Review Note

Last Update: 02/18/2024 05:30 AM

Current Deck: Part 2::1. Subsites::Gastrointestinal tract::Pancreatic cancer::Exocrine pancreas

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Front
GI | Pancreas | Exocrine | 2.4 | Imaging appearance | Briefly describe the appearance of pancreatic cancer on abdominal ultrasound, CT, ERCP and MRI
Back
Appearance on imaging
Imaging modalityAppearance of pancreatic cancerSensitivity
Abdominal ultrasoundHypoechoic, hypovascular solid mass with irregular margins;
Dilated bile ducts may also be present
95% for tumours >3cm; much lower for smaller tumours
Abdominal CTIll-defined, hypoattenuating mass within the pancreas.
Smaller lesions may be isoattenuating (difficult to identify, esp. non non-contrast CT);
Tumour enhances poorly compared to adjacent normal pancreatic tissue and thus appears hypodense on arterial pahse scans, may become isodense on delayed scans;
Secondary signs incl. "double duct sign"
Triple phase ("pancreatic protocol") CT most sensitive.
100% for >2cm;
75% for <2cm
ERCP (endoscopic retrograde cholangiopancreatography)Stricture in pancreatic duct. Obstruction/dilation of CBD+pancreatic duct (double duct sign); May miss tumours in uncinate process, accessory duct and tail
MRIT1/T1 FS: Hypointense cf. normal pancreas;
T1+C" Slower enhancement than normal pancreas;
T2/FLAIR: not useful;
MRCP: double duct sign may be seen

Double duct sign: Dilation of both the pancreatic duct and common bile duct, seen in ~70% but not diagnostic. Can also be seen in 50% of ampullary carcinomas, and occasionally in benign adenomas and autoimmune pancreatitis
Further information, not for memorising (no card)
Exam

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