Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Abdom Radiol (NY). 2020 Feb;45(2):457-478. doi: 10.1007/s00261-019-02390-9.
Multidetector computed tomography (MDCT) is a widely used cross-sectional imaging modality for initial evaluation of patients with suspected pancreatic ductal adenocarcinoma (PDAC). However, diagnosis of PDAC can be challenging due to numerous pitfalls associated with image acquisition and interpretation, including technical factors, imaging features, and cognitive errors. Accurate diagnosis requires familiarity with these pitfalls, as these can be minimized using systematic strategies. Suboptimal acquisition protocols and other technical errors such as motion artifacts and incomplete anatomical coverage increase the risk of misdiagnosis. Interpretation of images can be challenging due to intrinsic tumor features (including small and isoenhancing masses, exophytic masses, subtle pancreatic duct irregularities, and diffuse tumor infiltration), presence of coexisting pathology (including chronic pancreatitis and intraductal papillary mucinous neoplasm), mimickers of PDAC (including focal fatty infiltration and focal pancreatitis), distracting findings, and satisfaction of search. Awareness of pitfalls associated with the diagnosis of PDAC along with the strategies to avoid them will help radiologists to minimize technical and interpretation errors. Cognizance and mitigation of these errors can lead to earlier PDAC diagnosis and ultimately improve patient prognosis.
多排螺旋计算机断层扫描（MDCT）是一种广泛应用于疑似胰腺导管腺癌（PDAC）患者初始评估的横断面成像方式。然而，由于与图像采集和解释相关的许多陷阱，包括技术因素、成像特征和认知错误，PDAC 的诊断具有挑战性。准确的诊断需要熟悉这些陷阱，因为可以通过系统策略将这些陷阱最小化。次优的采集方案和其他技术错误，如运动伪影和不完全的解剖覆盖，增加了误诊的风险。由于肿瘤的固有特征（包括小而等增强肿块、外生性肿块、细微的胰管不规则和弥漫性肿瘤浸润）、共存病变的存在（包括慢性胰腺炎和胰管内乳头状黏液性肿瘤）、PDAC 的类似物（包括局灶性脂肪浸润和局灶性胰腺炎）、干扰性发现和搜索满足，图像的解释具有挑战性。了解与 PDAC 诊断相关的陷阱以及避免这些陷阱的策略将有助于放射科医生最大限度地减少技术和解释错误。认识和减轻这些错误可以导致更早的 PDAC 诊断，并最终改善患者的预后。
