Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

Elbanna, Khaled Y.; Jang, Hyun-Jung; Kim, Tae Kyoung

doi:10.1186/s13244-020-00861-y

Cited by 162Pancreatic and Hepatic Oncology ResearchMRI in cancer diagnosisMedical Imaging Techniques and Applications

Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

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Elbanna, Khaled Y., Jang, Hyun-Jung, Kim, Tae Kyoung·2020·Insights into Imaging

DOI 10.1186/s13244-020-00861-yPMC PMC7183518

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Abstract

Pancreatic ductal adenocarcinoma (PDAC) has continued to have a poor prognosis for the last few decades in spite of recent advances in different imaging modalities mainly due to difficulty in early diagnosis and aggressive biological behavior. Early PDAC can be missed on CT due to similar attenuation relative to the normal pancreas, small size, or hidden location in the uncinate process. Tumor resectability and its contingency on the vascular invasion most commonly assessed with multi-phasic thin-slice CT is a continuously changing concept, particularly in the era of frequent neoadjuvant therapy. Coexistent celiac artery stenosis may affect the surgical plan in patients undergoing pancreaticoduodenectomy. In this review, we discuss the challenges related to the imaging of PDAC. These include radiological and clinical subtleties of the tumor, evolving imaging criteria for tumor resectability, preoperative diagnosis of accompanying celiac artery stenosis, and post-neoadjuvant therapy imaging. For each category, the key imaging features and potential pitfalls on cross-sectional imaging will be discussed. Also, we will describe the imaging discriminators of potential mimickers of PDAC.

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MPD abnormalities are not specific to PDAC and are often observed in benign pancreatic diseases.
“However, MPD abnormalities are not specific to PDAC and are often observed in benign pancreatic diseases.”
From Focal Parenchymal Atrophy of the Pancreas Is Frequently Observed on Pre-Diagnostic Computed Tomography in Patients with Pancreatic Cancer: A Case-Control Study (2021) · cites this paper as [11]

