The Case for MDCT

Multidetector CT (MDCT) examination with multiphasic acquisition should be advocated as routine study in patient investigated for pancreatic adenocarcinoma. The application of a biphasic protocol gives the best results, using a pancreatic phase for tumor identification and arterial infiltration, and portal phase for the assement of venous infiltration and liver metastasis. Pancreatic adenocarcinoma is classically visualized as an ill-defined solid mass, not capsulated, isodense to the pancreatic parenchyma in pre-contrast scan and hypo-attenuating in the pancreatic-portal phases. Ancillary signs can be helpful in the diagnosis of small tumors (< 2 cm) and isoattenuating adenocarcinoma. Several benign and malignant condition can mimick adenocarcinoma, in this case magnetic resonance and endoscopic ultrasonography biopsy can be helpful in diagnosis. MDCT enables an accurate tumor staging and presents a positive predictive values for unresectability between 89% to 100%; it also allows a complete preoperative planning and presents high accuracy both in surgical complications and tumor recurrence detection.