Imaging patterns of pancreatic cancer recurrence

Sofia Gourtsoyianni, Charina Triantopoulou, Ioannis Passas, Christos Dervenis


Pancreatic cancer is characterised by its aggressive biological behaviour and may relapse even after optimal resection. Early recognition of local recurrence or metastatic disease is important in order to achieve better patient survival. Post-surgical anatomic alterations and the fact that early recognition of tumour relapse on imaging is difficult make the diagnosis even more challenging for Radiologists. Although MDCT is the preferred follow-up imaging method, it seems that MRI offers some advantages in cases of equivocal liver lesions, liver steatosis and when the study of the biliary tree is primarily requested. FDG-PET is advantageous when anatomic imaging is non-conclusive, in cases with strong clinical suspicion of tumour relapse. Postoperative changes and findings related to early or late complications should not be mistaken as tumour relapse. This is why it is of paramount importance that the Radiologist is aware of what kind of surgery was performed, of any postoperative complications, as well as of all necessary information from the final pathology report.  In this review paper, specific patterns of recurrence will be described that are related to tumour site, type of operation and histopathology concerning mainly resection margins. Important questions that are also related to imaging of early pancreatic cancer recurrence will be addressed.


Pancreatic adenocarcinoma/recurrence; CT/diagnosis; MR imaging/diagnosis

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