Imaging of the pancreas: Recent advances

Abstract

A wide spectrum of anomalies of pancreas and the pancreatic duct system are commonly encountered at radiological evaluation. Diagnosing pancreatic lesions generally requires a multimodality approach. This review highlights the new advances in pancreatic imaging and their applications in the diagnosis and management of pancreatic pathologies. The mainstay techniques include computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), radionuclide imaging (RNI) and optical coherence tomography (OCT).

Full text

Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 1 S25
Imaging of the pancreas: Recent advances
Vikas Chaudhary, Shahina Bano1
Department of Radiodiagnosis, Employees’ State Insurance Corporation (ESIC) Model Hospital, Gurgaon – 122001, Haryana, 1Department of
Radiodiagnosis, Govind Ballabh (GB) Pant Hospital and Maulana Azad Medical College, New Delhi – 110 002, India
ABSTRACT
A wide spectrum of anomalies of pancreas and the pancreatic duct system are commonly encountered at radiological evaluation.
Diagnosing pancreatic lesions generally requires a multimodality approach. This review highlights the new advances in pancreatic
imaging and their applications in the diagnosis and management of pancreatic pathologies. The mainstay techniques include computed
tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound (EUS), radionuclide imaging (RNI) and optical coherence
tomography (OCT).
Key words: Computed tomography, endoscopic ultrasound, magnetic resonance imaging, optical coherence tomography, pancreatic
imaging, radionuclide imaging, recent advances
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DOI:
10.4103/2230-8210.83060
IntRoductIon
Pancreatic imaging is an essential tool in the early diagnosis
and staging of pancreatic disease. The diagnosis of
pancreatic diseases generally requires the combined use
of different imaging modalities, allowing the evaluation of
pancreatic ducts, the pancreatic parenchyma and adjacent
soft tissues. This review analyzes the most recent advances
in pancreatic imaging.
technIques of PancReatIc IMagIng
Since the introduction of computed tomography (CT)
scan in late 1970s, there has been dramatic improvement in
pancreatic imaging. With early conventional CT scanners,
only 10-mm thick slices with a large acquisition time of
1 minute/slice were obtained; this resulted in motion
artifacts and limited resolution. In addition, only ionic
intravenous contrast agent was administered slowly over
time. Helical (spiral) CT scanners, introduced in late 1980s,
allowed much faster data acquisition with a slice thickness
of 1–2 mm and a volume data set for three-dimensional
imaging. Power injectors were introduced now, allowing
bolus contrast administration for fast dynamic scanning.
The better spatial resolution and dedicated pancreatic
and portal venous phase (dual-phase helical CT) dynamic
scanning increased the tumor conspicuity and allowed
better detection and staging of pancreatic neoplasms.
However, the multiplanar imaging still suffered from
stair-stepping artifacts. This drawback was overcome with
the introduction of multidetector computed tomography
(MDCT) in late 1990s. In contrast to single-detector
helical CT scanners, these scanners use multiple detector
rows, are 10 times faster, and can obtain 16–64 slices per
rotation at a slice thickness of 0.5 mm. The MDCT has
improved volume coverage speed and spatial resolution
along z-axis, and allows three-dimensional reformatting due
to isotropic voxels and exquisite multiplanar reconstruction
of pancreatic anatomy. High speed of MDCT also allows
organ imaging in clearly dened perfusion phase.[1]
MDCT permits the acquisition in the arterial phase,
pancreatic (parenchymal) phase and portal venous (hepatic)
phase with a delay of 20, 40 and 70 sec, respectively, using
120 ml of iodinated contrast medium injected intravenously
Corresponding Author: Dr. Vikas Chaudhary, Department of Radiodiagnosis, Employees’ State Insurance Corporation (ESIC) Model Hospital,
Gurgaon – 122 001, Haryana, India. E-mail: dr_vikaschaudhary@yahoo.com
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Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 1
S26
at a rate of 3 ml/sec. Maximum enhancement of pancreas
and the maximum tumor-to-parenchymal attenuation
difference is achieved during pancreatic phase followed by
portal venous phase and the arterial phase. Therefore, for
tumor detection, particularly adenocarcinoma [Figure 1],
pancreatic and portal venous phases are superior to those
obtained in the arterial phase. However, for detection
of vascular invasion and liver metastases, the sensitivity
of images obtained in the portal venous phase is better
than those obtained in the pancreatic and arterial phases.
