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You might have read about why pancreatic cancer is difficult to diagnose. As there is so much confusion around pancreatic disease and chances that a pancreatic malignancy could be missed, CT and MRI techniques designed specifically for the pancreas have been developed during the past decade. Dr Prasad Narayanan, Senior Consultant, Medical Oncology, Cytecare reveals the common tests used to diagnose pancreatic cancer.
CT Scan Techniques: According to an RSNA (Radiological Society of North America) publication, the CT technique revolves around multi-detector helical CT scans. In this, the images are taken in 5 mm slices before and after a low-density contrast medium such as water. Non-ionic iohexol is power injected at 3-4 ml per second, and images are taken after that. Thin collimation pancreatic phase volumetric scans are taken 70 seconds after injection, followed by portal venous phase scans. True arterial phase scans are then taken to spot the islet cell tumours if present.
MRI techniques: This is particularly useful as an adjunct to CT scan to visualise pancreatic cancers that are difficult to identify, particularly those arising from the pancreatic ducts, which have not quite altered the shape of the pancreas. MR cholangiopancreatography with 2D and 3D sequences is also used to examine the pancreatic duct and the biliary tract outside the liver. Such MR imaging can also help to differentiate a pancreatic neoplasm from pancreatic duct calculi (stones), ductal carcinomas and even a case of autoimmune pancreatitis.
Endoscopic ultrasound (EUS): With recent advances in ultrasound technology, such as colour power doppler and compound imaging, this diagnostic technique can detect small pancreatic tumors in the head and body of the pancreas. A promising test in this aspect is an endoscopic ultrasound (EUS), which as the name suggests is an ultrasound probe mounted on an endoscope. With the help of EUS, not only can a physician or radiologist get excellent images of the pancreas but also of the surrounding structures such as the stomach, small intestine, the bile duct and the liver. Hence it is extremely useful is the diagnosis of cancer of the pancreas and differentiating it from other medical conditions affecting the region such as pancreatic cysts, acute pancreatitis, chronic pancreatitis and autoimmune pancreatitis. It is complimentary to a CT or MRI examination where a suspicious pancreatic mass is found but more precise information is difficult to obtain. Another interesting application of EUS is a non-invasive technique for Fine Needle Aspiration (FNA) which helps to distinguish between a pancreatic tumour and pancreatic cyst. In this, fluid drawn from the pancreatic cyst can be subjected to cytological examination to ascertain the presence or absence of malignancy. Also read about common symptoms of pancreatic cancer.
PET-CT (Positron Emission Tomography): This is a relatively recent diagnostic modality which is supposed to be used alongside CT and MRI, for maximum usefulness. It can be brought into the picture at different stages of the disease such as suspected pancreatic tumour at the early stages, detection of distant spread (metastasis) and even monitoring the response of the disease to treatment. Here are all your questions on PET scan answered.
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