The imaging diagnosis of pancreatic cancer: recent advances_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Haopeng , HUANG Zixing ,  SONG Bin

Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R.China;

Corresponding?author：

SONG Bin, Email: anicesong@vip.com

Keywords：

pancreatic cancer; ultrasonic; computed tomography; magnetic resonance imaging; positron emission tomography

DOI：

10.7507/1007-9424.201703053

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summary the recent progression of imaging methods which mainly applied on the early detection and qualitative diagnosis of pancreatic cancer. Method The newest related literatures between home and abroad were collected and reviewed. Results Ultrasonic, computed tomography, magnetic resonance imaging and positron emission tomography mostly be used on pancreatic cancer detection and diagnosis. Conclusion Each method gets its own advantage even computed tomography seems like dominated on the detection and diagnosis pancreatic cancer, moreover, magnetic resonance imaging has been improved rapidly in recent years which shows its enormous potential.

Citation： YU Haopeng, HUANG Zixing, SONG Bin. The imaging diagnosis of pancreatic cancer: recent advances. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(4): 502-506. doi: 10.7507/1007-9424.201703053 Copy

1.	?Zhang Q, Zeng L, Chen Y, et al. Pancreatic cancer epidemiology, detection, and management. Gastroenterol Res Pract, 2016, 2016: 8962321.
2.	O’Hayer KM, Brody JR. Personalized therapy for pancreatic cancer: Do we need better targets, arrows, or both? Discov Med, 2016, 21(114): 117-123.
3.	Rahib L, Smith BD, Aizenberg R, et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res, 2014, 74(11): 2913-2921.
4.	Werner J, Buchler MW. Management of pancreatic cancer: recent advances. Dtsch Med Wochenschr, 2011, 136(36): 1807-1810.
5.	Winter JM, Cameron JL, Campbell KA, et al. 1 423 pancrea-ticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg, 2006, 10(9): 1199-1210; discussion 1210-1191.
6.	Brambs HJ, Claussen CD. Pancreatic and ampullary carcinoma. Ultrasound, computed tomography, magnetic resonance imaging and angiography. Endoscopy, 1993, 25(1): 58-68.
7.	盧祎, 龔彪. 超聲在胰腺癌診斷中的應用進展. 臨床超聲醫學雜志, 2015, 17(2): 108-111.
8.	Okamoto Y, Kawamoto H, Takaki A, et al. Contrast-enhanced ultrasonography depicts small tumor vessels for the evaluation of pancreatic tumors. Eur J Radiol, 2007, 61(1): 163-169.
9.	D’Onofrio M, Zamboni G, Tognolini A, et al. Mass-forming pancreatitis: value of contrast-enhanced ultrasonography. World J Gastroenterol, 2006, 12(26): 4181-4184.
10.	Rosch T, Hofrichter K, Frimberger E, et al. ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc, 2004, 60(3): 390-396.
11.	Varadarajulu S, Eloubeidi MA. The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer. Surg Clin North Am, 2010, 90(2): 251-263.
12.	DeWitt J, Devereaux B, Chriswell M, et al. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med, 2004, 141(10): 753-763.
13.	Agarwal B, Abu-Hamda E, Molke KL, et al. Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol, 2004, 99(5): 844-850.
14.	Larghi A, Correale L, Ricci R, et al. Interobserver agreement and accuracy of preoperative endoscopic ultrasound-guided biopsy for histological grading of pancreatic cancer. Endoscopy, 2015, 47(4): 308-314.
15.	National Comprehensive Cancer Network. (NCCN) Clinical Practice Guidelines in Oncology. Pancreatic Adenocarcinoma, Version 1. 2016. .
