Pancreatitis-imaging approach

Table 5 Differentiating imaging features between chronic pancreatitis and pancreatic adenocarcinoma

Chronic pancreatitis	Pancreatic adenocarcinoma
Preserved glandular, feathery or marbled texture similar to that of the remaining pancreas	Definable, circumscribed mass lesion is most often diagnostic for tumor, which disrupts the underlying architecture and results in loss of anatomic detail
Heterogeneous pancreatic enhancement with presence of signal void (cysts and calcifications) on immediate post-gadolinium images	Irregular, heterogeneous, diminished enhancement on postgadolinium images compared to adjacent pancreatic parenchyma
Irregular dilatation of main pancreatic duct with gradual narrowing. Presence of multiple intraductal calcifications (the most specific finding)	Abrupt cut off of the pancreatic duct with significant proximal dilatation +/- presence of double duct sign. Very few ductal calculi compared to chronic pancreatitis
Dilatation of main pancreatic duct with and ectasia of the side branches, giving chain of lakes appearance	Minimal dilatation of side branches
No vascular encasement, significant lymphadenopathy or distant metastasis.	Vascular encasement, lymphadenopathy or distant metastasis