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Pancreatic Ductal Carcinoma
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Pancreatic adenocarcinoma, pancreatic cancer
        • Definitions

          • Malignancy arising from ductal epithelium of exocrine pancreas

        IMAGING

        • General Features

          • CT Findings

            • MR Findings

              • Ultrasonographic Findings

                • Nuclear Medicine Findings

                  • Radiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Gaskill CE et al: History of preoperative therapy for pancreatic cancer and the MD Anderson experience. J Surg Oncol. 123(6):1414-22, 2021
                                              2. Gong XH et al: Atypical and uncommon CT and MR imaging presentations of pancreatic ductal adenocarcinoma. Abdom Radiol (NY). ePub, 2021
                                              3. Kato H et al: Essential updates 2019/2020: multimodal treatment of localized pancreatic adenocarcinoma: current topics and updates in survival outcomes and prognostic factors. Ann Gastroenterol Surg. 5(2):132-51, 2021
                                              4. Khristenko E et al: Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer. Sci Rep. 11(1):1800, 2021
                                              5. Nehlsen AD et al: Controversies in radiotherapy for pancreas cancer. J Surg Oncol. 123(6):1460-6, 2021
                                              6. Park SJ et al: Preoperative assessment of the resectability of pancreatic ductal adenocarcinoma on CT according to the NCCN Guidelines focusing on SMA/SMV branch invasion. Eur Radiol. ePub, 2021
                                              7. Arnone A et al: Clinical Impact of 18F-FDG PET/CT in the diagnostic workup of pancreatic ductal adenocarcinoma: a systematic review. Diagnostics (Basel). 10(12), 2020
                                              8. Haj-Mirzaian A et al: Pitfalls in the MDCT of pancreatic cancer: strategies for minimizing errors. Abdom Radiol (NY). 45(2):457-78, 2020
                                              9. Harrington KA et al: MRI of the pancreas. J Magn Reson Imaging. 53(2):347-59, 2020
                                              10. Kulkarni NM et al: White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part II, update on imaging techniques and screening of pancreatic cancer in high-risk individuals. Abdom Radiol (NY). 45(3):729-42, 2020
                                              11. Kulkarni NM et al: White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part I, AJCC staging system, NCCN guidelines, and borderline resectable disease. Abdom Radiol (NY). 45(3):716-28, 2020
                                              12. Lee JW et al: Impact of F-18 fluorodeoxyglucose PET/CT and PET/MRI on initial staging and changes in management of pancreatic ductal adenocarcinoma: a systemic review and meta-analysis. Diagnostics (Basel). 10(11), 2020
                                              13. Rhee H et al: The role of imaging in current treatment strategies for pancreatic adenocarcinoma. Korean J Radiol. 22(1):23-40, 2020
                                              14. Wang ZJ et al: Therapeutic response assessment in pancreatic ductal adenocarcinoma: society of abdominal radiology review paper on the role of morphological and functional imaging techniques. Abdom Radiol (NY). 45(12):4273-89, 2020
                                              15. Younan G: Pancreas solid tumors. Surg Clin North Am. 100(3):565-80, 2020
                                              16. Dallongeville A et al: Initial diagnosis and staging of pancreatic cancer including main differentials. Semin Ultrasound CT MR. 40(6):436-68, 2019
                                              17. Duan H et al: The role of PET/CT in the imaging of pancreatic neoplasms. Semin Ultrasound CT MR. 40(6):500-8, 2019
                                              18. Balachandran A et al: Imaging of pancreatic neoplasms. Surg Oncol Clin N Am. 23(4):751-88, 2014
                                              19. Becker AE et al: Pancreatic ductal adenocarcinoma: risk factors, screening, and early detection. World J Gastroenterol. 20(32):11182-98, 2014
                                              20. Loc WS et al: Novel strategies for managing pancreatic cancer. World J Gastroenterol. 20(40):14717-25, 2014
                                              21. O'Neill E et al: MR imaging of the pancreas. Radiol Clin North Am. 52(4):757-77, 2014
                                              22. Raman SP et al: Abnormalities of the Distal common bile duct and ampulla: diagnostic approach and differential diagnosis using multiplanar reformations and 3D imaging. AJR Am J Roentgenol. 203(1):17-28, 2014
                                              23. Rossi ML et al: Therapeutic options for the management of pancreatic cancer. World J Gastroenterol. 20(32):11142-59, 2014
                                              24. Wang XY et al: Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer. World J Gastroenterol. 20(42):15580-9, 2014
                                              25. Al-Hawary MM et al: Mimics of pancreatic ductal adenocarcinoma. Cancer Imaging. 13(3):342-9, 2013
                                              26. Raman SP et al: Endoscopic ultrasound and pancreatic applications: what the radiologist needs to know. Abdom Imaging. 38(6):1360-72, 2013
                                              27. Coakley FV et al: Pancreatic imaging mimics: part 1, imaging mimics of pancreatic adenocarcinoma. AJR Am J Roentgenol. 199(2):301-8, 2012
                                              28. Jeffrey RB: Pancreatic cancer: radiologic imaging. Gastroenterol Clin North Am. 41(1):159-77, 2012
                                              29. Raman SP et al: Multimodality imaging of pancreatic cancer-computed tomography, magnetic resonance imaging, and positron emission tomography. Cancer J. 18(6):511-22, 2012
                                              30. Low G et al: Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics. 31(4):993-1015, 2011
                                              31. Wang Y et al: Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographics. 2011 May-Jun;31(3):E47-64. Review. Erratum in: Radiographics. 31(5):1496, 2011
                                              32. Deshmukh SD et al: Pathways of extrapancreatic perineural invasion by pancreatic adenocarcinoma: evaluation with 3D volume-rendered MDCT imaging. AJR Am J Roentgenol. 194(3):668-74, 2010
                                              33. Morana G et al: Staging cancer of the pancreas. Cancer Imaging. 10 Spec no A:S137-41, 2010
                                              34. Kauhanen SP et al: A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg. 250(6):957-63, 2009
                                              35. Varadhachary GR et al: Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 13(8):1035-46, 2006
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Synonyms

