Pancreatic Cancer

Preliminary Diagnosis: Pancreatic Cancer

I. What imaging technique is first-line for this diagnosis?

• Pancreatic protocol CT abdomen and pelvis with and without contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of pancreatic cancer.

Advantages

• Enhancement patterns are often characteristic of different pancreatic neoplastic lesions, which may narrow the diagnosis

• Simultaneously evaluates the liver for metastatic disease and demonstrates intra- or extrahepatic biliary ductal dilation due to tumor mass effect

Disadvantages

• Administration of iodinated contrast may result in worsening renal function (contrast nephropathy) in patients with renal insufficiency. Contrast dose should be reduced or withheld in these patients

• Exposure to ionizing radiation

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III. What are the contraindications for the first-line imaging technique?

• History of allergic reaction to IV contrast requires pretreatment for a minimum of 13 hours with steroids and antihistamines

• Pregnant patients should not undergo CT

IV. What alternative imaging techniques are available?

• MRI abdomen with contrast, magnetic resonance cholangiopancreatography (MRCP)

• Abdominal ultrasound

• Endoscopic ultrasound

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of pancreatic cancer.

MRI/MRCP

Advantages

• Able to show level and degree of ductal obstruction

• Less invasive than ERCP

• Does not require sedation

Disadvantages

• Expensive

• Time consuming

• Requires significant patient cooperation to minimize motion artifact

Abdominal Ultrasound

Advantages

• Does not use ionizing radiation

• Quick and inexpensive exam

Disadvantages

• Does not provide the level of anatomic detail needed for surgical planning (eg, degree of vascular involvement)

• Less sensitive in evaluating the liver for metastatic disease

Endoscopic Ultrasound

Advantages

• Does not use ionizing radiation

• May get better images of pancreas than abdominal ultrasound

Disadvantages

• Invasive procedure

• Requires sedation

VI. What are the contraindications for the alternative imaging techniques?

MRI/MRCP

• Contraindicated in patients with non–MRI-approved metallic devices

• Gadolinium contrast is contraindicated in patients with decreased renal function (GFR <30-40 mL/min/1.73m2) due to risk of nephrogenic systemic fibrosis

Abdominal Ultrasound

• There are no contraindications to ultrasound

Endoscopic Ultrasound

• Contraindicated in patients that are at risk for perforation

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