Pancreatic Cancer - Pancreatic Carcinoma

Clinical History
A middle-aged man presented with acute epigastric pain. An abdominal CT was performed and showed streaks of fat around the body and tail of the pancreas, consistent with acute pancreatitis. Additional findings included a somewhat bulky pancreas head without any focal hypodensities. The patient was referred for an FDG PET•CT scan.

Imaging Findings
The FDG PET•CT scan revealed an intensely FDG-avid lesion (SUV 8.7) at the head of the pancreas and diffuse low-grade FDG uptake was noted at the body and tail of the pancreas. The CT scan also showed slight thickening of the tail of the pancreas.

Fig. 1 FDG PET image of the abdomen showing high uptake in the head of the pancreas

Fig. 2

CT, FDG PET and PET•CT fusion image, transaxial section at the level of the pancreatic head.

Fig. 3

CT, FDG PET and PET•CT fusion image, transaxial section at the level of the body and tail of the pancreas Diagnosis The level of FDG uptake at the body and tail of the pancreas appeared consistent with acute pancreatitis. Pathology The FDG-avid mass in the pancreas head was biopsied secondary to laparotomy and, on frozen section, confirmed to be adenocarcinoma of the pancreas. Discussion Pancreatic cancer coexisting with or causing acute pancreatitis is rare. FDG PET has been used to characterize indeterminate masses of the pancreas and is regarded to be of value in screening for pancreatic malignancy in at-risk patients, especially with chronic pancreatitis (EJNM Jan 2005-Marietta et al). This study found FDG PET to be 91% sensitive and 87% specific for detection of pancreatic malignancy in a setting of chronic pancreatitis. This presented case, previously unreported detection of pancreatic cancer in a patient with acute pancreatitis, demonstrates the clinical value PET•CT hybrid imaging provides. Acute inflammation of the pancreas is itself associated with high FDG accumulation, evident in the pancreas body and tail (Fig. 2). However, the associated malignant pancreatic tumor located in the head is conspicuous because of the very high FDG uptake (SUV of 8.3), reflecting the aggressive nature of the adenocarcinoma. Although CT demonstrates slight enlargement of the pancreatic head, it is not diagnostic by itself. In this case, FDG PET•CT is critical to diagnose the associated cancer, which otherwise would have been left untreated in the context of an acute pancreatitis episode.

Data courtesy of Dr. David Ng & Dr. Anthony Goh, Singapore General Hospital, Singapore.

* Any of the protocols presented herein are for informational purposes and are not meant to substitute for clinician judgment in how best to use any medical devices. It is the clinician that makes all diagnostic determinations based upon education, learning and experience.