16.	Ishigami K, Yoshimitsu K, Irie H, et al. Diagnostic value of the delayed phase image for iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography. Eur J Radiol, 2009, 69(1): 139-146.
17.	Peddu P, Quaglia A, Kane PA, et al. Role of imaging in the management of pancreatic mass. Crit Rev Oncol Hematol, 2009, 70(1): 12-23.
18.	Kim JH, Park SH, Yu ES, et al. Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology, 2010, 257(1): 87-96.
19.	Valls C, Andia E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. AJR Am J Roentgenol, 2002, 178(4): 821-826.
20.	Ahn SS, Kim MJ, Choi JY, et al. Indicative findings of pancreatic cancer in prediagnostic CT. Eur Radiol, 2009, 19(10): 2448-2455.
21.	Takeshita K, Kutomi K, Haruyama T, et al. Imaging of early pancreatic cancer on multidetector row helical computed tomography. Br J Radiol, 2010, 83(994): 823-830.
22.	Hijioka S, Ikari T, Kamei A, et al. CT and MRI findings with contrast enhancement of small pancreatic adenocarcinoma in the late phase. Hepatogastroenterology, 2007, 54(74): 389-392.
23.	Kim SH, Kamaya A, Willmann JK. CT perfusion of the liver: principles and applications in oncology. Radiology, 2014, 272(2): 322-344.
24.	梁宗輝, 馮曉源, 祝瑞江, 等. 正常胰腺的多層螺旋 CT 灌注成像研究. 生物醫學工程與臨床, 2006, 10(4): 218-222, 271.
25.	Kandel S, Kloeters C, Meyer H, et al. Whole-organ perfusion of the pancreas using dynamic volume CT in patients with primary pancreas carcinoma: acquisition technique, post-processing and initial results. Eur Radiol, 2009, 19(11): 2641-2646.
26.	Xu J, Liang Z, Hao S, et al. Pancreatic adenocarcinoma: dynamic 64-slice helical CT with perfusion imaging. Abdom Imaging, 2009, 34(6): 759-766.
27.	李海鷗. 低劑量胰腺 CT 灌注成像聯合雙能量增強掃描在胰腺癌診斷中的應用. 山東大學, 2015.
28.	解騫. 256 層螺旋 CT 全器官灌注成像在胰腺癌中的研究. 復旦大學, 2013.
29.	Liu K, Peng W, Zhou Z. The CT findings of pancreatic acinar cell carcinoma in five cases. Clin Imaging, 2013, 37(2): 302-307.
30.	Vachiranubhap B, Kim YH, Balci NC, et al. Magnetic resonance imaging of adenocarcinoma of the pancreas. Top Magn Reson Imaging, 2009, 20(1): 3-9.
31.	Schima W, Ba-Ssalamah A, Goetzinger P, et al. State-of-the-art magnetic resonance imaging of pancreatic cancer. Top Magn Reson Imaging, 2007, 18(6): 421-429.
32.	Kim JK, Altun E, Elias J Jr, et al. Focal pancreatic mass: distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo MRI. J Magn Reson Imaging, 2007, 26(2): 313-322.
33.	Kelekis NL, Semelka RC. MRI of pancreatic tumors. Eur Radiol, 1997, 7(6): 875-886.
34.	Chen FM, Ni JM, Zhang ZY, et al. Presurgical evaluation of pancreatic cancer: a comprehensive imaging comparison of CT versus MRI. AJR Am J Roentgenol, 2016, 206(3): 526-535.
35.	Koelblinger C, Ba-Ssalamah A, Goetzinger P, et al. Gadobenate dimeglumine-enhanced 3.0-T MR imaging versus multiphasic 64-detector row CT: prospective evaluation in patients suspected of having pancreatic cancer. Radiology, 2011, 259(3): 757-766.
36.	Kauhanen SP, Komar G, Seppanen MP, et al. A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg, 2009, 250(6): 957-963.
37.	Bipat S, Phoa SS, van Delden OM, et al. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis. J Comput Assist Tomogr, 2005, 29(4): 438-445.
38.	徐峻, 陸建平, 汪劍, 等. 胰膽管擴張的 MRCP 表現對胰腺癌和慢性胰腺炎的診斷意義. 胰腺病學, 2004, 4(1): 19-22.
39.	Hekimoglu K, Ustundag Y, Dusak A, et al. MRCP vs. ERCP in the evaluation of biliary pathologies: review of current literature. J Dig Dis, 2008, 9(3): 162-169.
