Background Few studies have focused on computed tomography findings before a pancreatic cancer diagnosis. We aimed to investigate the prediagnostic computed tomography findings of patients who had undergone computed tomography within the prediagnostic period of their pancreatic cancer diagnosis. Methods Between January 2008 and December 2019, 27 patients who underwent contrast-enhanced abdominal or chest computed tomography including the pancreas within 1 year of a pancreatic cancer diagnosis were enrolled in this retrospective study. The prediagnostic computed tomography imaging findings were divided into pancreatic parenchyma and pancreatic duct findings. Results All patients underwent computed tomography for reasons unrelated to pancreatic cancer. The pancreatic parenchyma and ducts showed normal findings in seven patients and abnormal findings in 20 patients. Hypoattenuating mass-like lesions were detected in nine patients with a median size of 1.2 cm. Six patients had focal pancreatic duct dilatations, and two patients had distal parenchymal atrophy. In three patients, two of these findings were found simultaneously. Taken together, 14 (51.9%) of 27 patients had findings suggestive of pancreatic cancer in prediagnostic computed tomography. Conclusions In contrast-enhanced computed tomography performed for other purposes, attention should be paid to the presence of a hypoattenuating mass, focal pancreatic duct dilatation, or distal parenchymal atrophy of the pancreas. These features may be clues for an early diagnosis of pancreatic cancer.

/pdf/suspicious-findings-observed-retrospectively-on-ct-imaging-2pq7drd3.pdf

Suspicious findings observed retrospectively on CT imaging performed before the diagnosis of pancreatic cancer

Objectives: The objectives of the study was to evaluate the diagnostic performance of findings on T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and magnetic resonance cholangiopancreatography (MRCP) separately and to identify an optimal Boolean interpretation model for discriminating patients with small pancreatic ductal adenocarcinoma (PDAC) from control groups in clinical practice. Material and Methods: We retrospectively enrolled 30 patients with surgery confirmed small PDAC (≤20 mm) and 302 patients without pancreatic abnormality between April 2008 and February 2020. The presence of masses was evaluated by T1WI, T2WI, and DWI. Abnormality of the main pancreatic duct (MPD) was evaluated by T2WI and MRCP. Multivariate logistic regression analysis was performed to select significant sequences for discriminating the small PDAC and control groups. Boolean operators “OR” or “AND” were used to construct sequence combinations. Diagnostic performances of these sequences and combinations were evaluated by X2 tests. Results: The sensitivity of T2WI was lowest (20%) for detecting masses. For evaluating MPD abnormality, sensitivity was higher for MRCP than for T2WI (86.7% vs. 53.3%). Multivariate logistic regression analysis showed that T1WI and DWI for detecting the presence of masses and MRCP for evaluating MPD abnormality were significantly associated with differentiation between the two groups (P = 0.0002, P = 0.0484, and P < 0.0001, respectively). Seven combinations were constructed with T1WI, DWI, and MRCP. The combination of findings on “T1WI or DWI or MRCP” achieved the highest sensitivity of 96.7% and negative predictive value of 99.6%. Conclusion: The combination of findings on “T1WI or DWI or MRCP” might be an optimal interpretation model for discriminating small PDAC from control groups in clinical practice.

Abnormal Findings on "T1WI or DWI or MRCP:" An Effective Boolean Interpretation Model in Discriminating Small Pancreatic Ductal Adenocarcinoma from Control Group.

Abstract: Pancreatic cancer is the fourth leading cancer-related cause of death throughout the world. Magnetic resonance imaging (MRI) is typically capable of quickly differentiating cystic from noncystic tumours due to the good soft tissue contrast resolution. Cystic tumours are frequently simple to identify with an MRI; however, non-cystic non-adenocarcinoma tumours can exhibit a wide range of imaging characteristics that may be mistaken for ductal adenocarcinoma. An effective method for identifying pancreatic lesions is MRI. This study investigates the current and recent evidence concerning the role of MRI in the diagnosis and staging of pancreatic cancer. PubMed, Web of Science, Science Direct, EBSCO, and Cochrane library were searched. Study articles were screened by title and abstract using Rayyan QCRI then a full-text assessment was implemented. A total of 7 studies were included, with 618 pancreatic cancer patients with different histopathological types. Most studies reported the benefits of MRI in the diagnosis and staging of pancreatic cancer and in identifying extra-abdominal metastases. Only one study found that MRI understaged the tumor size and did not detect the micro-infiltration of peri-pancreatic tissues. MRI has a significant role in diagnosing and staging pancreatic cancer. There have lately been substantial advancements in pancreatic imaging utilizing multiple imaging modalities, such as SG-KS-4D-MRI and DW imaging with traditional MR. 

Updates in The Role of MRI in Diagnosis and Staging of Pancreatic Cancer: A Systematic Review

Letter to the editor on "High signal intensity on diffusion-weighted magnetic resonance images is a useful finding for detecting early-stage pancreatic cancer".

Pancreatic cancer is a relatively common malignancy that carries a poor prognosis despite recent advances in medical and surgical treatment. Imaging plays an essential part in the diagnosis and staging of pancreatic carcinoma, specifically determining resectability. Multidetector CT is the most commonly used modality for staging of pancreatic cancer, given its temporal and spatial resolution. This is of utmost importance in determining vascular involvement, which is key to determining resectability. However, advances in MRI have made it an equivalent modality in diagnosis and staging, with advantages in assessing metastatic liver disease. Three-dimensional imaging techniques including cinematic rendering may also provide advantages for diagnosis, staging, and treatment planning. 

Radiologic Diagnosis of Pancreatic Cancer

Early detection of pancreatic ductal adenocarcinoma (PDAC) may improve the prognosis. We evaluated novel imaging findings that may contribute to early detection. This single-center, retrospective study enrolled 37 patients with a localized main pancreatic duct (MPD) stricture and no obvious pancreatic mass. All patients underwent endoscopic retrograde cholangiopancreatography and brush sampling with cytology and serial pancreatic juice aspiration cytologic examination via endoscopic naso-pancreatic drainage. Patients with cytology-confirmed malignancy underwent surgical resection. The remaining patients were followed by contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and endoscopic retrograde cholangiopancreatography. Twenty patients had confirmed malignancy (cancer group) and 17 did not (non-cancer group). Age, MPD stricture location, and PDAC risk factors were similar, but the sex predominance and symptom rate differed between the two groups. In the cancer group, 17 patients were diagnosed by cytology and three by clinical symptoms. CECT, MRI, and endoscopic ultrasonography (EUS) revealed no solid tumors in either group. CECT revealed no significant differences between groups. Diffusion-weighted MRI revealed significant differences in the signal intensity between groups. EUS detected indistinct and small hypoechoic areas in 70% and 41.2% of patients in the cancer and non-cancer groups, respectively. In the cancer group, 11 were diagnosed with cancer at the first indication, and nine were diagnosed at follow-up; the prognosis did not differ between these two subgroups.ss High signal intensity in diffusion-weighted MRI may be useful for detecting early-stage PDAC and may be an indication for surgical resection even without pathologic confirmation. The study was a registered at the University Hospital Medical Information Network (UMIN000039623).

/pdf/high-signal-intensity-on-diffusion-weighted-magnetic-3aqoeknn2w.pdf

High signal intensity on diffusion-weighted magnetic resonance images is a useful finding for detecting early-stage pancreatic cancer.

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High signal intensity on diffusion-weighted magnetic resonance images is a useful finding for detecting early-stage pancreatic cancer.