Magnetic Resonance Imaging of Adenocarcinoma of the Pancreas
Technical advances of magnetic resonance imaging (MRI), including ultrahigh-field magnetic resonance at 3.0 T, parallel imaging techniques, and multichannel receive coils of the abdomen, are valuable tools in the assessment of the pancreatic disease. A st
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Abstract Technical advances of magnetic resonance imaging (MRI), including ultrahigh-field magnetic resonance at 3.0 T, parallel imaging techniques, and multichannel receive coils of the abdomen, are valuable tools in the assessment of the pancreatic disease. A standard MR protocol including non-contrast T1-weighted fat-suppressed and dynamic gadolinium-enhanced gradient-echo imaging is sensitive for the evaluation of pancreatic cancer. Optimal use of MRI in the investigation of pancreatic cancer occurs in the following circumstances: (1) detection of small non-contour deforming tumors, (2) evaluation of local extension and vascular encasement, (3) determination of the presence of lymph node and peritoneal metastases, and (4) determination and characterization of associated liver lesions and liver metastases.
Introduction Epidemiology and Risk Factors Pancreatic ductal adenocarcinoma, referring to carcinoma arising in the exocrine portion of the gland, accounts for 95 % of malignant tumors of the pancreas and is the fourth most common cause of cancer death in the United States [1]. The lesion is more common in men and blacks, most frequently in the eighth decade of the life [2, 3]. Several predisposing factors have been related with an increased incidence of pancreatic cancer. Heavy alcohol drinking may result in chronic pancreatitis, which R.C. Semelka, M.D. (*) • L.A. Escobar, M.D. • N. Al Ansari, M.D. • C.T.A. Semelka, B.Sc. UNC Department of Radiology, 101 Manning Drive, CB# 7510 2001 Old Clinic Bldg, Chapel Hill, NC 27599-7510, USA e-mail: [email protected]; [email protected]; [email protected]; [email protected] A.S. El-Baz et al. (eds.), Abdomen and Thoracic Imaging: An Engineering & Clinical Perspective, DOI 10.1007/978-1-4614-8498-1_8, © Springer Science+Business Media New York 2014
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Fig. 1 Pancreatic cancer, arising in the head of the pancreas with biliary tree dilatation and main pancreatic duct dilatation, “double duct sign.” Immediate postgadolinium T1-weighted fat-suppressed SGE images (a) fat-suppressed T2-weighted SS-ETSE, (b) coronal T2-weighted SS-ETSE (c) thick section MRCP (d). A 2-cm tumor is shown in the pancreatic head with minimal peripheral enhancement on the early post-contrast images (arrow (a)), causing proximal dilatation and abrupt distal narrowing of the common bile duct (CBD), with simultaneous dilatation of the main pancreatic duct (MPD), which represents the “double duct sign” (d)
is a risk factor for pancreatic cancer. A strong family history of pancreatic cancer is also likely a risk factor, although the association is not as great as for breast or colon cancer. Pancreatic adenocarcinoma has a poor prognosis, with a 5-year survival rate of only 5 % [2, 3]. Approximately 60–70 % of pancreatic adenocarcinomas involve the pancreatic head (Fig. 1), 10–20 % area located in the body (Fig. 2) and 5–10 % in the tail. Diffuse glandular involvement occurs in 5 % of cases [4]. Pancreatic cancer arising in the head of the pancreas may cause obstru
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