AMERICAN RADIOLOGY SERVICES

CT Detects Pancreatic Tumors

By: Kara Waters, M.D.

Pancreatic cancer has recently been a hot topic in the mainstream news with the unfortunate passing of Patrick Swayze. Each year in the United States over 43,000 people are diagnosed with pancreatic cancer and there is a parallel mortality rate. Although life expectancy in these patients has historically been very short, less than 5% survival after 5 years, pancreatic cancer awareness, rapid detection, and early surgical intervention are truly the mainstays for prolonging life and achieving long-term survival while maintaining quality of life.

Pancreatic cancer has long been heralded as a "silent killer" because not infrequently the cancer develops in an area of the pancreas that does not cause symptoms until late-stage and oftentimes the disease has metastasized, spread to distant sites in the body. Symptoms may include painless yellowing of the skin or jaundice, loss of appetite, unintended weight loss, depression, unexpected onset of diabetes, darkening of the urine and lightening of stool, and abdominal pain.

Although there are a number of radiology modalities that are capable of imaging pancreatic tumors such as ultrasound, Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET), Computed Tomography (CT) is considered the gold standard for detecting pancreatic tumors, evaluating for metastatic disease, and determining vascular invasion, all of which will guide treatment and aid surgeons in determining tumor resectability. Many radiology practices now offer CT scans using state-of-the-art 64 slice scanners which can produce very high-quality images in a matter of seconds.

The hallmark of imaging pancreatic tumors relies on the use of a contrast agent that is administered intravenously. The premise of using intravenous contrast is that organs enhance differently depending on their blood supply and vascularity. The same holds true for pancreatic tumors which enhance differently than the adjacent normal pancreatic tissue. Extensive research has shown that optimal visualization of many pancreatic tumors is best achieved using a very specific technique which relies on imaging the pancreas immediately after administering the IV contrast, during the arterial phase. A second CT is performed once the contrast has entered the venous system. This very specific protocol is called "dual-phase" imaging and has been shown to accurately diagnose pancreatic neoplasms with a 97% accuracy rate when interpreted by a Board certified radiologist.

If a pancreatic tumor is suspected by symptoms, history, and physical examination, a dual-phase CT of the abdomen and pelvis should be promptly considered in an effort to rapidly diagnose this aggressive neoplasm and assess for metastatic disease which will help guide treatment and ultimately save a life.

For more information regarding pancreatic cancer symptoms, diagnosis, imaging, and treatment, please view the following:

American Cancer Society: http://www.cancer.org
Emedicine: http://www.emedicinehealth.com
National Cancer Institute: http://www.cancer.gov/cancertopics/types/pancreatic
Pancreatic Cancer: value of dual-phase helical CT in assessing respectability: http://radiology.rsna.org/content/206/2/373.abstract