title: Multimodality imaging of pancreatic ductal adenocarcinoma: a review of the literature.
abstract: BACKGROUND
  Accurate pre-operative imaging in pancreatic cancer helps avoid unsuccessful surgical explorations and forewarns surgeons regarding aberrant anatomy. This review aimed to determine the role of current imaging modalities in the diagnosis and determination of resectability of pancreatic and peri-ampullary adenocarcinomas.
  
  
  METHODS
  A systematic search of the scientific literature was carried out using EMBASE, PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials for the years 1990 to 2011 to obtain access to all publications, especially randomized controlled trials, reporting on the diagnostic accuracy of ultrasonography, multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) or positron emission tomography (PET)-computed tomography (CT) and the evaluation of resectability of pancreatic and peri-ampullary adenocarcinomas.
  
  
  RESULTS
  Based on 66 articles analysed in the review, MDCT and MRI/MRCP have comparable sensitivity and specificity rates for diagnosis and staging of pancreatic cancers. EUS offers the best sensitivity and specificity rates for lesions <2 cm. Improved staging has been noted when PET-CT scans are added to pre-operative evaluation.
  
  
  CONCLUSIONS
  MDCT with angiography or MRI/MRCP should constitute the first imaging modality in suspected pancreatic adenocarcinomas. EUS is recommended for assessing lesions not clearly detected, but suspected, on CT/MRI and in tumours considered 'borderline resectable' on MDCT to assess vascular involvement. PET-CT in locally advanced lesions will help rule out distant metastases.
authors.affiliation: Departments of Hepato-Pancreato-Biliary Surgical Oncology Radiology, Tata Memorial Hospital, Mumbai, India. shailushrikhande@hotmail.com
authors.forename: Shailesh V
authors.initials: SV
authors.lastname: Shrikhande
authors.forename: Savio George
authors.initials: SG
authors.lastname: Barreto
authors.forename: Mahesh
authors.initials: M
authors.lastname: Goel
authors.forename: Supreeta
authors.initials: S
authors.lastname: Arya
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D014463:Ultrasonography