Anatomical, Physiological, and Molecular Imaging for Pancreatic Cancer: Current Clinical Use and Future Implications

Abstract

Pancreatic adenocarcinoma is one of the deadliest human malignancies. Early detection is difficult and effective treatment is limited. Verifying the presence of micrometastatic dissemination and vessel invasion remains elusive, limiting radiological staging once this diagnosis is made. Diagnostic imaging provides independent tools to evaluate and characterize the biologic behavior of pancreatic cancer. Conventional anatomic imaging alone with either CT or MRI yields useful information on organ involvement but is limited in providing molecular and physiological information. Molecular imaging techniques such as PET or MRS provide information on metabolic and signaling pathways. Advanced MR sequences that target physiological parameters expand imaging options to characterize these tumors. By considering the parametric data from these three imaging approaches (anatomic, molecular, and physiological) we can better define specific tumor signatures. Such parametric characterization can provide insight into tumor metabolism, cellular density, protein expression, focal perfusion, and vascular permeability of these tumors. Radiogenomics research has already demonstrated ability to obtain information about cancer's genotype and phenotype; this is without invasive procedures or surgery. Further advances in these areas of experimental imaging hold promise to enable future clinical advances in detection and therapy of pancreatic cancer.

Multidetector computer tomography in the pancreatic adenocarcinoma assessment: an update

“…MDCT has become the modality of choice in the preoperative diagnosis and staging and in treatment planning and follow-up of patients with pancreatic tumors [5]. Since its introduction in clinical practice, volumetric CT scanning has revolutionized pancreatic imaging, although the greatest benefits have occurred with the development of MDCT.…”

“…A precise diagnosis of pancreatic tumor is not always simple because the tumor can have atypical imaging features and many other disorders may mimic pancreatic adenocarcinoma [3, 4]. Multidetector row (MD) CT has become the modality of choice in the preoperative diagnosis and staging of the disease and in treatment planning and follow-up in patients with pancreatic tumors [5]. Although many studies have investigated the effect of different techniques of contrast medium injection for improving the enhancement of the pancreas and peripancreatic vasculature during the pancreatic parenchymal phase [6–10], approximately 11% of ductal adenocarcinomas remain undetected at MDCT.…”

Background, current role, and potential applications of radiogenomics

“…Bai et al, in their review of the current state of radiogenomics research, which included studies employing a “radiomics approach to radiogenomics,” as well as studies that associated imaging features with specific genes and expression of specific gene subsets (eg, tumor molecular subtype), identified a total of 65 publications between 2007–2015. However, the field of radiogenomics is expected to grow rapidly as more discoveries are made in conjunction with technological innovation, with an increasing number of articles being published, mostly addressing challenges in oncology. Several articles on radiogenomics have been published in lung cancer, where the main imaging modality employed is computed tomography (CT).…”

Novel Diagnostic and Predictive Biomarkers in Pancreatic Adenocarcinoma

“…Other prognostic and predictive markers include estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor receptor 2 (HER2) for breast cancer, KRAS mutation for colon cancer, and anaplastic lymphoma kinase (ALK) mutation for lung cancer. However, no such effective screening technique or biomarker has been identified for PDAC at this time [9]. The goal of this review is to evaluate and understand current and emerging biochemical and imaging techniques that can provide important screening and predictive functions in the care of pancreatic cancer patients.…”