Imaging in pancreatic disease

Abstract

Pancreatic diseases, chronic pancreatitis, pancreatic cancer and diabetes mellitus, taken together, occur in >10% of the world population. Pancreatic diseases, as with other diseases, benefit from early intervention and appropriate diagnosis. Although imaging technologies have given clinicians an unprecedented toolbox to aid in clinical decision-making, advances in these technologies and development of molecular-based diagnostic tools could enable physicians to identify diseases at an even earlier stage and, thereby, improve patient outcomes. In this Review, we discuss and identify gaps in the use of imaging techniques for the early detection and appropriate treatment stratification of various pancreatic diseases, including diabetes mellitus, acute and chronic pancreatitis and pancreatic cancer. Imaging techniques discussed are MRI, CT, PET and ultrasonography. Additionally, the identification of new molecular targets for imaging and the development of contrast agents that are able to give molecular information in noninvasive radionuclear imaging and ultrasonography are emerging areas of innovation that could lead to increased diagnostic accuracy and improved patient outcomes.

Enzyme therapy for functional bowel disease‐like post‐prandial distress

“…The pain pattern among those with abnormal results differed from the pain of typical irritable bowel syndrome as it was more often described as radiating through to the back and waking them from sleep and less likely to be post‐prandial . Distinguishing between pancreatic pain and pain related to irritable bowel syndrome has become easier since the introduction of more accurate tests such as computed tomography or endoscopic ultrasound . Currently, assessment for pancreatic disease is often included in the evaluation of those with suspected functional dyspepsia especially if the pain pattern or other features are atypical.…”

“…10 Distinguishing between pancreatic pain and pain related to irritable bowel syndrome has become easier since the introduction of more accurate tests such as computed tomography or endoscopic ultrasound. [11][12][13] Currently, assessment for pancreatic disease is often included in the evaluation of those with suspected functional dyspepsia especially if the pain pattern or other features are atypical.…”

PET Imaging in Pancreatic Cancer

“…MRCP allows the non-invasive delineation of the pancreatic duct and biliary tract. This technique will probably replace invasive endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis of small pancreatic masses , although its disadvantage is that it does not permit tissue sampling.However,these used structual imaging modalities are not specific in disease diagnosis, then distinguishing pancreatic adenocarcinoma from nonmalignant masses remains a challenge [3,4], especially for lesions smaller than 2 cm and cause an inconspicuous border deformity of the pancreas [5]. Meanwhile, chronic pancreatitis is notoriously difficult to diagnose, no applicable blood test currently used for chronic pancreatitis, and consequently this disease is diagnosed mainly through conventional insensitive imaging techniques.…”

Super-Resolution Ultrasound Bubble Tracking for Preclinical and Clinical Multiparametric Tumor Characterization

“…The application of gas-filled microbubbles (MB) as US contrast agents further enhances the diagnostic accuracy of US by adding morphological and functional information about the tissue vascularization 1 . This is particularly relevant in oncology, since the vascular structure of tumors contains essential information for their differential diagnosis [2][3][4] , prognostication 5 , and for the prediction and monitoring of therapy responses [6][7][8] . In particular, some vascular features have already been shown to be capable of identifying patients not responding to antiangiogenic therapy 9 , who, then, can be reoriented towards alternative approaches 10 .…”