Images of the pancreas obtained in the arterial phase
are helpful in good visualization of the peripancreatic
arterial supply. Using this image acquisition, it is possible
to diagnose and characterize a small pancreatic lesion
(less than 2 cm in diameter) more accurately, establish
the level of peripancreatic vascular invasion and detect
liver metastasis. Most of the authors are of opinion that
the pancreatic parenchymal phase and the portal venous
phase (dual phase) are sufcient for the detection of the
pancreatic adenocarcinoma and the arterial phase may be
reserved for those patients who require CT angiography
(CTA). Thus, the biphasic contrast-enhanced MDCT
is a very effective diagnostic tool in the detection and
accurate preoperative staging of pancreatic malignancies,
which remain a challenge for radiologists. The addition of
multidetector CTA improves the accuracy of diagnosing
unresectable pancreatic carcinoma. Features indicating
vascular involvement include: tumor involvement for one
half of the vessel’s circumference, focal narrowing of the
vessels and dilatation of peripancreatic veins. Criteria for
unresectability include involvement of superior mesenteric
artery or celiac trunk, involvement of superior mesenteric
vein–portal vein conuence, and hepatic, peritoneal or
lymph nodal metastases. The major limitation with the use
of CT is that it cannot accurately differentiate between
benign and malignant lymph nodal enlargement.[1-5]
Recently, a 320-detector CT scan has been introduced.
Comparison of 320-detector volumetric and 64-detector
helical CT images of the pancreas revealed no signicant
difference in CT numbers of pancreas. Signal-to-noise
ratio (SNR) of the pancreas on biphasic images was
signicantly lower in the 320-detector group than in the
64-detector group. Image quality was acceptable in both the
groups and was slightly better in the 64-detector group for
pancreatic phase axial images and arterial phase multiplanar
reformatted images. No signicant difference was found in
the depiction of pancreatic parenchyma, main pancreatic
duct and focal pancreatic lesions.[6]
Majority of pancreatic endocrine tumors [Figures 2 and 3]
are small and very vascular and will be best seen in arterial
phase images; however, in some cases, portal venous phase
imaging best demonstrates the tumor. Thus, dual-phase
MDCT imaging, at 20 and 70 sec following intravenous
contrast infusion, is recommended to optimize the detection
of both the primary tumor and liver metastases.[7]
MDCT is the modality of choice for the diagnosis and
staging of acute pancreatitis. It is highly sensitive in detecting
the necrosis, the hallmark of severe acute pancreatitis
and peripancreatic uid collections. CT outclasses all
imaging modalities in detecting calcications [Figure 4],
a specific sign of advanced chronic pancreatitis, and
complications associated with chronic pancreatitis such
as pseudocyst, intraductal calculi, inammatory masses or
Figure 1: Pancreatic adenocarcinoma. Axial plain (a) and triple-phase
contrast-enhanced CT upper abdomen obtained in arterial (b), pancreatic
parenchymal (c) and portal venous (d) phase, in a 70-year-old male
who presented with severe abdominal pain, demonstrates an ill-dened
nonenhancing hypodense mass involving the head and proximal part of
body of pancreas (thick vertical white arrow). Peripancreatic extension
with encasement/attenuation of celiac axis branches (thin black arrow),
inltration and dilatation of main pancreatic duct (thin white arrow) and
liver metastases (black arrow head) are also evident which make the tumor
unt for resection. Note that the pancreatic and portal venous phases are
best for tumor detection, the hypovascular metastases stand out best in
portal venous phase, while the arterial phase is good for demonstration of
celiac axis encasement
a
b
c
d
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Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 1 S27
Figure 2: Functioning islet cell tumor: Gastrinoma in a 25-year-old male
patient with Zollinger–Ellison syndrome (ZES). Axial plain (a) and dual-
phase contrast-enhanced CT abdomen obtained in arterial (b) and portal
venous (c, d) phase shows a small, well-dened mass of 1 × 0.5 cm size in
the gastric triangle (thick vertical white arrow). The lesion is homogenous
and hypodense on non-contrast CT, shows marked homogenous contrast
enhancement in arterial phase image (suggesting hypervascular nature) and
washout of contrast in portal venous phase. Majority of liver metastases from
the tumor are hypervascular, appearing as homogenous hyperenhancing
foci (thin white arrow) in arterial phase image, while a few are hypovascular
appearing as non-enhancing foci both on arterial and portal venous phase
