Imaging diagnosis of pancreatic cancer: A state-of-the-art review

Abstract

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.

Keywords: Pancreatic neoplasms; Multi-detector computed tomography; Magnetic resonance imaging; Ultrasonography; Endoscopic ultrasound-guided fine needle aspiration; Positron-emission tomography

Core tip: To improve the survival rate of pancreatic cancer, early detection and optimal treatment with various imaging modalities is essential. Our study investigates the current role of pancreatic imaging, including computed tomography (CT), magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography, and biopsy/fine-needle aspiration using endoscopic ultrasound, focused on the pancreatic cancer. This study introduces rapidly-developing novel imaging techniques, including dual energy, low-tube-voltage CT techniques, iterative reconstruction CT algorithms, functional MRI methods, and hybrid positron emission tomography/MR, which are expected to become widely used and to show excellent performance for pancreatic cancer imaging in the near future.