Mri Imaging of Pancreatic Disease

Pancreatic imaging is an essential tool in the early diagnosis and staging of pancreatic disease. This presentation reviews the most recent advances in pancreatic MR imaging. The specific modalities discussed include magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP), before and after secretin stimulation. Introduction With the advent of newer imaging techniques, radiologists can now choose among several noninvasive imaging modalities for evaluating patients with suspected pancreatic disorders. Pancreatic imaging is an essential tool in reaching early diagnosis of pancreatic diseases, particularly pancreatic adenocarcinoma, where early diagnosis may lead to improved survival among patients whose prognosis would otherwise be dismal. Unfortunately, preoperative imaging based staging has two major limiting factors: (1) the inability to accurately judge the degree of tumor invasion or encasement of vascular structures and (2) the sometimes subtle extension of the tumor into surrounding peripancreatic tissues and invasion of non enlarged lymph nodes. In this presentation, the MR imaging findings of pancreatic adenocarcinoma and other pancreatic neoplasms, such as endocrine tumors and cystic neoplasms, are illustrated. Furthermore, the imaging characteristics of inflammatory processes, such as chronic and acute pancreatitis, are also highlighted. Magnetic Resonance Imaging Pancreatic Ductal Adenocarcinoma With recent advances in examination techniques, the diagnosis of ductal adenocarcinoma using MRI has improved. Actually, detection of pancreatic adenocarcinoma is based on non-contrast T1 weighted fat-suppressed images and immediate post-gadolinium T1-weighted spoiled gradient echo images. Pancreatic cancer appears as low signal-intensity masses on T1-weighted fat suppressed images, and small tumors are clearly separated from normal pancreatic tissue, which is high in signal intensity. Post-gadolinium breath-hold gradient echo images are key to detect both hepatic metastases as well as small pancreatic tumors. Recent studies have compared the accuracy of MRI in staging pancreatic carcinoma with helical CT. With breath-hold imaging and the use of phased array coils dynamic MRI was shown superior to helical CT in determining the degree of tumor extension, while both modalities performed