images (thin black arrow). Due to hypervascular nature, both the tumor (thick
vertical white arrow) and metastases (thick vertical black arrow) appear
echogenic on ultrasound (e). Double-contrast barium meal (f) of the same
patient demonstrates thickened gastric folds. Endoscopy revealed peptic
ulceration of upper gastrointestinal tract. Patient also had hypergastrinemia
a
e
f
b
c d Figure 3: Functioning islet cell tumor: Insulinoma in a 55-year-old male
patient who presented with hypoglycemic symptoms. Axial plain (a) and
dual-phase contrast-enhanced CT abdomen obtained in portal venous
phase (b) shows a well-dened intrapancreatic subcentimeter size mass
(thin white arrow). The lesion is inconspicuous on non-contrast CT,
however shows marked homogenous contrast enhancement in portal
venous phase image
a b
Figure 4: Chronic pancreatitis. Axial non-contrast CT abdomen shows
features of chronic pancreatitis evidenced as atrophic pancreas, dilated
main pancreatic duct (thin black arrow) and dense calcications (thin white
arrow) in pancreatic head region and within the dilated main pancreatic duct
a b
pseudoaneurysm. However, its sensitivity to detect early
chronic pancreatitis is poor. Unenhanced CT has negative
attenuation value of pancreatic tissue replaced by the
fat, therefore can reliably diagnose diffuse fatty change
involving the pancreas.[8] MDCT is also the noninvasive
modality of choice for characterizing pancreatic cystic
lesions more accurately.[9]
MDCT perfusion study is an evolving and promising
technique having various applications. Perfusion CT
involves dynamic scanning after administration of
iodinated contrast material, followed by mathematical
modeling to study contrast material kinetics in the tissue.
The CT perfusion data set derived from kinetic model
allows assessment of physiological parameters such as
tumor and normal pancreatic blood ow (BF), blood
volume (BV), mean transit time (MTT) and permeability–
surface area product (PS). The normal pancreas displays
symmetrical BF, BV, MTT and PS. Comparing with normal
value, CT perfusion imaging helps in diagnosing various
pancreatic diseases (e.g. necrotizing acute pancreatitis, mass
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Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 1
S28
forming chronic pancreatitis) and angiogenesis in different
pancreatic neoplasms (e.g. pancreatic and ampullary
adenocarcinoma, cystadenoma, endocrine tumors, solid
pseudopapillary neoplasm and pancreatic metastasis).[10-13]
It aids in differential diagnosis of pancreatic tumors by
detecting change in their perfusion pattern.[14] It may
help in early detection of small (<2 cm size) pancreatic
adenocarcinomas, when these masses are still resectable,
thereby improving the prognosis of the patients.[15] It has a
crucial role in efcient management in the eld of oncology
as it provides physiological information about tumor neo-
angiogenesis. New blood vessel growth is critical for tumor
growth and metastasis, and newer generation oncologic
treatment regimens target the neo-angiogenesis and the
growth factors that stimulate neo-angiogenesis.[16] Perfusion
CT can be used to predict tumor response to concurrent
chemotherapy and radiotherapy (CCRT).[17]
Dynamic contrast-enhanced CT is the mainstay of imaging
in suspected pancreatic injury, but is frequently normal in
the acute phase. Repeat CT is indicated after 24–48 hours
if there are persistent unexplained symptoms or elevated
amylase.[18]
Although CT remains the most effective imaging modality
for evaluation of the pancreas, magnetic resonance imaging
(MRI) is increasingly used for further identification
and characterization of pancreatic diseases. Technical
innovation in MRI, such as use of phased-array coils,
allows improved spatial resolution and faster T1- and T2-
weighted sequences for imaging the entire upper abdomen
in a single breathhold and providing cross-sectional images
of pancreatic parenchyma analogous to CT images. The
use of fat saturation pulses and dynamic studies following
gadolinium injection increases the sensitivity of MR in
detecting pancreatic lesions. MR angiography (MRA)
is useful in noninvasive evaluation of splanchnic blood
vessels. Half-Fourier T2-weighted pulse sequences for
magnetic resonance cholangiopancreaticography (MRCP)
allow pancreatic duct and side branch delineation
[Figure 5] and detection of anatomic variants such as
pancreatic divisum. Administration of secretin further
improves the conspicuity of the ductal system, allows
monitoring of pancreatic ow dynamics, helps in evaluation
of pancreatic exocrine function, and planning surgery or
therapeutic endoscopic and follow-up study after therapy.
