Imaging Methods for Pancreatic Neoplasms

Imaging of pancreatic neoplasms is complex and insidious, requiring a deep knowledge of radiological techniques but also a very thorough knowledge of pancreatic pathology, its management, its risk factors, and possible complications. Although the in-depth evaluation of pancreatic imaging is often reserved for a few reference centers, every radiologist should know the main imaging features of pancreatic diseases, being able to distinguish benign from malignant pathology, using the correct imaging methods, and directing the patient to the most correct diagnostic and therapeutic process. US is easy and fast to be performed, low-cost, but has a limited field of view and is limited by the interposition of gas and fat. Contrast-enhanced CT is the gold standard for the staging of solid pancreatic neoplasms, with its large scan volume, but employs ionizing radiation and is contraindicated in patients with renal failure or allergies to iodinated contrast. MRI is the gold standard for the characterization of cystic lesions and is the exam with the highest tissue contrast resolution, but is very expensive and requires excellent cooperation from the patient. This chapter provides a general overview of the main radiological methods used in pancreatic imaging, from the most consolidated and universally available to the most modern developments of these.