Standardization of EUS imaging and reporting in high-risk individuals of pancreatic adenocarcinoma: consensus statement of the Pancreatic Cancer Early Detection Consortium.
Gastrointestinal endoscopy
BACKGROUND AND AIMS:Pancreatic ductal adenocarcinoma is an aggressive disease most often diagnosed after local progression or metastatic dissemination, precluding resection and resulting in a high mortality rate. For individuals with elevated personal risk of the development of pancreatic cancer, EUS is a frequently used advanced imaging and diagnostic modality. However, variability in the expertise and definition of EUS findings exists among gastroenterologists, as well as a lack of standardized reporting of relevant findings at the time of examination. Adoption of standardized EUS reporting, using a universally accepted and agreed on terminology, is needed. METHODS:A consensus statement designed to create a standardized reporting template was authored by a multidisciplinary group of experts in pancreatic diseases that includes gastroenterologists, radiologists, surgeons, oncologists, and geneticists. This statement was developed using a modified Delphi process as part of the Pancreatic Cancer Early Detection Consortium, and >75% agreement was required to reach consensus. RESULTS:We identified reporting elements and present standardized reporting templates for EUS indications, procedural data, EUS image capture, and descriptors of findings, tissue sampling, and postprocedural assessment of adequacy. CONCLUSIONS:Adoption of this standardized EUS reporting template should improve consistency in clinical decision-making for individuals with elevated risk of pancreatic cancer by providing complete and accurate reporting of pancreatic abnormalities. Standardization will also help to facilitate research and clinical trial design by using clearly defined and consistent imaging descriptions, thus allowing for comparison of results across different centers.
10.1016/j.gie.2021.10.025
The Role of Imaging in Current Treatment Strategies for Pancreatic Adenocarcinoma.
Rhee Hyungjin,Park Mi Suk
Korean journal of radiology
In pancreatic cancer, imaging plays an essential role in surveillance, diagnosis, resectability evaluation, and treatment response evaluation. Pancreatic cancer surveillance in high-risk individuals has been attempted using endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI). Imaging diagnosis and resectability evaluation are the most important factors influencing treatment decisions, where computed tomography (CT) is the preferred modality. EUS, MRI, and positron emission tomography play a complementary role to CT. Treatment response evaluation is of increasing clinical importance, especially in patients undergoing neoadjuvant therapy. This review aimed to comprehensively review the role of imaging in relation to the current treatment strategy for pancreatic cancer, including surveillance, diagnosis, evaluation of resectability and treatment response, and prediction of prognosis.
10.3348/kjr.2019.0862
MRI evaluation of pancreatic ductal adenocarcinoma: diagnosis, mimics, and staging.
Bowman Andrew W,Bolan Candice W
Abdominal radiology (New York)
The radiologist's role in the evaluation of pancreatic ductal adenocarcinoma remains critical in the management of this deadly disease. Imaging plays a vital role in the diagnosis and staging of pancreatic cancer. Although CT is more commonly used for staging pancreatic cancer, MR is increasingly playing an important role in this regard. In our institution, all pancreatic malignancies undergo staging with MRI. In this pictoral essay, we illustrate the MR imaging features of pancreatic ductal adenocarcinoma and its mimics, and we also discuss pearls and pitfalls in MR staging of pancreatic carcinoma.
10.1007/s00261-018-1686-x
Endoscopic ultrasonography for pancreatic solid lesions.
Yamashita Yasunobu,Kitano Masayuki
Journal of medical ultrasonics (2001)
The incidence and mortality rates of pancreatic cancer, which has a poor prognosis, are rising rapidly. Endoscopic ultrasonography (EUS) provides superior spatial resolution compared with other imaging modalities such as transabdominal ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), and it is considered among the most reliable and efficient diagnostic modalities for pancreatic diseases. In this review, we show that EUS is useful for detection of pancreatic solid lesions and staging of pancreatic cancer. EUS also plays an important role in screening patients with high-risk factors for pancreatic cancer. Although EUS is useful for detection of small pancreatic lesions, pancreatic lesions are difficult to characterize using this modality, because most pancreatic solid lesions appear hypoechoic on EUS. From this point of view, contrast-enhanced harmonic EUS (CH-EUS) plays an important role in the differential diagnosis of pancreatic lesions. EUS and CH-EUS are also useful for staging pancreatic cancer. Moreover, EUS-guided fine-needle aspiration (EUS-FNA) is superior to other modalities in terms of cytopathological diagnosis. Although EUS-FNA has a high diagnostic ability for pancreatic cancer, the combination of EUS-FNA and CH-EUS improves the diagnostic ability by decreasing the number of false-negative cases. Thus, conventional EUS, EUS-FNA, and CH-EUS are essential in clinical practice for the diagnosis of pancreatic solid lesions.
