Overview of Imaging Modalities Radiologic evaluation of patients with pancreatic cancer for staging should assess tumor size, extension of tumor beyond the pancreas including adjacent significant vasculature (namely the SMA, celiac artery, common hepatic artery, and splenic artery, hepatic arterial variants, and the main PV, splenic vein, SMV, and whether the tumor is extending to divisions of these veins, which would preclude placement of a graft), presence of regional adenopathy (especially nodes that may be beyond the surgical field and may be suspicious, based on size or morphology), and whether there is metastatic involvement of the liver, peritoneum, and lungs. CT CT At many institutions, contrast-enhanced MDCT is the preferred imaging technique for the staging of pancreatic cancer. It is quick, robust, and especially has superb spatial resolution. It is particularly useful for the assessment of tumor involvement of vascular structures. Imaging should be obtained as a multiphasic acquisition, with a late arterial phase timed to optimize peak enhancement of the pancreas (typically at 45-50 seconds after the start of contrast injection, depending on injection rate) to maximize visualization of the primary tumor, and a portal venous phase for optimum enhancement of venous structures and to maximize detectability of typically hypodense liver metastases (typically 70 seconds after the start of contrast injection) [28]. Many practices employ use of bolus tracking to optimize timing of the arterial and portal venous phase of enhancement. A recent study comparing 64-detector row MDCT and 3T MRI showed overall comparable sensitivities and specificities between the two modalities regarding resectability (CT sensitivity 87%, specificity 63% to 75%; MRI sensitivity 93%, specificity 50% to 75%) [11].
Staging of Pancreatic Ductal Adenocarcinoma. Overview of Imaging Modalities Radiologic evaluation of patients with pancreatic cancer for staging should assess tumor size, extension of tumor beyond the pancreas including adjacent significant vasculature (namely the SMA, celiac artery, common hepatic artery, and splenic artery, hepatic arterial variants, and the main PV, splenic vein, SMV, and whether the tumor is extending to divisions of these veins, which would preclude placement of a graft), presence of regional adenopathy (especially nodes that may be beyond the surgical field and may be suspicious, based on size or morphology), and whether there is metastatic involvement of the liver, peritoneum, and lungs. CT CT At many institutions, contrast-enhanced MDCT is the preferred imaging technique for the staging of pancreatic cancer. It is quick, robust, and especially has superb spatial resolution. It is particularly useful for the assessment of tumor involvement of vascular structures. Imaging should be obtained as a multiphasic acquisition, with a late arterial phase timed to optimize peak enhancement of the pancreas (typically at 45-50 seconds after the start of contrast injection, depending on injection rate) to maximize visualization of the primary tumor, and a portal venous phase for optimum enhancement of venous structures and to maximize detectability of typically hypodense liver metastases (typically 70 seconds after the start of contrast injection) [28]. Many practices employ use of bolus tracking to optimize timing of the arterial and portal venous phase of enhancement. A recent study comparing 64-detector row MDCT and 3T MRI showed overall comparable sensitivities and specificities between the two modalities regarding resectability (CT sensitivity 87%, specificity 63% to 75%; MRI sensitivity 93%, specificity 50% to 75%) [11].