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From Machine Learning to Patient Outcomes: A Comprehensive Review of AI in Pancreatic Cancer
Tripathi, S., Tabari, A., Mansur, A., Dabbara, H., Bridge, C. P., & Daye, D. (2024) · Diagnostics · doi:10.3390/diagnostics14020174 · Cited by 64 · see citing works
Computed tomography-based radiomics approach in pancreatic tumors characterization
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Targeted Nanoparticle-Based Diagnostic and Treatment Options for Pancreatic Cancer
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Yield of Staging Laparoscopy for Pancreatic Cancer in the Modern Era: Analysis of More than 1,000 Consecutive Patients
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Clinical features and prognostic impact of asymptomatic pancreatic cancer
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Towards Generalizable Tumor Synthesis
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Focal Parenchymal Atrophy of the Pancreas Is Frequently Observed on Pre-Diagnostic Computed Tomography in Patients with Pancreatic Cancer: A Case-Control Study
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Locally Advanced Pancreatic Ductal Adenocarcinoma: Challenges and Progress
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Improved Pancreatic Cancer Detection and Localization on CT Scans: A Computer-Aided Detection Model Utilizing Secondary Features
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Annotation-Efficient Deep Learning Model for Pancreatic Cancer Diagnosis and Classification Using CT Images: A Retrospective Diagnostic Study
Viriyasaranon, T., Chun, J. W., Koh, Y., Cho, J.-H., Jung, M., Kim, S.-H., Kim, H. J., Lee, W.-J., Choi, J.-H., & Woo, S. (2023) · Cancers · doi:10.3390/cancers15133392 · Cited by 35 · see citing works
White paper on pancreatic ductal adenocarcinoma from society of abdominal radiology’s disease-focused panel for pancreatic ductal adenocarcinoma: Part II, update on imaging techniques and screening of pancreatic cancer in high-risk individuals
Kulkarni, N. M., Mannelli, L., Zins, M., Bhosale, P., Arif‐Tiwari, H., Brook, O. R., Hecht, E. M., Kastrinos, F., Wang, Z. J., Soloff, E. V., et al. (2019) · Abdominal Radiology · doi:10.1007/s00261-019-02290-y · Cited by 33 · see citing works
Plasma miRNA Biomarkers in Limited Volume Samples for Detection of Early-stage Pancreatic Cancer
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Early Detection of Pancreatic Cancer: Current Advances and Future Opportunities
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Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: Role of the Radiologist and Oncologist in the Era of Precision Medicine
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Overcoming the Fibrotic Fortress in Pancreatic Ductal Adenocarcinoma: Challenges and Opportunities
Min, K. K. M., Ffrench, C. B., Jessup, C. F., Shepherdson, M., Barreto, S. G., & Bonder, C. S. (2023) · Cancers · doi:10.3390/cancers15082354 · Cited by 31 · see citing works
Unravelling the complexities of resistance mechanism in pancreatic cancer: Insights from in vitro and ex-vivo model systems
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Deuterium MRSI characterizations of glucose metabolism in orthotopic pancreatic cancer mouse models
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Automatic Detection of Pancreatic Lesions and Main Pancreatic Duct Dilatation on Portal Venous CT Scans Using Deep Learning
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Prognostic role of cell-free DNA biomarkers in pancreatic adenocarcinoma: A systematic review and meta–analysis
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Use of individualized 3D-printed models of pancreatic cancer to improve surgeons’ anatomic understanding and surgical planning
Song, C., Min, J. H., Jeong, W. K., Kim, S. H., Heo, J. S., Han, I. W., Shin, S. H., Yoon, S. J., Choi, S., & Moon, S.-J. (2023) · European Radiology · doi:10.1007/s00330-023-09756-0 · Cited by 27 · see citing works
nnU-Net-Based Pancreas Segmentation and Volume Measurement on CT Imaging in Patients with Pancreatic Cancer
Yang, E., Kim, J., Min, J. H., Jeong, W. K., Hwang, J. A., Lee, J. H., Shin, J., Kim, H., Lee, S. E., & Baek, S. (2024) · Academic Radiology · doi:10.1016/j.acra.2024.01.004 · Cited by 26 · see citing works
Pancreatic Ductal Adenocarcinoma: Relating Biomechanics and Prognosis