40.	Wang Y, Miller FH, Chen ZE, et al. Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographics, 2011, 31(3): E47-E64.
41.	Matsuki M, Inada Y, Nakai G, et al. Diffusion-weighed MR imaging of pancreatic carcinoma. Abdom Imaging, 2007, 32(4): 481-483.
42.	Muraoka N, Uematsu H, Kimura H, et al. Apparent diffusion coefficient in pancreatic cancer: characterization and histopathological correlations. J Magn Reson Imaging, 2008, 27(6): 1302-1308.
43.	Niu X, Das SK, Bhetuwal A, et al. Value of diffusion-weighted imaging in distinguishing pancreatic carcinoma from mass-forming chronic pancreatitis: a meta-analysis. Chin Med J (Engl), 2014, 127(19): 3477-3482.
44.	Hong BZ, Li XF, Lin JQ. Differential diagnosis of pancreatic cancer by single-shot echo-planar imaging diffusion-weighted imaging. World J Gastroenterol, 2015, 21(20): 6374-6380.
45.	林麗麗, 黃子星, 宋彬. 磁共振波譜成像在胰腺癌診斷中的應用進展. 中國普外基礎與臨床雜志, 2013, 20(10): 1179-1182.
46.	Ma X, Zhao X, Ouyang H, et al. The metabolic features of normal pancreas and pancreatic adenocarcinoma: preliminary result of in vivo proton magnetic resonance spectroscopy at 3.0 T. J Comput Assist Tomogr, 2011, 35(5): 539-543.
47.	Kaplan O, Kushnir T, Askenazy N, et al. Role of nuclear magnetic resonance spectroscopy (MRS) in cancer diagnosis and treatment: 31P, 23Na, and 1H MRS studies of three models of pancreatic cancer. Cancer Res, 1997, 57(8): 1452-1459.
48.	Cho SG, Lee DH, Lee KY, et al. Differentiation of chronic focal pancreatitis from pancreatic carcinoma by in vivo proton magnetic resonance spectroscopy. J Comput Assist Tomogr, 2005, 29(2): 163-169.
49.	Sperti C, Pasquali C, Decet G,et al. F-18-fluorodeoxyglucose positron emission tomography in differentiating malignant from benign pancreatic cysts: a prospective study. J Gastrointest Surg, 2005, 9(1): 22-28; discussion 28-29.
50.	Singer E, Gschwantler M, Plattner D, et al. Differential diagnosis of benign and malign pancreatic masses with 18F-fluordeoxyglucose-positron emission tomography recorded with a dual-head coincidence gamma camera. Eur J Gastroenterol Hepatol, 2007, 19(6): 471-478.
51.	Bang S, Chung HW, Park SW, et al. The clinical usefulness of 18-fluorodeoxyglucose positron emission tomography in the differential diagnosis, staging, and response evaluation after concurrent chemoradiotherapy for pancreatic cancer. J Clin Gastroenterol, 2006, 40(10): 923-929.
52.	Nishiyama Y, Yamamoto Y, Monden T, et al. Evaluation of delayed additional FDG PET imaging in patients with pancreatic tumour. Nucl Med Commun, 2005, 26(10): 895-901.
53.	Lytras D, Connor S, Bosonnet L,et al. Positron emission tomography does not add to computed tomography for the diagnosis and staging of pancreatic cancer. Digestive surgery, 2005, 22(1-2): 55-61; discussion 62.
54.	Tang S, Huang G, Liu J, et al. Usefulness of 18F-FDG PET, combined FDG-PET/CT and EUS in diagnosing primary pancreatic carcinoma: a meta-analysis. Eur J Radiol, 2011, 78(1): 142-150.
55.	Rijkers AP, Valkema R, Duivenvoorden HJ, et al. Usefulness of F-18-fluorodeoxyglucose positron emission tomography to confirm suspected pancreatic cancer: a meta-analysis. Eur J Surg Oncol, 2014, 40(7): 794-804.
56.	Wu LM, Hu JN, Hua J, et al. Diagnostic value of diffusion-weighted magnetic resonance imaging compared with fluorodeoxyglucose positron emission tomography/computed tomography for pancreatic malignancy: a meta-analysis using a hierarchical regression model. J Gastroenterol Hepatol, 2012, 27(6): 1027-1035.