Although MRI is accurate in local staging of the pancreatic
malignancies owing to high soft tissue contrast resolution
(for assessment of peripancreatic fat inltration), for
evaluation of vascular encasement, peritoneal deposits and
lymph nodal involvement, it has limitations as compared
to CT. However, for identifying the liver metastases,
MRI has high sensitivity and specicity when compared
Figure 5: Chronic pancreatitis. Axial fat suppression T2-weighted MR image
(a) and MRCP (b) shows atrophic pancreas with gross dilatation of main
pancreatic duct and side branches (thin white arrow)
a b
to CT. The use of liver-specic contrast agents further
improves the diagnostic value of MRI for detecting liver
metastases. Thus, MRI in combination with secretin-
enhanced MRCP and MRA is useful in the diagnosis and
management of pancreatic malignancies.[19,20] Focal fatty
replacement of the pancreas may appear as hypodense
mass on contrast-enhanced CT and thus mimic an ill-
dened neoplasm. MRI establishes the correct diagnosis
of focal fatty replacement of pancreas using dual-echo
(in-phase and opposed phase) chemical shift imaging
and avoids invasive diagnostic procedures and surgery.[21]
Diffusion-weighted MRI helps to differentiate the subtypes
of pancreatic endocrine neoplasms on the basis of tumor
cellularity and/or extracellular brosis that may account
for various apparent diffusion coefcient (ADC) values
in these tumors.[22] MRI is as sensitive as CT for the
depiction of necrosis and peripancreatic uid collection
in the case of acute pancreatitis [Figure 6], but is less
sensitive than CT for detection of calcications associated
with chronic pancreatitis. However, fat-suppressed T1-
weighted MRI is more sensitive for the detection of
early chronic pancreatitis, prior to the development of
calcications. MRI is also useful in differentiating pancreatic
pseudocysts [Figure 7] from pancreatic cystic neoplasms
[Figures 8–11]. Presence of internal dependant debris is a
highly specic MR nding for diagnosing pseudopancreatic
cyst.[23] Magnetic resonance spectroscopy (MRS) is a
promising clinical tool for oncologic management of
patients. MRS can differentiate chronic focal pancreatitis
from pancreatic cancer. In proton MRS, chronic focal
pancreatitis shows less lipid than pancreatic carcinoma
due to difference in brous tissue content in the two
conditions.[24] MRI also has an important role in the
pancreatic transplantation. Standard MRI, MRCP (secretin-
induced MRCP) and MRA demonstrate the pancreatic
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Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 1 S29
Figure 6: Acute necrotizing pancreatitis. Axial T1W (a) and spectrally
selective inversion recovery (SPIR; fat-suppressed T2W) (b) MR images
through upper abdomen show severe acute necrotizing pancreatitis. The
body of pancreas is replaced by a large cystic appearing lesion (asterisk)
showing internal debris in the dependant portion of the cyst. Extensive
peripancreatic inammatory changes are also present, best appreciated
on SPAIR image. Pancreatic tissue in the tail region shows heterogeneous
signal intensity (thin white arrow) consistent with intraparenchymal
inammatory change
a b
Figure 7: Pancreatic pseudocyst in a 50-year-old male who presented
after an episode of pancreatitis. Axial T1W (a) and T2W (b) MR images
of abdomen show a large, walled-off cystic lesion localized to lesser sac
(asterisk). The lesion shows internal debris along with hemorrhage (arrow).
