New insight of pancreatic imaging: from "unexplored" to "explored"

Abstract

Pancreatic cancer remains one of the most difficult neoplasms for early diagnosis and treatment. Recent advances of imaging including 3D volume data setting in multidetector-row CT (MDCT) and MRI are urging us to focus on the imaging of normal and pathological conditions of pancreatic parenchyme and peripancreatic structures, which are frequently involved by pancreatic cancers and are affecting the prognosis of patients with pancreatic cancers. In this Feature Section, five main topics of pancreatic imaging are addressed: pancreatic arterial territories, imaging of the intra- and peripancreatic venous anatomy and its clinical significance, imaging of the peripancreatic lymphatic network and its clinical significance for staging of pancreatic cancer, perfusion characteristics of pancreatic cancer to differentiate chronic mass-forming pancreatitis, and development of intraductal papillary mucinus neoplasms of the pancreas (IPMNs) to adenocarcinoma and pancreatic invasion. Recognition and understanding of the imaging anatomy of the pancreas might lead to precise staging of pancreatic cancer and to new approaches of less-invasive treatment. Follow-up of patients with IPMNs of the pancreas on imaging seems, at this time, to be the most valuable strategy in the high-risk group selection.

Fig. 1

Pancreas as unexplored territory. Upper row: Japanese Kanji (Chinese character) representing pancreas means “an organ consisting of glands.” Lower row: Chinese character representing pancreas means “ an organ of remote region” or “ an organ of unexplored territory”.

Fig. 2

Lymphatic spread of pancreatic cancer. Axial images of postcontrast CT showed some linear areas of increased attenuation (arrows, b) in the retroperitoneal fat planes which are contiguous to the cancer of pancreatic tail (CA, a, b). Resected specimen revealed cancer invasion along the lymphatic channels (arrows, c) which are contiguous to the cancer of the tail (CA, c). The foci of cancer cells in the peripancreatic fat are associated with fibrous stroma similar to the primary cancer (CA, c).