1. ?Zhang Q, Zeng L, Chen Y, et al. Pancreatic cancer epidemiology, detection, and management. Gastroenterol Res Pract, 2016, 2016: 8962321.
2. O’Hayer KM, Brody JR. Personalized therapy for pancreatic cancer: Do we need better targets, arrows, or both? Discov Med, 2016, 21(114): 117-123.
3. Rahib L, Smith BD, Aizenberg R, et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res, 2014, 74(11): 2913-2921.
4. Werner J, Buchler MW. Management of pancreatic cancer: recent advances. Dtsch Med Wochenschr, 2011, 136(36): 1807-1810.
5. Winter JM, Cameron JL, Campbell KA, et al. 1 423 pancrea-ticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg, 2006, 10(9): 1199-1210; discussion 1210-1191.
6. Brambs HJ, Claussen CD. Pancreatic and ampullary carcinoma. Ultrasound, computed tomography, magnetic resonance imaging and angiography. Endoscopy, 1993, 25(1): 58-68.
7. 盧祎, 龔彪. 超聲在胰腺癌診斷中的應用進展. 臨床超聲醫學雜志, 2015, 17(2): 108-111.
8. Okamoto Y, Kawamoto H, Takaki A, et al. Contrast-enhanced ultrasonography depicts small tumor vessels for the evaluation of pancreatic tumors. Eur J Radiol, 2007, 61(1): 163-169.
9. D’Onofrio M, Zamboni G, Tognolini A, et al. Mass-forming pancreatitis: value of contrast-enhanced ultrasonography. World J Gastroenterol, 2006, 12(26): 4181-4184.
10. Rosch T, Hofrichter K, Frimberger E, et al. ERCP or EUS for tissue diagnosis of biliary strictures? A prospective comparative study. Gastrointest Endosc, 2004, 60(3): 390-396.
11. Varadarajulu S, Eloubeidi MA. The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer. Surg Clin North Am, 2010, 90(2): 251-263.
12. DeWitt J, Devereaux B, Chriswell M, et al. Comparison of endoscopic ultrasonography and multidetector computed tomography for detecting and staging pancreatic cancer. Ann Intern Med, 2004, 141(10): 753-763.
13. Agarwal B, Abu-Hamda E, Molke KL, et al. Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol, 2004, 99(5): 844-850.
14. Larghi A, Correale L, Ricci R, et al. Interobserver agreement and accuracy of preoperative endoscopic ultrasound-guided biopsy for histological grading of pancreatic cancer. Endoscopy, 2015, 47(4): 308-314.
15. National Comprehensive Cancer Network. (NCCN) Clinical Practice Guidelines in Oncology. Pancreatic Adenocarcinoma, Version 1. 2016. .
16. Ishigami K, Yoshimitsu K, Irie H, et al. Diagnostic value of the delayed phase image for iso-attenuating pancreatic carcinomas in the pancreatic parenchymal phase on multidetector computed tomography. Eur J Radiol, 2009, 69(1): 139-146.
17. Peddu P, Quaglia A, Kane PA, et al. Role of imaging in the management of pancreatic mass. Crit Rev Oncol Hematol, 2009, 70(1): 12-23.
18. Kim JH, Park SH, Yu ES, et al. Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology, 2010, 257(1): 87-96.
19. Valls C, Andia E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. AJR Am J Roentgenol, 2002, 178(4): 821-826.