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Artificial intelligence and imaging for risk prediction of pancreatic cancer: a narrative review
Qureshi, T. A., Javed, S., Sarmadi, T., Pandol, S. J., & Li, D. (2022) · Chinese Clinical Oncology · doi:10.21037/cco-21-117 · Cited by 27 · see citing works
Computer-Aided Detection for Pancreatic Cancer Diagnosis: Radiological Challenges and Future Directions
Ramaekers, M., Viviers, C. G. A., Janssen, B. V., Hellström, T. A. E., Ewals, L. J. S., van der Wulp, K., Nederend, J., Jacobs, I., Pluyter, J. R., Mavroeidis, D., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12134209 · Cited by 26 · see citing works
Exosomes as prognostic biomarkers in pancreatic ductal adenocarcinoma—a systematic review and meta-analysis
Bunduc, Ș., Gede, N., Váncsa, S., Lillik, V., Kiss, S., Juhász, M. F., Erőss, B. M., Szakács, Z., Gheorghe, C., Mikó, A., et al. (2022) · Translational research · doi:10.1016/j.trsl.2022.01.001 · Cited by 25 · see citing works
Immuno-PET and Targeted α-Therapy Using Anti–Glypican-1 Antibody Labeled with89Zr or211At: A Theranostic Approach for Pancreatic Ductal Adenocarcinoma
Watabe, T., Kabayama, K., Naka, S., Yamamoto, R., Kaneda‐Nakashima, K., Serada, S., Ooe, K., Toyoshima, A., Wang, Y., Haba, H., et al. (2023) · Journal of Nuclear Medicine · doi:10.2967/jnumed.123.266313 · Cited by 24 · see citing works
Focal Parenchymal Atrophy and Fat Replacement Are Clues for Early Diagnosis of Pancreatic Cancer with Abnormalities of the Main Pancreatic Duct
Miura, S., Kume, K., Kikuta, K., Hamada, S., Takikawa, T., Yoshida, N., Hongo, S., Tanaka, Y., Matsumoto, R., Sano, T., et al. (2020) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.252.63 · Cited by 22 · see citing works
High-performance Collective Biomarker from Liquid Biopsy for Diagnosis of Pancreatic Cancer Based on Mass Spectrometry and Machine Learning
Iwano, T., Yoshimura, K., Watanabe, G., Saito, R., Kiritani, S., Kawaida, H., Moriguchi, T., Murata, T., Ogata, K., Ichikawa, D., et al. (2021) · Journal of Cancer · doi:10.7150/jca.63244 · Cited by 22 · see citing works
Dual-energy CT with virtual monoenergetic images to improve the visualization of pancreatic supplying arteries: the normal anatomy and variations
Liang, H., Zhou, Y., Zhang, Z., Yan, G.-W., Du, S., Zhang, X., Li, X., Lv, F., Zheng, Q., & Li, Y. (2022) · Insights into Imaging · doi:10.1186/s13244-022-01157-z · Cited by 21 · see citing works
Aptamer-Targeted Calcium Phosphosilicate Nanoparticles for Effective Imaging of Pancreatic and Prostate Cancer
Abraham, T., McGovern, C. O., Linton, S. S., Wilczynski, Z. R., Adair, J. H., & Matters, G. L. (2021) · International Journal of Nanomedicine · doi:10.2147/ijn.s295740 · Cited by 20 · see citing works
Artificial Intelligence in Pancreatic Ductal Adenocarcinoma Imaging: A Commentary on Potential Future Applications
Schuurmans, M., Alves, N., Vendittelli, P., Huisman, H. J., Hermans, J. J., Litjens, G. J. S., Chang, D. K.-F., Verbeke, C. S., Malats, N., & Löhr, M. J. (2023) · Gastroenterology · doi:10.1053/j.gastro.2023.04.003 · Cited by 20 · see citing works
Impact of Endoscopic Ultrasound-Guided Tissue Acquisition on Decision-Making in Precision Medicine for Pancreatic Cancer: Beyond Diagnosis
Imaoka, H., Sasaki, M., Hashimoto, Y., Watanabe, K., Miyazawa, S., Shibuki, T., Mitsunaga, S., & Ikeda, M. (2021) · Diagnostics · doi:10.3390/diagnostics11071195 · Cited by 19 · see citing works
Percutaneous ultrasound and endoscopic ultrasound-guided biopsy of solid pancreatic lesions: An analysis of 1074 lesions
Chai, W., Kuang, X.-F., Li, Y., Cheng, C., Jin, X., Zhao, Q., & Jiang, T.-A. (2022) · Hepatobiliary & pancreatic diseases international · doi:10.1016/j.hbpd.2022.06.017 · Cited by 18 · see citing works
Pancreatic Incidentaloma
Caban, M., & Małecka-Wojciesko, E. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11164648 · Cited by 19 · see citing works
Prevalence, features, and explanations of missed and misinterpreted pancreatic cancer on imaging: a matched case–control study
Hoogenboom, S. A. M., Engels, M. M. L., Chuprin, A., van Hooft, J. E., LeGout, J. D., Wallace, M. B., & Bolan, C. W. (2022) · Abdominal Radiology · doi:10.1007/s00261-022-03671-6 · Cited by 17 · see citing works
Pancreatic Ductal Adenocarcinoma: The Dawn of the Era of Nuclear Medicine?
Montemagno, C., Cassim, S., Leiris, N. D., Durivault, J., Faraggi, M., & Pagès, G. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22126413 · Cited by 17 · see citing works
