Solid pancreatic tumors encompass a variety of neoplasms with characteristic imaging features. Pancreatic ductal adenocarcinoma (PDAC) is the most common solid tumor associated with extremely poor prognosis with low resection rates and poor post-surgical survival. Dual-phase computed tomography (CT) (pancreatic protocol) is the primary imaging modality for assessment of resectability of these tumors with the tumor showing hypo-enhancement on the arterial phase. Dual-energy CT further increases the tumor conspicuity and improves the detection rate. Multimodality approaches including magnetic resonance imaging with diffusion-weighted imaging and endoscopic ultrasound are useful adjuncts to CT and are used in indeterminate cases. A structured radiological reporting format should be used for accurate staging and predicting resectability. Other solid pancreatic tumors can be differentiated from PDAC by certain key imaging features like post-contrast hyperenhancement in neuroendocrine tumors along with typical clinical features in functional tumors, demographic clues like young female with a solid cystic tumor in solid pseudopapillary tumor, pediatric age in pancreatoblastoma, large size with the absence of duct obstruction in pancreatic lymphoma, and history of a primary tumor in pancreatic metastases. Benign mimics of solid tumors include focal/autoimmune pancreatitis and intrapancreatic splenule. This chapter aims to provide a comprehensive and lucid understanding of the imaging approach to solid pancreatic tumors.

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Approach to Solid Pancreatic Tumors

  • Smily Sharma,
  • Taruna Yadav

摘要

Solid pancreatic tumors encompass a variety of neoplasms with characteristic imaging features. Pancreatic ductal adenocarcinoma (PDAC) is the most common solid tumor associated with extremely poor prognosis with low resection rates and poor post-surgical survival. Dual-phase computed tomography (CT) (pancreatic protocol) is the primary imaging modality for assessment of resectability of these tumors with the tumor showing hypo-enhancement on the arterial phase. Dual-energy CT further increases the tumor conspicuity and improves the detection rate. Multimodality approaches including magnetic resonance imaging with diffusion-weighted imaging and endoscopic ultrasound are useful adjuncts to CT and are used in indeterminate cases. A structured radiological reporting format should be used for accurate staging and predicting resectability. Other solid pancreatic tumors can be differentiated from PDAC by certain key imaging features like post-contrast hyperenhancement in neuroendocrine tumors along with typical clinical features in functional tumors, demographic clues like young female with a solid cystic tumor in solid pseudopapillary tumor, pediatric age in pancreatoblastoma, large size with the absence of duct obstruction in pancreatic lymphoma, and history of a primary tumor in pancreatic metastases. Benign mimics of solid tumors include focal/autoimmune pancreatitis and intrapancreatic splenule. This chapter aims to provide a comprehensive and lucid understanding of the imaging approach to solid pancreatic tumors.