Imaging

Pancreatic Cancer

Preliminary Diagnosis: Pancreatic Cancer

I. What imaging technique is first-line for this diagnosis?

  • Pancreatic protocol CT abdomen and pelvis with and without contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of pancreatic cancer.

Advantages

  • Enhancement patterns are often characteristic of different pancreatic neoplastic lesions, which may narrow the diagnosis

  • Simultaneously evaluates the liver for metastatic disease and demonstrates intra- or extrahepatic biliary ductal dilation due to tumor mass effect

Disadvantages

  • Administration of iodinated contrast may result in worsening renal function (contrast nephropathy) in patients with renal insufficiency. Contrast dose should be reduced or withheld in these patients

  • Exposure to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • History of allergic reaction to IV contrast requires pretreatment for a minimum of 13 hours with steroids and antihistamines

  • Pregnant patients should not undergo CT

IV. What alternative imaging techniques are available?

  • MRI abdomen with contrast, magnetic resonance cholangiopancreatography (MRCP)

  • Abdominal ultrasound

  • Endoscopic ultrasound

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pancreatic cancer.

MRI/MRCP

Advantages

  • Able to show level and degree of ductal obstruction

  • Less invasive than ERCP

  • Does not require sedation

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

Abdominal Ultrasound

Advantages

  • Does not use ionizing radiation

  • Quick and inexpensive exam

Disadvantages

  • Does not provide the level of anatomic detail needed for surgical planning (eg, degree of vascular involvement)

  • Less sensitive in evaluating the liver for metastatic disease

Endoscopic Ultrasound

Advantages

  • Does not use ionizing radiation

  • May get better images of pancreas than abdominal ultrasound

Disadvantages

  • Invasive procedure

  • Requires sedation

VI. What are the contraindications for the alternative imaging techniques?

MRI/MRCP

  • Contraindicated in patients with non–MRI-approved metallic devices

  • Gadolinium contrast is contraindicated in patients with decreased renal function (GFR <30-40 mL/min/1.73m2) due to risk of nephrogenic systemic fibrosis

Abdominal Ultrasound

  • There are no contraindications to ultrasound

Endoscopic Ultrasound

  • Contraindicated in patients that are at risk for perforation

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