Virtual 3D models, augmented reality systems and virtual laparoscopic simulations in complicated pancreatic surgeries: state of art, future perspectives, and challenges
Laga, I., Franco, C. C., Sierra, J. D. S., Monsalve, J. C., & Ruiz, F. J. P. (2025) · International Journal of Surgery · doi:10.1097/js9.0000000000002231 · Cited by 16 · see citing works
Setting the Research Agenda for Clinical Artificial Intelligence in Pancreatic Adenocarcinoma Imaging
Schuurmans, M., Alves, N., Vendittelli, P., Huisman, H. J., & Hermans, J. J. (2022) · Cancers · doi:10.3390/cancers14143498 · Cited by 14 · see citing works
Circulating Tumor Cell Subpopulations Predict Treatment Outcome in Pancreatic Ductal Adenocarcinoma (PDAC) Patients
Freed, I. M., Kasi, A., Fateru, O., Hu, M., Gonzalez, P., Weatherington, N., Pathak, H. B., Hyter, S. D., Sun, W., Al-Rajabi, R. M. T., et al. (2023) · Cells · doi:10.3390/cells12182266 · Cited by 16 · see citing works
Revolutionizing the Pancreatic Tumor Diagnosis: Emerging Trends in Imaging Technologies: A Systematic Review
Șolea, S. F., Brisc, M. C., Orășeanu, A., Venter, F. C., Brisc, C., Șolea, R. M., Davidescu, L., Venter, A., & Brisc, C. (2024) · Medicina · doi:10.3390/medicina60050695 · Cited by 15 · see citing works
Tumor-Specific miRNA Signatures in Combination with CA19-9 for Liquid Biopsy-Based Detection of PDAC
Kim, M. W., Koh, H., Kim, J. Y., Lee, S., Lee, H., Kim, Y. T., Hwang, H. K., & Kim, S. I. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms222413621 · Cited by 14 · see citing works
CT Radiomics and Whole Genome Sequencing in Patients with Pancreatic Ductal Adenocarcinoma: Predictive Radiogenomics Modeling
Hinzpeter, R., Kulanthaivelu, R., Kohan, A. A., Avery, L. M., Pham, N., Ortega, C., Metser, U., Haider, M. A., & Veit‐Haibach, P. (2022) · Cancers · doi:10.3390/cancers14246224 · Cited by 14 · see citing works
DeepOptimalNet: optimized deep learning model for early diagnosis of pancreatic tumor classification in CT imaging
Thanya, T., & Jeslin, T. (2025) · Abdominal Radiology · doi:10.1007/s00261-025-04860-9 · Cited by 13 · see citing works
Diagnosis of Pancreatic Ductal Adenocarcinoma by Immuno-Positron Emission Tomography
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Is Cell-Free DNA Testing in Pancreatic Ductal Adenocarcinoma Ready for Prime Time?
Sheel, A., Addison, S., Nuguru, S. P., & Manne, A. (2022) · Cancers · doi:10.3390/cancers14143453 · Cited by 12 · see citing works
Predictive role of radiomics features extracted from preoperative cross-sectional imaging of pancreatic ductal adenocarcinoma in detecting lymph node metastasis: a systemic review and meta-analysis
Mirza‐Aghazadeh‐Attari, M., Madani, S. P., Shahbazian, H., Ansari, G., Mohseni, A., Borhani, A., Afyouni, S., & Kamel, I. R. (2023) · Abdominal Radiology · doi:10.1007/s00261-023-03940-y · Cited by 12 · see citing works
Hidden in plain sight: commonly missed early signs of pancreatic cancer on CT
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Authors: Elbanna, K. Y., Jang, H.-J., & Kim, T. K.
Affiliations: Mount Sinai Hospital (CA)
Corresponding author: Elbanna, Khaled Y.
ORCID: Elbanna, Khaled Y.
Jang, Hyun-Jung
Kim, Tae Kyoung
Venue: Insights into Imaging
Publisher: Springer Science and Business Media LLC
Published: 2020-04-25
Volume: 11
Issue: 1
Pages: 58-58
ISSN: 1869-4101 (ISSN-L)
DOI: 10.1186/s13244-020-00861-y
PMC: PMC7183518
OpenAlex: W3020216905
Semantic Scholar: 39a22c3369f8e93fba45dd757563476bc863f51e
Cited by: 162
References: 103
Citations by year: 2026: 28 · 2025: 31 · 2024: 29 · 2023: 28 · 2022: 21 · 2021: 22 · 2020: 2 · 2019: 1
FWCI: 1.96
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (tdm)
creativecommons.org/licenses/by/4.0 (vor)
Locations: Insights into Imaging (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
TSpace (University of Toronto) (submittedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics: Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › MRI in cancer diagnosis
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
Keywords: pancreatic ductal adenocarcinoma, tumor resectability, celiac artery stenosis, pancreaticoduodenectomy, neoadjuvant therapy, tumor staging, early diagnosis, vascular invasion, uncinate process

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Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review

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