CT and MRI features of pancreatic adenocarcinoma
What is pancreatic adenocarcinoma, and what are its CT and MRI features?
Pancreatic adenocarcinoma is the most common pancreatic malignancy, the most common cause of a solid pancreatic mass, and the fourth leading cause of cancer death in the United States. It occurs more commonly in men than in women, predominantly occurs in older adults, usually presents with advanced unresectable disease, and is associated with a poor prognosis.
A pancreatic mass with poorly defined borders is seen, sometimes in association with a focal contour abnormality, typically with soft tissue attenuation, low-intermediate signal intensity on T1-weighted images, and intermediate-slightly high signal intensity on T2-weighted images, as well as hypoenhancement on arterial phase contrast-enhanced images (secondary to presence of desmoplastic stroma). Sometimes, cystic or necrotic change within the mass may be present, which appears as nonenhancing components with attenuation and signal intensity characteristics similar to fluid. About 70% arise in the pancreatic head, with the remainder occurring in other regions of the pancreas. Associated features such as biliary ductal dilation, upstream pancreatic ductal dilation often with abrupt transition (the “interrupted duct” sign), upstream pancreatic parenchymal atrophy, local invasion of surrounding organs and tissues, regional lymphadenopathy, and distant metastatic disease may sometimes be encountered as well