Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
Diagnostic Medical Imaging, IRCCS SDN, Naples, Italy.
Abdom Radiol (NY). 2020 Mar;45(3):729-742. doi: 10.1007/s00261-019-02290-y.
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive gastrointestinal malignancy with a poor 5-year survival rate. Its high mortality rate is attributed to its aggressive biology and frequently late presentation. While surgical resection remains the only potentially curative treatment, only 10-20% of patients will present with surgically resectable disease. Over the past several years, development of vascular bypass graft techniques and introduction of neoadjuvant treatment regimens have increased the number of patients who can undergo resection with a curative intent. While the role of conventional imaging in the detection, characterization, and staging of patients with PDAC is well established, its role in monitoring treatment response, particularly following neoadjuvant therapy remains challenging because of the complex anatomic and histological nature of PDAC. Novel morphologic and functional imaging techniques (such as DECT, DW-MRI, and PET/MRI) are being investigated to improve the diagnostic accuracy and the ability to measure response to therapy. There is also a growing interest to detect PDAC and its precursor lesions at an early stage in asymptomatic patients to increase the likelihood of achieving cure. This has led to the development of pancreatic cancer screening programs. This article will review recent updates in imaging techniques and the current status of screening and surveillance of individuals at a high risk of developing PDAC.
胰腺导管腺癌(PDAC)是一种侵袭性的胃肠道恶性肿瘤,其 5 年生存率较低。其高死亡率归因于其侵袭性生物学和经常出现的晚期表现。虽然手术切除仍然是唯一潜在的治愈性治疗方法,但只有 10-20%的患者会出现可手术切除的疾病。在过去的几年中,血管旁路移植技术的发展和新辅助治疗方案的引入增加了可以进行根治性切除的患者数量。虽然常规成像在检测、特征描述和分期 PDAC 患者方面的作用已得到充分确立,但由于 PDAC 的复杂解剖学和组织学性质,其在监测治疗反应方面的作用(特别是在新辅助治疗后)仍然具有挑战性。新型形态和功能成像技术(如 DECT、DW-MRI 和 PET/MRI)正在被研究,以提高诊断准确性和测量对治疗反应的能力。人们也越来越有兴趣在无症状患者中早期发现 PDAC 及其前体病变,以增加治愈的可能性。这导致了胰腺癌筛查计划的发展。本文将综述成像技术的最新进展以及对高危人群进行 PDAC 筛查和监测的现状。