ACR Appropriateness Criteria® Staging of Pancreatic Ductal Adenocarcinoma

Qayyum, Aliya; Tamm, Eric P.; Kamel, Ihab R.; Allen, Peter J.; Arif-Tiwari, Hina; Chernyak, Victoria; Gonda, Tamas A.; Grajo, Joseph R.; Hindman, Nicole; Horowitz, Jeanne M.; Kaur, Harmeet; McNamara, Michelle; Noto, Richard B.; Srivastava, Pavan K; Lalani, Tasneem

doi:10.1016/j.jacr.2017.08.050

Cited by 29 publications

(37 citation statements)

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“…Missed liver metastases are usually small and are found in the subcapsular area of the liver, raising the possibility of being a form of locoregional peritoneal dissemination rather than hematogenous metastasis [55]. MR imaging is more sensitive for the depiction of small liver metastasis with a sensitivity of 90─100% for MR imaging with either gadobenate dimeglumine or gadoxetic acid compared with 70─76% for CT [56]. Also, MR with DWI has a greater specificity for characterizing indeterminate liver lesions identified on CT; metastases usually demonstrate intermediate hyperintensity on T2weighted MR images with restricted diffusion on DWI and rim enhancement on dynamic contrast-enhanced images [55,57].…”

Section: Evolving Imaging Criteria For Tumor Resectabilitymentioning

confidence: 99%

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Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

2020

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Pancreatic ductal adenocarcinoma (PDAC) has continued to have a poor prognosis for the last few decades in spite of recent advances in different imaging modalities mainly due to difficulty in early diagnosis and aggressive biological behavior. Early PDAC can be missed on CT due to similar attenuation relative to the normal pancreas, small size, or hidden location in the uncinate process. Tumor resectability and its contingency on the vascular invasion most commonly assessed with multi-phasic thin-slice CT is a continuously changing concept, particularly in the era of frequent neoadjuvant therapy. Coexistent celiac artery stenosis may affect the surgical plan in patients undergoing pancreaticoduodenectomy. In this review, we discuss the challenges related to the imaging of PDAC. These include radiological and clinical subtleties of the tumor, evolving imaging criteria for tumor resectability, preoperative diagnosis of accompanying celiac artery stenosis, and post-neoadjuvant therapy imaging. For each category, the key imaging features and potential pitfalls on cross-sectional imaging will be discussed. Also, we will describe the imaging discriminators of potential mimickers of PDAC.

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Section: Evolving Imaging Criteria For Tumor Resectabilitymentioning

confidence: 99%

“…Therefore, unexplained peritoneal thickening or ascites should raise the suspicion of peritoneal carcinomatosis. In a suspected peritoneal disease, laparoscopic staging may be considered in patients with resectable PDAC [54,56].…”

Section: Evolving Imaging Criteria For Tumor Resectabilitymentioning

confidence: 99%

Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

2020

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“…2,5 Pancreatic computed tomography (CT), which typically includes a pancreatic parenchymal phase and portal venous phase acquisition using thin sections, 6 is usually performed in the preoperative workup of pancreatic adenocarcinoma to assess the local extent of the primary tumor and to identify the presence of nodal disease and metastases. 7 However, several recent studies have suggested that a significant number of pancreatic adenocarcinoma liver metastases are missed on CT. 8,9 This may result in patients with no chance of cure undergoing unnecessary surgical resection. Pancreatectomy is an aggressive and frequently morbid procedure that should only be performed in patients who are likely to benefit.…”

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confidence: 99%

MRI vs. CT for the Detection of Liver Metastases in Patients With Pancreatic Carcinoma: A Comparative Diagnostic Test Accuracy Systematic Review and Meta‐Analysis