                                                      • Pancreatic adenocarcinoma, pancreatic cancer
                                                    • Definitions

                                                      • Malignancy arising from ductal epithelium of exocrine pancreas

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Nuclear Medicine Findings

                                                              • Radiographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Gaskill CE et al: History of preoperative therapy for pancreatic cancer and the MD Anderson experience. J Surg Oncol. 123(6):1414-22, 2021
                                                                                          2. Gong XH et al: Atypical and uncommon CT and MR imaging presentations of pancreatic ductal adenocarcinoma. Abdom Radiol (NY). ePub, 2021
                                                                                          3. Kato H et al: Essential updates 2019/2020: multimodal treatment of localized pancreatic adenocarcinoma: current topics and updates in survival outcomes and prognostic factors. Ann Gastroenterol Surg. 5(2):132-51, 2021
                                                                                          4. Khristenko E et al: Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer. Sci Rep. 11(1):1800, 2021
                                                                                          5. Nehlsen AD et al: Controversies in radiotherapy for pancreas cancer. J Surg Oncol. 123(6):1460-6, 2021
                                                                                          6. Park SJ et al: Preoperative assessment of the resectability of pancreatic ductal adenocarcinoma on CT according to the NCCN Guidelines focusing on SMA/SMV branch invasion. Eur Radiol. ePub, 2021
                                                                                          7. Arnone A et al: Clinical Impact of 18F-FDG PET/CT in the diagnostic workup of pancreatic ductal adenocarcinoma: a systematic review. Diagnostics (Basel). 10(12), 2020
                                                                                          8. Haj-Mirzaian A et al: Pitfalls in the MDCT of pancreatic cancer: strategies for minimizing errors. Abdom Radiol (NY). 45(2):457-78, 2020
                                                                                          9. Harrington KA et al: MRI of the pancreas. J Magn Reson Imaging. 53(2):347-59, 2020
                                                                                          10. Kulkarni NM et al: White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part II, update on imaging techniques and screening of pancreatic cancer in high-risk individuals. Abdom Radiol (NY). 45(3):729-42, 2020
                                                                                          11. Kulkarni NM et al: White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology's disease-focused panel for pancreatic ductal adenocarcinoma: Part I, AJCC staging system, NCCN guidelines, and borderline resectable disease. Abdom Radiol (NY). 45(3):716-28, 2020
                                                                                          12. Lee JW et al: Impact of F-18 fluorodeoxyglucose PET/CT and PET/MRI on initial staging and changes in management of pancreatic ductal adenocarcinoma: a systemic review and meta-analysis. Diagnostics (Basel). 10(11), 2020
                                                                                          13. Rhee H et al: The role of imaging in current treatment strategies for pancreatic adenocarcinoma. Korean J Radiol. 22(1):23-40, 2020
                                                                                          14. Wang ZJ et al: Therapeutic response assessment in pancreatic ductal adenocarcinoma: society of abdominal radiology review paper on the role of morphological and functional imaging techniques. Abdom Radiol (NY). 45(12):4273-89, 2020
                                                                                          15. Younan G: Pancreas solid tumors. Surg Clin North Am. 100(3):565-80, 2020
