Conditions at risk of pancreatic cancer: The radiology perspective

Pancreatic cancer remains one for the most aggressive cancer worldwide, with pancreatic ductal adenocarcinoma being the most common malignant pancreatic lesion, associated with poor prognosis. While surgical resection is the only curative treatment, only a minority of patients is eligible for surgery due to its diagnosis at advanced stages. Therefore, strategies for early detection of pancreatic cancer are needed. This article aims to provide a state-of-the-art review of the most common conditions associated to an increased risk of pancreatic cancer. Conditions linked to risk of pancreatic cancer development include certain pancreato-biliary anatomical variants, intraductal papillary mucinous neoplasms, mucinous cystic neoplasm, and familial pancreatic cancer with specific genetic mutations. Early imaging signs of pancreatic cancer can also be incidentally encountered on CT or MRI performed for other indications and they should be promptly recognized by the radiologists in order to avoid delays in the diagnosis. The features include focal pancreatic atrophy, contour deformity, dilation of the main pancreatic duct (MPD), changes in the caliber of the MPD, abrupt interruption of the MPD, and biliary tree dilation. MRI with the adoption of abbreviated protocols has been increasingly evaluated for the follow-up of cystic lesions. Although screening of the general population is not recommended due to the low incidence and high costs, surveillance with MRI can be considered in selected high-risk individuals.