Radiological evaluation of focal pancreatic lesions

The early and accurate characterization of pancreatic masses remains a challenge in diagnostic radiology, while the continuously evolving diagnostic possibilities give rise to an ever-increasing number of incidentally found pancreatic masses. This article discusses the relevance and role of ultrasound, endoscopic ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) in the diagnosis of pancreatic lesions. Specific protocols such as MR cholangiopancreatography and multiphase CT allow for a close characterization. While CT and MRI deliver information to further evaluate pancreatic disease, PET/CT has shown potential for staging purposes and in the clinical follow-up of pancreatic cancer patients. Common differential diagnoses regarding pancreatic cancer are discussed, and typical imaging features of anatomical variations, cystic lesions and pancreatitis are illustrated, together with clinical signs of pancreatic disease. The use of cross-sectional imaging in correlation with clinical features allows for an accurate and early detection of pancreatic masses and assists in differentiating benign from malignant disease.