Radiologic staging of pancreatic adenocarcinoma

Dynamic CT currently is the imaging modality of choice for staging of pancreatic carcinoma. It has an accuracy of 72% in predicting tumor resectability and an accuracy of virtually 100% in predicting tumor unresectability. However, it is important that the CT criteria of unresectability be defined for each individual institution. In some hospitals, extended pancreatectomy, including resection of involved major extrapancreatic vessels, contiguous solid or hollow organs, and regional lymph nodes, is performed for pancreatic carcinoma. Thus, these CT findings would not be considered to obviate surgical resection, whereas in other hospitals, surgeons consider tumor spread beyond the gland, particularly vascular involvement, as a contraindication for resection. It is also important to note that enlarged regional lymph nodes that would be included in the resection are not considered to be a CT criteria of unresectability when they occur as an isolated finding. MR imaging, EUS, and angiography have less significant roles compared with CT in the staging of pancreatic carcinoma; however, MR imaging and EUS can be valuable staging techniques in patients in whom an optimal dynamic contrast-enhanced CT cannot be obtained, although angiography now is indicated primarily to provide the surgeon with a vascular roadmap prior to resection or to evaluate patients in whom CT is equivocal.