CT of pancreatic neoplasms. Part I: Adenocarcinoma

Adenocarcinoma of the pancreas has been one of the most formidable, diseases of the past half century, consistently ranking among the leading causes of death from cancer in the industrialized world. The profound diagnostic difficulties that characterized this neoplasm during the early decades of that era have largely given way to radiologic advances of recent decades. Daunting therapeutic challenges persist, however, as few individuals in whom this common form of pancreatic cancer develops are aware of their illness before the disease has advanced beyond the stage of curability. The benefits of recent diagnostic break-throughs in pancreatic adenocarcinoma are nonetheless immense. Although their proportion remains disappointingly small, an increasing number of persons owe their lives to the detection of pancreatic carcinoma at a stage amenable to complete surgical resection. Far more patients benefit from timely detection, accurate staging, and nonsurgical biopsy of an unresectable neoplasm. Still more, perhaps, benefit from the confident exclusion of pancreatic cancer as a source of worrisome symptoms. The goal of this discussion is to help the radiologist achieve full diagnostic potential in examining patients who have, or who are suspected to have, adenocarcinoma of the pancreas. As the leading method in the diagnostic advance on pancreatic cancer, computed tomography (CT) is given predominant attention. The principles of diagnostic interpretation, however, are based on an understanding of the neoplasm itself. In that respect, the manifestations of pancreatic adenocarcinoma as displayed by CT are in large measure just as pertinent to any other worthwhile method of pancreatic imaging.