10.1007/s10396-019-00959-x
Pancreatic cancer, radiomics and artificial intelligence.
The British journal of radiology
Patients with pancreatic ductal adenocarcinoma (PDAC) are generally classified into four categories based on contrast-enhanced CT at diagnosis: resectable, borderline resectable, unresectable, and metastatic disease. In the initial grading and staging of PDAC, structured radiological templates are useful but limited, as there is a need to define the aggressiveness and microscopic disease stage of these tumours to ensure adequate treatment allocation. Quantitative imaging analysis allows radiomics and dynamic imaging features to provide information of clinical outcomes, and to construct clinical models based on radiomics signatures or imaging phenotypes. These quantitative features may be used as prognostic and predictive biomarkers in clinical decision-making, enabling personalised management of advanced PDAC. Deep learning and convolutional neural networks also provide high level bioinformatics tools that can help define features associated with a given aspect of PDAC biology and aggressiveness, paving the way to define outcomes based on these features. Thus, the prediction of tumour phenotype, treatment response and patient prognosis may be feasible by using such comprehensive and integrated radiomics models. Despite these promising results, quantitative imaging is not ready for clinical implementation in PDAC. Limitations include the instability of metrics and lack of external validation. Large properly annotated datasets, including relevant semantic features (demographics, blood markers, genomics), image harmonisation, robust radiomics analysis, clinically significant tasks as outputs, comparisons with gold-standards (such as TNM or pretreatment classifications) and fully independent validation cohorts, will be required for the development of trustworthy radiomics and artificial intelligence solutions to predict PDAC aggressiveness in a clinical setting.
10.1259/bjr.20220072
Pancreatic adenocarcinoma: cross-sectional imaging techniques.
Kulkarni Naveen M,Hough David M,Tolat Parag P,Soloff Erik V,Kambadakone Avinash R
Abdominal radiology (New York)
Pancreatic adenocarcinoma is a common malignancy that has a poor prognosis. Imaging is vital in its detection, staging, and management. Although a variety of imaging techniques are available, MDCT is the preferred imaging modality for staging and assessing the resectability of pancreatic adenocarcinoma. MR also has an important adjunct role, and may be used in addition to CT or as a problem-solving tool. A dedicated pancreatic protocol should be acquired as a biphasic technique optimized for the detection of pancreatic adenocarcinoma and to allow accurate local and distant disease staging. Emerging techniques like dual-energy CT and texture analysis of CT and MR images have a great potential in improving lesion detection, characterization, and treatment monitoring.
10.1007/s00261-017-1380-4
Clinical suspicion of pancreatic cancer despite negative endoscopic ultrasound-guided fine-needle aspiration biopsy.
Masuda Hiro,Kotecha Krishna,Maitra Rudra,Gill Anthony J,Mittal Anubhav,Samra Jaswinder S
ANZ journal of surgery
BACKGROUND:The early and accurate diagnosis of pancreatic ductal adenocarcinoma is vital for improving the efficacy of therapeutic interventions and to provide patients with the best chance of survival. While endoscopic ultrasound-fine needle aspiration (EUS-FNA) has been demonstrated to be a reliable and accurate diagnostic tool for solid pancreatic neoplasms, the ongoing management of patients with a high clinical suspicion for malignancy but with a negative EUS-FNA biopsy result can prove a challenge. METHODS:We describe five patients from a single centre who presented for further work-up of a pancreatic mass and/or imaging features concerning for a periampullary malignancy. RESULTS:All patients had at least one EUS-FNA biopsy performed which returned no malignant cells on cytology. Despite these negative cytology results, all patients underwent further invasive investigation through upfront resection (pancreaticoduodenectomy) or extra-pancreatic biopsy (laparoscopic biopsy of peritoneal nodule) due to worrisome features on imaging, biochemical factors and clinical presentation culminating in a high degree of suspicion for malignancy. The final tissue histopathological diagnosis in all patients was pancreatic ductal adenocarcinoma. CONCLUSION:This case series highlights the important clinical findings, imaging and biochemical features which need to be considered in patients who have high suspicion for malignancy despite having a negative EUS-FNA cytology result. In these patients with a high index of suspicion, surgical intervention through an upfront resection or further invasive investigation should not be delayed.
