis.
Of those patients deemed resectable prior to surgery,
14-30% of these patients are found to be unresectable at the time of surgery.
Patients who undergo incomplete resection with residual microscopic (R1) or macroscopic (R2) disease have similar survival rates to those patients with metastatic disease and should be spared this relatively morbid surgery.
Thus,
the key to optimal management is accurately determining which patients have potentially resectable surgery and which patients would not benefit from surgery.
Detection and accurate staging of pancreatic carcinoma utilizing imaging is essential to providing optimal therapy for patients.
For this,
MDCT is the first-line tool in detecting vascular involvement and distant metastatic that are the most important component of determining the resectability.
MRI is equivalent to MDCT in detection and staging pancreatic cancer but is better at detecting isoattenuating tumors and liver metastases.