Alabousi

McInnes

Salameh

et al. 2020

Magnetic Resonance Imaging

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Background: The detection of liver metastases is important for pancreatic cancer curative treatment eligibility. The data suggest that magnetic resonance imaging (MRI) is more sensitive than computed tomography (CT) for the diagnosis of pancreatic cancer liver metastases. However, MRI is not currently recommended in multiple published guidelines. Purpose: To perform a comparative diagnostic test accuracy systematic review and meta-analysis comparing CT and MRI for pancreatic cancer liver metastases detection. Study Type: Systematic review and meta-analysis. Data Sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and multiple radiology society meeting archives were searched until November 2018. Comparative design studies reporting on liver CT and MRI accuracy for detection of pancreatic cancer liver metastases in the same cohort were included. Field Strength: 1.5T or 3.0T. Assessment: Demographic, methodologic, and diagnostic test accuracy data were extracted. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Statistical Tests: Accuracy metrics were obtained using bivariate random-effects meta-analysis. The impact of different covariates on accuracy estimates was assessed using a meta-regression model. Covariates included modality, study design, tumor characteristics, risk of bias, and imaging protocols. Results: Fourteen studies including 987 patients with pancreatic cancer (205 with liver metastases) were included. Sensitivity for CT and MRI was 45% (confidence intervals [95% CI] 21-71%) and 83% (95% CI 74-88%), respectively. Specificity for CT and MRI was 94% (95% CI 84-98%) and 96% (95% CI 93-97%), respectively. The greater observed sensitivity of MRI was preserved in the meta-regression model (P = 0.01), while no difference in specificity was detected (P = 0.16). CT sensitivity was highest for triphasic and quadriphasic examinations compared to single phase or biphasic protocols (P = 0.03). Most studies were at high risk of bias.

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“…Computed Tomography Scan merupakan modalitas yang lazim digunakan pada kelainan pankreas. Menurut Qayyum et al, ( 2017) Computed Tomography Scan 64 slice memiliki sensitivitas 87 % dan spesifisitas 63% -75%, sedangkan MRI 3 Tesla memiliki sensitivitas 93 % dan spesifisitas 50% -75% dalam mendeteksi kelainan pada pankreas. Quencer et al, (2013) menyatakan bahwa meski untuk melihat duktus pankreas MRI lebih unggul, namun CT scan mampu memperlihatkan duktus pankreas dengan baik melalui teknik post processing.…”

Section: Pendahuluanunclassified

Comparative Analysis Image Results of Pancreas in Portal Vein Phase on Ct Scan Abdomen Contrast Without and With Minimum Intensity Projection in Ct Scan 64 Slice

Ramandita¹,

Muqmiroh

Pramono

2019

Jour.Voc.HS

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Background: Minimum Intensity Projection is a post-proccesing technique on CT Scan that useful for showing structures with low Hounsfiled Unit (HU) values such as pancreas. To demonstrate the anatomy and pathology of the pancreatic organs, a contrast CT scan was performed on pancreatic phase but pancreatic phase was rarely used, so it was replaced by the portal venous phase, but this technique is still rarely used among the radiographers. Objective: This study aimed to prove the image of the portal venous pancreatic vein on contrast contrast CT scan by using minimum intensity projection (MinIP) on CT scan 64 slices will produce a more optimal image than without the minimum intensity projection (MinIP). Methods: This study is a retrospective study with an observational analytic method to assess differences of pancreatic image in contrasting contrast CT scans with and with MinIP reforms on CT 64 slice modalities Philips Briliance. 30 images as samples, with the criteria set by the researchers. The image will be post proccesing without and by using MinIP reformat. Image results will be evaluated by two radiologist, then the data obtained will be tabulated and processed using SPSS software version 17. Result: From this research obtained the result that MinIP reformat able to produce pancreas image more optimal than image without MinIP reformat on CT scan 64 slice and shows a significant difference. Overall assessment of the image has an improvement with the MinIP but for the homogeneity of pancreatic images decreased. Conclusions: There was a significant difference between pancreatic venous porta port results in contrasting CT scans of the abdomen without and with MinIP reformat.

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ACR Appropriateness Criteria® Staging of Pancreatic Ductal Adenocarcinoma

Cited by 29 publications

References 50 publications

Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

MRI vs. CT for the Detection of Liver Metastases in Patients With Pancreatic Carcinoma: A Comparative Diagnostic Test Accuracy Systematic Review and Meta‐Analysis

Comparative Analysis Image Results of Pancreas in Portal Vein Phase on Ct Scan Abdomen Contrast Without and With Minimum Intensity Projection in Ct Scan 64 Slice

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