10.1111/ans.17256
Rate of pancreatic cancer following a negative endoscopic ultrasound and associated factors.
Endoscopy
BACKGROUND : Data are limited regarding pancreatic cancer diagnosed following a pancreaticobiliary endoscopic ultrasound (EUS) that does not diagnose pancreatic cancer. We have studied the frequency of, and factors associated with, post-EUS pancreatic cancer (PEPC) and 1-year mortality. METHODS : Between 2010 and 2017, patients with pancreatic cancer and a preceding pancreaticobiliary EUS were identified in a national cohort using Hospital Episode Statistics. Patients with a pancreaticobiliary EUS 6-18 months before a later pancreatic cancer diagnosis were the PEPC cases; controls were those with pancreatic cancer diagnosed within 6 months of pancreaticobiliary EUS. Multivariable logistic regression models examined the factors associated with PEPC and a Cox regression model examined factors associated with 1-year cumulative mortality. RESULTS : 9363 pancreatic cancer patients were studied; 93.5 % identified as controls (men 53.2 %; median age 68 [interquartile range (IQR) 61-75]); 6.5 % as PEPC cases (men 58.2 %; median age 69 [IQR 61-77]). PEPC was associated with older age (≥ 75 years compared with < 65 years, odds ratio [OR] 1.42, 95 %CI 1.15-1.76), increasing co-morbidity (Charlson co-morbidity score > 5, OR 1.90, 95 %CI 1.49-2.43), chronic pancreatitis (OR 3.13, 95 %CI 2.50-3.92), and diabetes mellitus (OR 1.58, 95 %CI 1.31-1.90). Metal biliary stents (OR 0.57, 95 %CI 0.38-0.86) and EUS-FNA (OR 0.49, 95 %CI 0.41-0.58) were inversely associated with PEPC. PEPC was associated with a higher cumulative mortality at 1 year (hazard ratio 1.12, 95 %CI 1.02-1.24), with only 14 % of PEPC patients (95 %CI 12 %-17 %) having a surgical resection, compared with 21 % (95 %CI 20 %-22 %) of controls. CONCLUSIONS : PEPC occurred in 6.5 % of patients and was associated with chronic pancreatitis, older age, more co-morbidities, and specifically diabetes mellitus. PEPC was associated with a worse prognosis and lower surgical resection rates.
10.1055/a-1784-1661
Early pancreatic cancer - The role of endoscopic ultrasound with or without tissue acquisition in diagnosis and staging.
Moutinho-Ribeiro Pedro,Iglesias-Garcia Julio,Gaspar Rui,Macedo Guilherme
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
Pancreatic cancer (PC) is one of the deadliest cancers with a 5-year overall survival of less than 6%. Due to its insidious clinical course and unspecific symptoms, the diagnosis is usually late, with only 15-20% patients presenting with potentially curable disease. It is, therefore, extremely important to identify patients with PC at early stages of the disease when tumors may be amenable to surgical resection. For unresectable and borderline resectable PC it is consensual to perform a biopsy to have a cyto/histological confirmation of malignancy before treatment. However, for patients presenting with promptly resectable disease, the role of biopsy is more debatable. There are, in the literature, arguments both for and against the usefulness of a preoperative biopsy. Endoscopic ultrasound (EUS) is an important technique assisting in the diagnosis and staging of PC. EUS-guided tissue acquisition is a well-established tool to demonstrate the malignant nature of a pancreatic lesion. This review focuses on the role of EUS in the diagnosis and staging of PC, and highlights the controversy related to the role of EUS-guided tissue acquisition in the preoperative assessment of patients presenting with promptly resectable tumors (early PC).
10.1016/j.dld.2018.09.027
Endoscopic ultrasound (EUS) and the management of pancreatic cancer.