Presence of internal debris is a highly specic MR nding for diagnosing
pseudopancreatic cyst
a b
Figure 8: Solid and Papillary Epithelial Neoplasm in a 35-year-old female
who presented with epigastric pain. Axial non-contrast (a) and contrast-
enhanced (b) CT abdomen shows a mixed solid and cystic mass in the
pancreatic head (arrow). The diagnosis of SPEN was conrmed after surgery
on histopathologic examination
a b
Figure 9: Branch duct type Intraductal Papillary Mucinous Tumor (IPMT)
in a 55-year-old male who presented with vague abdominal pain. Axial
T2-weighted MR image (a) of upper abdomen shows a well-dened, thin-
walled cystic lesion in the pancreatic head (asterisk). Associated dilatation
of main pancreatic duct is also evident (thin white arrow), which appears
inseparable from the cystic mass lesion on MRCP image (b). ERCP revealed
communication between the cystic mass and the dilated proximal pancreatic
duct. The diagnosis of IPMT was conrmed on histopathologic examination
of the resected tumor
a b
anatomy well before and after transplantation. Serial
contrast-enhanced MRI may demonstrate diminished
perfusion in case of graft rejection, and the vascular
complications are assessed by MRA.[25]
Although high-resolution MDCT with 3D image
reconstruction remains the prime imaging modality for
diagnosing and staging pancreatic cancers, endoscopic
ultrasound (EUS) can be a valuable adjunct to MDCT for
diagnostic evaluation of patients with suspected pancreatic
tumors. EUS with ne needle aspiration cytology (EUS-
FNA) is a highly accurate method for preoperative staging
of pancreatic cancer, as it has the ability to obtain the
tissue conrmation and permit accurate nodal staging
without relying on lymph node size.[26] The intraoperative
ultrasound (IOUS) and laparoscopic ultrasound (LUS) are
highly sensitive methods to assess tumor resectability during
surgery as they permit accurate assessment of location and
number of lesions, locoregional tumor extension, vascular
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Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 1
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Figure 10: Mucinous cystadenocarcinoma in a 42-year-old female who
presented with recurrent upper abdominal pain. Axial T2-weighted MR (a)
and MRCP (b) images of abdomen show multilocular macrocystic lesion
(thick white arrow) involving pancreatic head. Note ne internal septations
within the lesion and associated dilatation of MPD and side branches
(thin white arrow). The diagnosis of mucinous cystadenocarcinoma was
conrmed after surgery and histopathologic examination
a b
Figure 11: Serous cystadenocarcinoma in a 72-year-old male who presented with jaundice and recurrent abdominal pain. T2-weighted MRI (a) and MRCP
(b) show multilocular microcystic lesion involving pancreatic head (thick white arrow). The lesion shows very thin internal septations. Large pseudocyst
(asterisk), dilated common bile duct/intrahepatic biliary radicles (CBD/IHBR) (thin black arrow) and normal MPD (white arrow head) are well seen on
MRCP. Cystogastrostomy and choledochoduodenostomy were performed to drain the pseudocyst and relieve the jaundice. Three months later, follow-
up CECT abdomen (c) revealed increase in size of tumor (thick white arrow), multiple liver metastases (thick black arrow) and encasement of superior
mesenteric vessels (thin white arrow) by the cystic mass. The diagnosis of serous cystadenocarcinoma made on imaging was conrmed after surgery
and histopathologic examination
a b c
involvement and lymph nodal or liver metastases.[27] EUS,
particularly the intraductal endoscopic ultrasonography
(IDUS), accurately localizes the pancreatic endocrine tumors,
especially those which are too small to be characterized by
CT or MRI. EUS with color Doppler further improves
the detection of small pancreatic endocrine tumors and
adenocarcinomas. Endocrine tumors, being hypervascular,
demonstrate abundant color Doppler signal having pulsatile
and/or continuous waveform pattern, while majority of
adenocarcinomas demonstrate low vascularity.[28] Contrast-
enhanced EUS using microbubbles has also shown to
improve the detection and characterization of pancreatic
lesions and liver metastasis.[29] EUS-FNA for cytology and
cyst uid analysis aids in the differential diagnosis of cystic
lesions of pancreas that are indeterminate at cross-sectional
imaging.[30] Finally, EUS may also be used therapeutically
in image-guided drainage such as gastrocystostomy in
pancreatic pseudocyst and celiac plexus neurolysis for pain
control in patients of pancreatic cancer or pancreatitis.[31]
Ultrasound elastography, a new technique, evaluates the
relative stiffness of the tissues. EUS real-time elastography
distinguishes normal pancreas from the abnormal pancreas
affected by inammatory or focal disease. However, it
cannot differentiate chronic pancreatitis from malignant
tumor because of their similar brous architecture. This
technique is also useful to select lymph nodes suitable for
biopsy as it can differentiate between benign and malignant
lymph node involvement.[32]
Radionuclide imaging (RNI) aids in improving the diagnosis
and staging of the pancreatic tumors, identifying and
localizing disseminated disease, differentiating post-
treatment recurrent and residual disease from brosis,
and planning and monitoring response to the therapy.
