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Imaging in pancreatic disease

Key Points

  • Pancreatic cancer is frequently diagnosed after the appearance of symptoms, which is too late for curable treatment

  • No blood test currently exists for chronic pancreatitis and the diagnosis can be difficult to make, even with current imaging technologies

  • Treating pancreatic disease at an early stage of the pathogenesis could lead to better prognosis

  • Currently used imaging techniques have various limitations, including difficulty in discriminating between benign and malignant conditions

  • Molecular imaging can augment conventional imaging modalities for the diagnosis of incipient pancreatic diseases

Abstract

Pancreatic diseases, chronic pancreatitis, pancreatic cancer and diabetes mellitus, taken together, occur in >10% of the world population. Pancreatic diseases, as with other diseases, benefit from early intervention and appropriate diagnosis. Although imaging technologies have given clinicians an unprecedented toolbox to aid in clinical decision-making, advances in these technologies and development of molecular-based diagnostic tools could enable physicians to identify diseases at an even earlier stage and, thereby, improve patient outcomes. In this Review, we discuss and identify gaps in the use of imaging techniques for the early detection and appropriate treatment stratification of various pancreatic diseases, including diabetes mellitus, acute and chronic pancreatitis and pancreatic cancer. Imaging techniques discussed are MRI, CT, PET and ultrasonography. Additionally, the identification of new molecular targets for imaging and the development of contrast agents that are able to give molecular information in noninvasive radionuclear imaging and ultrasonography are emerging areas of innovation that could lead to increased diagnostic accuracy and improved patient outcomes.

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Figure 1: Use of endoscopic ultrasonography in pancreatic lesions.
Figure 2: Use of molecular imaging in experimental pancreatic disease.
Figure 3: Molecular imaging in a mouse model of pancreatic cancer.
Figure 4: PET imaging in experimental pancreatic cancer.
Figure 5: Molecular imaging of experimental diabetes mellitus.
Figure 6: Conceptual view of pancreatic disease imaging.

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Acknowledgements

The authors thank S. L. Hasbrouck, Curry School of Education, University of Virginia, for her kind help reading and editing the manuscript.

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Correspondence to Kimberly A. Kelly.

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Dimastromatteo, J., Brentnall, T. & Kelly, K. Imaging in pancreatic disease. Nat Rev Gastroenterol Hepatol 14, 97–109 (2017). https://doi.org/10.1038/nrgastro.2016.144

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