Yousaf Muhammad Nadeem,Chaudhary Fizah S,Ehsan Amrat,Suarez Alejandro L,Muniraj Thiruvengadam,Jamidar Priya,Aslanian Harry R,Farrell James J
BMJ open gastroenterology
Pancreatic cancer is one of the leading causes of cancer-related mortality in western countries. Early diagnosis of pancreatic cancers plays a key role in the management by identification of patients who are surgical candidates. The advancement in the radiological imaging and interventional endoscopy (including endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography and endoscopic enteral stenting techniques) has a significant impact in the diagnostic evaluation, staging and treatment of pancreatic cancer. The multidisciplinary involvement of radiology, gastroenterology, medical oncology and surgical oncology is central to the management of patients with pancreatic cancers. This review aims to highlight the diagnostic and therapeutic role of EUS in the management of patients with pancreatic malignancy, especially pancreatic ductal adenocarcinoma.
10.1136/bmjgast-2020-000408
Diagnostic Accuracy of CT for Evaluating Circumferential Resection Margin Status in Resectable or Borderline Resectable Pancreatic Head Cancer: A Prospective Study Using Axially Sliced Surgical Pathologic Correlation.
Korean journal of radiology
OBJECTIVE:CT plays a central role in determining the resectability of pancreatic cancer, which directs the use of neoadjuvant therapy. This study aimed to assess the diagnostic accuracy of CT in predicting circumferential resection margin (CRM) involvement in patients with resectable or borderline resectable pancreatic head cancer. MATERIALS AND METHODS:Seventy-seven patients who were scheduled for upfront surgery for resectable or borderline resectable pancreatic head cancer were prospectively enrolled, and 75 patients (38 male and 37 female; mean age ± standard deviation, 68 ± 11 years) were finally analyzed. The CRM status was evaluated separately for the superior mesenteric artery (SMA) and posterior and superior mesenteric vein/portal vein (SMV/PV) margins. Three independent radiologists reviewed the preoperative CT images and evaluated the resection margin status. The reference standard for CRM status was pathologic examination of pancreaticoduodenectomy specimens in an axial plane perpendicular to the axis of the second portion of the duodenum. The diagnostic accuracy of CT was assessed for overall CRM involvement, defined as involvement of the SMA or posterior margins (per-patient analysis), and involvement of each of the three resection margins (per-margin analysis). The data were pooled using a crossed random effects model. RESULTS:Forty patients had pathologically confirmed overall CRM involvement in pancreatic cancer, while CRM involvement was not seen in 35 patients. For overall CRM involvement, the pooled sensitivity and specificity were 15% (95% confidence interval: 7%-49%) and 99% (96%-100%), respectively. For each of the resection margins, the pooled sensitivity and specificity were 14% (9%-54%) and 99% (38%-100%) for the SMA margin, 12% (8%-46%) and 99% (97%-100%) for the posterior margin; and 37% (29%-53%) and 96% (31%-100%) for the SMV/PV margin, respectively. CONCLUSION:CT showed very high specificity but low sensitivity in predicting pathological CRM involvement in pancreatic cancer.
10.3348/kjr.2021.0483
Diagnostic accuracy of EUS and CT of vascular invasion in pancreatic cancer: a systematic review.
Yang RenBao,Lu ManPeng,Qian XiaoXing,Chen Jiong,Li Liang,Wang JiaWen,Zhang YouQian
Journal of cancer research and clinical oncology
OBJECTIVE:The objective of this study was to summarize the accuracy of preoperative vascular invasion with endoscopic ultrasound (EUS) and computed tomography (CT) test performance in pancreatic cancer with meta-analysis METHOD:Two reviewers searched MEDLINE database to identify relevant studies. The reference lists of the trials were manually searched. Included studies used surgical and/or histological findings as the "gold standard," and provided sufficient data to construct a diagnostic 2 × 2 table. A statistical program of Meta-Disc was used to calculate the pooled sensitivity, specificity, positive LR, negative LR, DOR, and the SROC curve. Publication bias was assessed by Deeks' asymmetry test. Sensitivity analysis and subgroup analysis were calculated to down the heterogeneity. Meta-regression was calculated to evaluate potential sources of heterogeneity RESULT:A total of 30 studies with 1,554 patients were included for the analysis, nine of these studies compared EUS with CT to assess the diagnostic efficiency The pooled sensitivity of EUS and CT was 72 % (95 % CI 67-77 %) and 63 % (95 % CI 58-67 %), and the pooled specificity of EUS and CT was 89 % (95 % CI 86-92 %) and 92 % (95 % CI 90-94 %), respectively. The positive LR of EUS and CT was 5.14 (95 % CI 3.14-8.40) and 6.21 (95 % CI 3.96-9.71), and the negative LR was 0.36 (95 % CI 0.25-0.52) and 0.41 (95 % CI 0.31-0.55), respectively. The AUCs of EUS and CT were 0.9037 and 0.8948. The subgroup analysis of nine studies performed both EUS and CT showed CT scan with a lower sensitivity of 48 % (95 % CI 0.40-0.56), when compared to EUS of 69 % (95 % CI 0.61-0.77). The overall AUCs of CT scan appear to be lower (AUCs = 0.8589), compared with EUS (AUCs = 0.9379) CONCLUSION: EUS performed better than CT in differentiating vascular invasion preoperative on pancreatic cancer. EUS could provide other additional information when compared with CT.
