Pancreatic adenocarcinoma |
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Authors: | Wolfgang Schima Ahmed Ba-Ssalamah Claus Kölblinger Christiane Kulinna-Cosentini Andreas Puespoek Peter Götzinger |
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Institution: | (1) Department of Radiology, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria;(2) Department of Internal Medicine 4, Division of Gastroenterology and Hepatology, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria;(3) Department of Surgery, Medical University of Vienna, Austria, Waehringer Guertel 18–20, 1090 Vienna, Austria |
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Abstract: | Adenocarcinoma is the most common malignant pancreatic tumor, affecting the head of the pancreas in 60–70% of cases. By the
time of diagnosis, at least 80% of tumors are unresectable. Helical computed tomography (CT) is very effective in detecting
and staging adenocarcinoma, with a sensitivity of up to 90% for detection and an accuracy of 80–90% for staging, but it has
limitations in detecting small cancers. Moreover, it is not very accurate for determining nonresectability because small liver
metastases, peritoneal carcinomatosis, and subtle signs of vascular infiltration may be missed. Multidetector-row CT (MDCT)
has brought substantial improvements with its inherent ability to visualize vascular involvement in three dimensions. MDCT
has been found to be at least equivalent to contrast-enhanced magnetic resonance imaging (MRI) for detecting adenocarcinoma.
MRI can be used as a problem-solving tool in equivocal CT: MRI may help rule out pitfalls, such as inflammatory pseudotumor,
focal lipomatosis, abscess, or cystic tumors. Mangafodipir-enhanced MRI reveals a very high tumor-pancreas contrast, which
helps in diagnosing small cancers. Endosonography is, if available, also a very accurate tool for detecting small cancers,
with a sensitivity of up to 98%. It is the technique of choice for image-guided biopsy if a histologic diagnosis is required
for further therapy. |
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Keywords: | Pancreas Tumor Adenocarcinoma MDCT MR imaging Gadolinium Mangafodipir trisodium |
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