Detection of pancreatic cancer at early stage improves
the long-term survival of the patient. The diagnosis
of early stage pancreatic cancer (small in size, free of
peripancreatic extension and without lymph nodal/liver
metastases) is often difcult with the structural imaging
techniques. [18F]-uorodeoxyglucose positron emission
tomography (FDG-PET) scanning has been found to be
more accurate than other imaging modalities for diagnosing
early pancreatic cancer. The sensitivity of PET is superior
to CT in detecting lesions less than 2 cm in diameter, but
CT scanning is superior to PET for diagnosing cancers
larger than 4 cm in diameter because of lower metabolic
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Indian Journal of Endocrinology and Metabolism / 2011 / Vol 15 / Supplement 1 S31
rates in larger tumors.[33] The sensitivity of FDG-PET
for detecting lymph node metastasis in patients with
pancreatic cancer and differentiating pancreatic cancer
from chronic pancreatitis is more than that of CT or
MRI.[34] FDG-PET can also alter the management of
pancreatic cancer by revealing unsuspected metastases
to liver, lung and bone, thereby avoiding the mortality
and morbidity associated with unnecessary surgical
intervention.[35] FDG-PET has the advantage of
differentiating residual and recurrent tumor from
postoperative inammation or brosis.[36] It is also useful
in the follow-up of patients undergoing chemoradiation
therapy or surgical resection.[37] FDG-PET is less sensitive
for detecting pancreatic endocrine tumors, particularly
those which are non-functional and have small size at
presentation. However, two PET radiopharmaceutical
agents such as C-11 labeled 5-hydroxytryptophan (5-HPT)
and l-Dopa are known to detect endocrine pancreatic
tumors.[38] FDG-PET has been found to be more accurate
than CT in characterizing cystic pancreatic lesions as
malignant.[39] The main drawback of PET is its relative
low spatial resolution which limits its role in detecting
direct invasion of adjacent structures or encasement of
blood vessels; these factors are important in planning
surgery. 111In-octreotide single-photon emission computed
tomography (SPECT) has also shown to improve the
localization of pancreatic endocrine tumors. It has been
established that the anatomical–functional image fusion
techniques such as hybrid PET/CT and SPECT/CT
improve the localization and characterization of pancreatic
endocrine tumors and therefore alter the treatment plan.[40]
Optical coherence tomography (OCT) is a new optical
imaging modality introduced in 1991. It uses infrared light
to produce high-resolution, cross-sectional, subsurface
imaging of the microstructure. It has a promising role
in evaluating pancreaticobiliary ductal system, as it can
recognize different patterns of the duct wall structure
in neoplastic and non-neoplastic conditions. OCT has
high diagnostic accuracy, better than brush cytology, for
distinguishing neoplastic from a non-neoplastic MPD
stricture.[41]
Thus, we conclude that MDCT, MRI, EUS and RNI are
excellent modalities for both detection and characterization
of pancreatic lesions. Structural imaging techniques such
as CT and MR provide superior information regarding
local tumor invasion and surgical resectability, whereas
FDG-PET offers a noninvasive and accurate method
for detection of early pancreatic cancer, unsuspected
metastases, differentiation between benign and malignant
pancreatic lesions (such as inammatory or scar tissue
from recurrent or residual tumor), and evaluation of
pancreatic masses with equivocal CT/MRI diagnosis.
EUS-guided aspiration and biopsy is useful in cases that are
indeterminate at cross-sectional imaging. OCT has emerged
as a new technique that differentiates between neoplastic
and non-neoplastic pancreatic duct stricture.
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Cite this article as: Chaudhary V, Bano S. Imaging of the pancreas: Recent
advances. Indian J Endocr Metab 2011;15:S25-32.
Source of Support: Nil, Conict of Interest: Nil.
Chaudhary and Bano: Pancreatic imaging
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