Magnetic Resonance Imaging of Adenocarcinoma of the Pancreas

Abstract

Magnetic resonance imaging (MRI) is a valuable tool in the assessment of the full spectrum of pancreatic disease. A standard MR protocol including noncontrast T1-weighted fat-suppressed and dynamic gadolinium-enhanced gradient-echo imagings is sensitive for the evaluation of pancreatic cancer. Optimal use of MRI in the investigation of pancreatic cancer occurs in the following circumstances: (1) detection of small non-contour-deforming tumors, (2) evaluation of local extension and vascular encasement, (3) determination of the presence of lymph node and peritoneal metastases, and (4) determination and characterization of associated liver lesions and liver metastases. The objective of this study was to describe the attribute of MRI for evaluating pancreatic cancer.

Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

“…11,[13][14][15][16] Pancreas protocol MRI with contrast can be a helpful adjunct to CT in the staging of pancreatic cancer, particularly for characterization of CT-indeterminate liver lesions and when suspected tumors are not visible on CT or in cases of contrast allergy. 17,18 The difference in contrast enhancement between the parenchyma and adenocarcinoma is highest during the pancreatic phase, thereby providing a clear distinction between a hypodense lesion in the pancreas and the rest of the organ. A multiphasic pancreatic protocol also allows for enhanced visualization of important arterial (eg, celiac axis, superior mesenteric artery [SMA], and hepatic artery) and venous structures (eg, superior mesenteric vein [SMV], splenic vein, portal vein), thereby providing an assessment of vascular invasion by the tumor.…”

“…Criteria for Resection: The NCCN Panel recommends that pancreatic resections be performed at institutions that perform a large number (at least [15][16][17][18][19][20] of pancreatic resections annually. It is again emphasized that institutions performing pancreatic resections should have a multidisciplinary team with focus in pancreatic cancer that actively participates in the decision-making process regarding which patients should undergo surgery.…”

Combining in Vitro Diagnostics with in Vivo Imaging for Earlier Detection of Pancreatic Ductal Adenocarcinoma: Challenges and Solutions

“…Currently, PDAC is best detected by using nonenhanced T1-weighted fat-suppressed gradientrecalled-echo imaging followed by contrast-enhanced imaging with gadolinium-based contrast agents (97)(98)(99). Normal pancreatic tissue has high signal intensity on noncontrast T1-weighted fat-suppressed images because of the presence of aqueous protein in the …”

Molecular imaging in pancreatic cancer – A roadmap for therapeutic decisions

“…Some consider MRI to be the best first line noninvasive imaging modality in suspected PDAC patients, since it can evaluate pancreas (benign vs. malignant), vasculature and pancreaticobiliary ducts in a single examination [37]. Due to its high soft tissue contrast and more extensive types of data that can be acquired, some argue that MRI is even more predictable than CT in evaluation of pancreatic tumors, especially in detecting small non-contour-deforming lesions and subtle liver metastasis [58]. …”