1. To learn about diagnostic imaging findings of solid pancreatic neoplasms.
2. To understand treatment planning.
3. To appreciate differential diagnosis of solid pancreatic neoplasms.
CT remains the standard of reference technique for diagnosis and staging of pancreatic ductal adenocarcinoma (PDA). Most PDA appear as a hypodense mass at pancreatic or portal phase CT with associated dilatation of the bile ducts and/or the pancreatic ducts. Pancreatic MRI is a solving tool that helps in the diagnosis of the isodense lesion at CT and in the assessment of liver metastases. Differential diagnosis of Solid pancreatic tumours includes a Neuroendocrine tumour (NET) of the pancreas. Typical Pancreatic NETs appear as hypervascularized tumours in the arterial phase using CT or MR.
1. To learn how to stage pancreatic adenocarcinoma.
2. To understand resectability criteria.
3. To appreciate the role of imaging in treatment planning.
Pancreatic cancer is a disease with a very dismal prognosis. The 5-year survival is around 5% and has been stable over the last decades. The only potentially curative treatment is surgical resection combined with adjuvant and/or neoadjuvant therapy. However, at diagnosis, less than 20% of patients have a resectable tumour, while the rest have tumours that are locally advanced and/or have distant metastases. In order to improve survival, there is a need to increase the number of patients that undergo surgery. However, for the surgical removal to be meaningful, the goal is to achieve complete macroscopic and microscopic removal of a tumour (R0-resection). For the identification of patients who will benefit from surgery, the so-called “resectability status” was developed. It is based on the presence and extent of tumour contact with the major peripancreatic vessels such as portomesenteric axis (PV/SMV), hepatic artery, celiac artery and superior mesenteric artery. Depending on the presence and degree of the circumferential tumour-vessel contact the tumours are classified in one of the three categories: resectable, borderline resectable and unresectable. The criteria of the various existing classification systems will be discussed and their differences outlined. Furthermore, potential areas of improvement will be analysed and, finally, the role of CT, MRI and PET-CT in the evaluation of these patients will be presented.