10.1007/s00432-014-1728-x
PANCREATIC CANCER CT IMAGING: COMPARISON WITH SURGERY.
Jari Irina,Ursaru Manuela,Naum A G,Gheorghe Liliana,Manea Paloma,Negru D
Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi
AIM:To establish the best protocol for pancreatic computer tomography and criteria for staging (mainly for vascular invasion). MATERIAL AND METHODS:Our research included 49 consecutive patients with pancreatic cancer examined at the Iasi "Sf. Spiridon" Hospital between January and December 2014 with a Siemens 16 Emotion CT unit. CT protocol included no enhanced CT and pancreatic phase of the superior abdomen, portal venous phase of the abdomen and pelvis. RESULTS AND DISCUSSION:The study patients were stratified into 5 age groups and the most frequently affected by pancreatic cancer were the patients aged 60 to 79 years. For T staging the extension in the per pancreatic fat tissue, into surrounding organs (5 patients had extension in other organs) and vessels was evaluated. We determined the degree of contact between the tumor and the artery, thrombosis and deformity of the veins and we have found 8 resettable lesions, 28 tumors in stage T3 and 13 pancreatic cancers in stage T4. Thirty-three patients had lymphadenopathies and 31 of them had distant metastases. CONCLUSIONS:Our study proved that computed tomography is a good method of examination for pancreatic cancer when the right imaging protocol is used; during the pancreatic phase the arteries and the tumor are well depicted, liver metastases are best evaluated during the portal venous phase. The best criterion for arterial invasion is tumor contiguity with more than half of vessel circumference, and for vein invasion deformity or thrombosis. Comparison with surgical staging was o good backup for the radiologist and depicted several differences with imaging staging, more often understating than over staging.
Early features of pancreatic cancer on magnetic resonance imaging (MRI): a case-control study.
Abdominal radiology (New York)
PURPOSE:Magnetic resonance imaging has been recommended as a primary imaging modality among high-risk individuals undergoing screening for pancreatic cancer. We aimed to delineate potential precursor lesions for pancreatic cancer on MR imaging. METHODS:We conducted a case-control study at Kaiser Permanente Southern California (2008-2018) among patients that developed pancreatic cancer who had pre-diagnostic MRI examinations obtained 2-36 months prior to cancer diagnosis (cases) matched 1:2 by age, gender, race/ethnicity, contrast status and year of scan (controls). Patients with history of acute/chronic pancreatitis or prior pancreatic surgery were excluded. Images underwent blind review with assessment of a priori defined series of parenchymal and ductal features. We performed logistic regression to assess the associations between individual factors and pancreatic cancer. We further assessed the interaction among features as well as performed a sensitivity analysis stratifying based on specific time-windows (2-3 months, 4-12 months, 13-36 months prior to cancer diagnosis). RESULTS:We identified 141 cases (37.9% stage I-II, 2.1% III, 31.4% IV, 28.6% unknown) and 292 matched controls. A solid mass was noted in 24 (17%) of the pre-diagnostic MRI scans. Compared to controls, pre-diagnostic images from cancer cases more frequently exhibited the following ductal findings: main duct dilatation (51.4% vs 14.3%, OR [95% CI]: 7.75 [4.19-15.44], focal pancreatic duct stricture with distal (upstream) dilatation (43.6% vs 5.6%, OR 12.71 [6.02-30.89], irregularity (42.1% vs 6.0%, OR 9.73 [4.91-21.43]), focal pancreatic side branch dilation (13.6% vs1.6%, OR 11.57 [3.38-61.32]) as well as parenchymal features: atrophy (57.9% vs 27.4%, OR 46.4 [2.71-8.28], focal area of signal abnormality (39.3% vs 4.8%, OR 15.69 [6.72-44,78]), all p < 0.001). CONCLUSION:In addition to potential missed lesions, we have identified a series of ductal and parenchymal features on MRI that are associated with increased odds of developing pancreatic cancer.