                                                                                          16. Dallongeville A et al: Initial diagnosis and staging of pancreatic cancer including main differentials. Semin Ultrasound CT MR. 40(6):436-68, 2019
                                                                                          17. Duan H et al: The role of PET/CT in the imaging of pancreatic neoplasms. Semin Ultrasound CT MR. 40(6):500-8, 2019
                                                                                          18. Balachandran A et al: Imaging of pancreatic neoplasms. Surg Oncol Clin N Am. 23(4):751-88, 2014
                                                                                          19. Becker AE et al: Pancreatic ductal adenocarcinoma: risk factors, screening, and early detection. World J Gastroenterol. 20(32):11182-98, 2014
                                                                                          20. Loc WS et al: Novel strategies for managing pancreatic cancer. World J Gastroenterol. 20(40):14717-25, 2014
                                                                                          21. O'Neill E et al: MR imaging of the pancreas. Radiol Clin North Am. 52(4):757-77, 2014
                                                                                          22. Raman SP et al: Abnormalities of the Distal common bile duct and ampulla: diagnostic approach and differential diagnosis using multiplanar reformations and 3D imaging. AJR Am J Roentgenol. 203(1):17-28, 2014
                                                                                          23. Rossi ML et al: Therapeutic options for the management of pancreatic cancer. World J Gastroenterol. 20(32):11142-59, 2014
                                                                                          24. Wang XY et al: Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer. World J Gastroenterol. 20(42):15580-9, 2014
                                                                                          25. Al-Hawary MM et al: Mimics of pancreatic ductal adenocarcinoma. Cancer Imaging. 13(3):342-9, 2013
                                                                                          26. Raman SP et al: Endoscopic ultrasound and pancreatic applications: what the radiologist needs to know. Abdom Imaging. 38(6):1360-72, 2013
                                                                                          27. Coakley FV et al: Pancreatic imaging mimics: part 1, imaging mimics of pancreatic adenocarcinoma. AJR Am J Roentgenol. 199(2):301-8, 2012
                                                                                          28. Jeffrey RB: Pancreatic cancer: radiologic imaging. Gastroenterol Clin North Am. 41(1):159-77, 2012
                                                                                          29. Raman SP et al: Multimodality imaging of pancreatic cancer-computed tomography, magnetic resonance imaging, and positron emission tomography. Cancer J. 18(6):511-22, 2012
                                                                                          30. Low G et al: Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics. 31(4):993-1015, 2011
                                                                                          31. Wang Y et al: Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographics. 2011 May-Jun;31(3):E47-64. Review. Erratum in: Radiographics. 31(5):1496, 2011
                                                                                          32. Deshmukh SD et al: Pathways of extrapancreatic perineural invasion by pancreatic adenocarcinoma: evaluation with 3D volume-rendered MDCT imaging. AJR Am J Roentgenol. 194(3):668-74, 2010
                                                                                          33. Morana G et al: Staging cancer of the pancreas. Cancer Imaging. 10 Spec no A:S137-41, 2010
                                                                                          34. Kauhanen SP et al: A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg. 250(6):957-63, 2009
                                                                                          35. Varadhachary GR et al: Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 13(8):1035-46, 2006