Studies that have recently examined the role of FDG-PET/CT in the staging of pancreatic cancer have focused on its supplementary ability to detect additional distant metastases beyond those detected by conventional cross-sectional imaging of the abdomen and pelvis or chest, abdomen, and pelvis given the advantage that FDG-PET/CT is a whole-body examination [31]. Nodal staging is a limitation for any of the imaging modalities because of its relative insensitivity to micrometastases detection. Another challenge is the varying imaging criteria for identifying potential nodal involvement between studies. A recent study that used, as criterion for nodal involvement, a nodal short axis diameter of >5 mm or morphologic features of necrosis showed an accuracy of 55% to 60% for the detection of nodal metastatic disease, which is similar to findings seen on older studies regardless of criteria (44%-68%) [29,32,34,35]. Little information is available regarding sensitivity for detecting liver metastases originating from pancreatic cancer for the current generation of MDCT scanners (64-detector row or better). Two studies that have compared 64-detector row MDCT with 3T MRI showed for CT a sensitivity of 70% to 76% in the detection of liver metastases compared to 90% to 100% for MRI with either gadobenate dimeglumine or gadoxetic acid [33,36]. Ikuta et al [37] studied 192 patients to compare 4-detector row multiphasic MDCT with CT arterial portography (CTAP) and computed tomography-assisted hepatic arteriography (CTHA) with intraoperative US as the gold standard in the assessment of those patients identified as not having metastatic disease. Of note, CTAP with CTHA is an invasive technique requiring a separate interventional procedure for placement of an arterial catheter to optimize contrast evaluation by CT, and as such is not practiced routinely. Furthermore, MDCT was performed with only four detectors, which is far less than many contemporary scanners.
Staging of Pancreatic Ductal Adenocarcinoma. Studies that have recently examined the role of FDG-PET/CT in the staging of pancreatic cancer have focused on its supplementary ability to detect additional distant metastases beyond those detected by conventional cross-sectional imaging of the abdomen and pelvis or chest, abdomen, and pelvis given the advantage that FDG-PET/CT is a whole-body examination [31]. Nodal staging is a limitation for any of the imaging modalities because of its relative insensitivity to micrometastases detection. Another challenge is the varying imaging criteria for identifying potential nodal involvement between studies. A recent study that used, as criterion for nodal involvement, a nodal short axis diameter of >5 mm or morphologic features of necrosis showed an accuracy of 55% to 60% for the detection of nodal metastatic disease, which is similar to findings seen on older studies regardless of criteria (44%-68%) [29,32,34,35]. Little information is available regarding sensitivity for detecting liver metastases originating from pancreatic cancer for the current generation of MDCT scanners (64-detector row or better). Two studies that have compared 64-detector row MDCT with 3T MRI showed for CT a sensitivity of 70% to 76% in the detection of liver metastases compared to 90% to 100% for MRI with either gadobenate dimeglumine or gadoxetic acid [33,36]. Ikuta et al [37] studied 192 patients to compare 4-detector row multiphasic MDCT with CT arterial portography (CTAP) and computed tomography-assisted hepatic arteriography (CTHA) with intraoperative US as the gold standard in the assessment of those patients identified as not having metastatic disease. Of note, CTAP with CTHA is an invasive technique requiring a separate interventional procedure for placement of an arterial catheter to optimize contrast evaluation by CT, and as such is not practiced routinely. Furthermore, MDCT was performed with only four detectors, which is far less than many contemporary scanners.