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Pancreatitis and PDAC: association and differentiation
Sherif B Elsherif1,2, Mayur Virarkar3, Sanaz Javadi3
1The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA. sherif.b.elsherif@gmail.com.
Abdominal Radiology (New York)
|November 10, 2019
Summary
Differentiating mass-forming chronic pancreatitis (MFCP) from pancreatic ductal adenocarcinoma (PDAC) is challenging due to overlapping imaging features. Specific signs on CT, DCE-MRI, and MRCP can suggest one over the other, but tissue sampling remains definitive.
Area of Science:
- Gastroenterology and Hepatology
- Radiology and Medical Imaging
- Surgical Oncology
Background:
- Distinguishing mass-forming chronic pancreatitis (MFCP) from pancreatic ductal adenocarcinoma (PDAC) presents a significant diagnostic challenge.
- Accurate differentiation is crucial due to the vastly different prognoses and treatment strategies for MFCP and PDAC.
- Imaging findings for MFCP and PDAC often overlap across various modalities, complicating diagnosis.
Purpose of the Study:
- To review and highlight key imaging features that aid in differentiating MFCP from PDAC.
- To discuss the utility of different imaging techniques, including CT, DCE-MRI, and MRCP, in this diagnostic process.
Main Methods:
- Review of imaging characteristics on perfusion CT, dynamic contrast-enhanced MRI (DCE-MRI), and magnetic resonance cholangiopancreatography (MRCP).
- Identification of specific signs associated with each condition, such as the duct-penetrating sign (MFCP) and the double-duct sign (PDAC).
Main Results:
- Perfusion CT and DCE-MRI may reveal distinct enhancement patterns between MFCP and PDAC.
- The duct-penetrating sign on MRCP is more indicative of MFCP.
- Abrupt main pancreatic duct cutoff with upstream dilatation and the double-duct sign are more frequently observed in PDAC.
Conclusions:
- While specific imaging features can suggest MFCP or PDAC, overlap exists.
- Tissue sampling (biopsy) is currently the most reliable method for definitive differentiation and guiding patient management.
- Further research may refine imaging criteria to improve non-invasive diagnostic accuracy.
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