10.1007/s00261-024-04271-2
Deep learning DCE-MRI parameter estimation: Application in pancreatic cancer.
Medical image analysis
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is an MRI technique for quantifying perfusion that can be used in clinical applications for classification of tumours and other types of diseases. Conventionally, the non-linear least squares (NLLS) methods is used for tracer-kinetic modelling of DCE data. However, despite promising results, NLLS suffers from long processing times (minutes-hours) and noisy parameter maps due to the non-convexity of the cost function. In this work, we investigated physics-informed deep neural networks for estimating physiological parameters from DCE-MRI signal-curves. Three voxel-wise temporal frameworks (FCN, LSTM, GRU) and two spatio-temporal frameworks (CNN, U-Net) were investigated. The accuracy and precision of parameter estimation by the temporal frameworks were evaluated in simulations. All networks showed higher precision than the NLLS. Specifically, the GRU showed to decrease the random error on v by a factor of 4.8 with respect to the NLLS for noise (SD) of 1/20. The accuracy was better for the prediction of the v parameter in all networks compared to the NLLS. The GRU and LSTM worked with arbitrary acquisition lengths. The GRU was selected for in vivo evaluation and compared to the spatio-temporal frameworks in 28 patients with pancreatic cancer. All neural network approaches showed less noisy parameter maps than the NLLS. The GRU had better test-retest repeatability than the NLLS for all three parameters and was able to detect one additional patient with significant changes in DCE parameters post chemo-radiotherapy. Although the U-Net and CNN had even better test-retest characteristics than the GRU, and were able to detect even more responders, they also showed potential systematic errors in the parameter maps. Therefore, we advise using our GRU framework for analysing DCE data.
10.1016/j.media.2022.102512
Screening for pancreatic cancer in high-risk individuals using MRI: optimization of scan techniques to detect small lesions.
Familial cancer
Pancreatic cancer has a dismal prognosis in the general population. However, early detection and treatment of disease in high-risk individuals can improve survival, as patients with localized disease and especially patients with lesions smaller than 10 mm show greatly improved 5-year survival rates. To achieve early detection through MRI surveillance programs, optimization of imaging is required. Advances in MRI technologies in both hardware and software over the years have enabled reliable detection of pancreatic cancer at a small size and early stage. Standardization of dedicated imaging protocols for the pancreas are still lacking. In this review we discuss state of the art scan techniques, sequences, reduction of artifacts and imaging strategies that enable early detection of lesions. Furthermore, we present the imaging features of small pancreatic cancers from a large cohort of high-risk individuals. Refinement of MRI techniques, increased scan quality and the use of artificial intelligence may further improve early detection and the prognosis of pancreatic cancer in a screening setting.
10.1007/s10689-024-00394-z
Imaging diagnosis of pancreatic cancer: a state-of-the-art review.
Lee Eun Sun,Lee Jeong Min
World journal of gastroenterology
Pancreatic cancer (PC) remains one of the deadliest cancers worldwide, and has a poor, five-year survival rate of 5%. Although complete surgical resection is the only curative therapy for pancreatic cancer, less than 20% of newly-diagnosed patients undergo surgical resection with a curative intent. Due to the lack of early symptoms and the tendency of pancreatic adenocarcinoma to invade adjacent structures or to metastasize at an early stage, many patients with pancreatic cancer already have advanced disease at the time of their diagnosis and, therefore, there is a high mortality rate. To improve the patient survival rate, early detection of PC is critical. The diagnosis of PC relies on computed tomography (CT) and/or magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP), or biopsy or fine-needle aspiration using endoscopic ultrasound (EUS). Although multi-detector row computed tomography currently has a major role in the evaluation of PC, MRI with MRCP facilitates better detection of tumors at an early stage by allowing a comprehensive analysis of the morphological changes of the pancreas parenchyma and pancreatic duct. The diagnosis could be improved using positron emission tomography techniques in special conditions in which CT and EUS are not completely diagnostic. It is essential for clinicians to understand the advantages and disadvantages of the various pancreatic imaging modalities in order to be able to make optimal treatment and management decisions. Our study investigates the current role and innovative techniques of pancreatic imaging focused on the detection of pancreatic cancer.
10.3748/wjg.v20.i24.7864