Imaging pancreatic cancer: the role of multidetector CT with three-dimensional CT angiography

Over the past two decades, there have been significant technical advancements in computed tomography (CT). This has allowed CT to remain the gold standard for the evaluation of pancreatic pathology despite the advent of other imaging modalities, including MRI, PET and endoscopic ultrasound. Initially, CT scanners could only obtain 10-mm-thick slices at a rate of 4 slices per minute. Today, the current state of the art is multidetector CT (MDCT) technology, which allows the entire pancreas to be imaged by 1-mm slices in under 20 s. In addition, these new scanners allow true volume acquisition. The resultant data sets can be displayed not only as axial slices but also as a three-dimensional (3D) volume. The detail of these reconstructions when performed with volume rendering and maximum intensity projection techniques allows a detailed vascular mapping with accuracy that may exceed classic angiography. The use of thin collimation and dual-phase acquisition also improves the detection of hepatic metastasis as well as other sites of extrapancreatic disease. This article reviews the current state of the art of pancreatic imaging with specific emphasis on the use of MDCT, volume acquisitions and 3D arterial- and venous-phase vascular mapping. The advantages of these techniques and their impact on diagnosis and patient management are also addressed.