Editorial for "MRI vs. CT for the Detection of Liver Metastases in Patients With Pancreatic Carcinoma: A Comparative Diagnostic Test Accuracy Systematic Review and Meta-Analysis"

The Clinical Diagnostic Value of F-FDG PET/CT Combined with MRI in Pancreatic Cancer

Pancreatic cancer is a common gastrointestinal tumor with increasing morbidity and mortality, and it is difficult to differentiate it from chronic mass pancreatitis. F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) can be used for diagnosis of pancreatic cancer, staging, radiotherapy planning, evaluation of efficacy and recurrence, and differentiation from posttreatment fibrosis but the sensitivity and specificity of diagnosis of chronic pancreatitis are poor. Magnetic resonance imaging (MRI) not only shows the morphology, location, and size of organs and lesions but also has the advantages of low radiation, high soft tissue contrast, and multiparameter imaging, which can help determine the nature of occupying pancreatic lesions. In this study, the watershed algorithm (WA) was used to segment the abdominal images to extract images of pancreatic cancer cells and to compare the value of F-FDG PET/CT combined with MRI in the diagnosis of pancreatic occupying lesions.

Imaging Assessment of Pancreatic Cancer Resectability After Neoadjuvant Therapy: AJR Expert Panel Narrative Review

Despite important innovations in the treatment of pancreatic ductal adenocarcinoma (PDAC), PDAC remains a disease with poor prognosis and high mortality. A key area for potential improvement in the management of PDAC, aside from earlier detection in patients with treatable disease, is the improved ability of imaging techniques to differentiate treatment response after neoadjuvant therapy (NAT) from worsening disease. It is well established that current imaging techniques cannot reliably make this distinction. This narrative review provides an update on the imaging assessment of pancreatic cancer resectability after NAT. Current definitions of borderline resectable PDAC, as well as implications for determining likely patient benefit from NAT, are described. Challenges associated with PDAC pathologic evaluation and surgical decision making that are of relevance to radiologists are discussed. Also explored are the specific limitations of imaging in differentiating the response after NAT from stable or worsening disease, including issues relating to protocol optimization, tumor size assessment, vascular assessment, and liver metastasis detection. The roles of MRI as well as PET and/or hybrid imaging are considered. Finally, a short PDAC reporting template is provided for use after NAT. The highlighted methods seek to improve radiologists' assessment of PDAC treatment response after NAT.