20. Ahn SS, Kim MJ, Choi JY, et al. Indicative findings of pancreatic cancer in prediagnostic CT. Eur Radiol, 2009, 19(10): 2448-2455.
21. Takeshita K, Kutomi K, Haruyama T, et al. Imaging of early pancreatic cancer on multidetector row helical computed tomography. Br J Radiol, 2010, 83(994): 823-830.
22. Hijioka S, Ikari T, Kamei A, et al. CT and MRI findings with contrast enhancement of small pancreatic adenocarcinoma in the late phase. Hepatogastroenterology, 2007, 54(74): 389-392.
23. Kim SH, Kamaya A, Willmann JK. CT perfusion of the liver: principles and applications in oncology. Radiology, 2014, 272(2): 322-344.
24. 梁宗輝, 馮曉源, 祝瑞江, 等. 正常胰腺的多層螺旋 CT 灌注成像研究. 生物醫學工程與臨床, 2006, 10(4): 218-222, 271.
25. Kandel S, Kloeters C, Meyer H, et al. Whole-organ perfusion of the pancreas using dynamic volume CT in patients with primary pancreas carcinoma: acquisition technique, post-processing and initial results. Eur Radiol, 2009, 19(11): 2641-2646.
26. Xu J, Liang Z, Hao S, et al. Pancreatic adenocarcinoma: dynamic 64-slice helical CT with perfusion imaging. Abdom Imaging, 2009, 34(6): 759-766.
27. 李海鷗. 低劑量胰腺 CT 灌注成像聯合雙能量增強掃描在胰腺癌診斷中的應用. 山東大學, 2015.
28. 解騫. 256 層螺旋 CT 全器官灌注成像在胰腺癌中的研究. 復旦大學, 2013.
29. Liu K, Peng W, Zhou Z. The CT findings of pancreatic acinar cell carcinoma in five cases. Clin Imaging, 2013, 37(2): 302-307.
30. Vachiranubhap B, Kim YH, Balci NC, et al. Magnetic resonance imaging of adenocarcinoma of the pancreas. Top Magn Reson Imaging, 2009, 20(1): 3-9.
31. Schima W, Ba-Ssalamah A, Goetzinger P, et al. State-of-the-art magnetic resonance imaging of pancreatic cancer. Top Magn Reson Imaging, 2007, 18(6): 421-429.
32. Kim JK, Altun E, Elias J Jr, et al. Focal pancreatic mass: distinction of pancreatic cancer from chronic pancreatitis using gadolinium-enhanced 3D-gradient-echo MRI. J Magn Reson Imaging, 2007, 26(2): 313-322.
33. Kelekis NL, Semelka RC. MRI of pancreatic tumors. Eur Radiol, 1997, 7(6): 875-886.
34. Chen FM, Ni JM, Zhang ZY, et al. Presurgical evaluation of pancreatic cancer: a comprehensive imaging comparison of CT versus MRI. AJR Am J Roentgenol, 2016, 206(3): 526-535.
35. Koelblinger C, Ba-Ssalamah A, Goetzinger P, et al. Gadobenate dimeglumine-enhanced 3.0-T MR imaging versus multiphasic 64-detector row CT: prospective evaluation in patients suspected of having pancreatic cancer. Radiology, 2011, 259(3): 757-766.
36. Kauhanen SP, Komar G, Seppanen MP, et al. A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg, 2009, 250(6): 957-963.
37. Bipat S, Phoa SS, van Delden OM, et al. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis. J Comput Assist Tomogr, 2005, 29(4): 438-445.
38. 徐峻, 陸建平, 汪劍, 等. 胰膽管擴張的 MRCP 表現對胰腺癌和慢性胰腺炎的診斷意義. 胰腺病學, 2004, 4(1): 19-22.
39. Hekimoglu K, Ustundag Y, Dusak A, et al. MRCP vs. ERCP in the evaluation of biliary pathologies: review of current literature. J Dig Dis, 2008, 9(3): 162-169.
40. Wang Y, Miller FH, Chen ZE, et al. Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographics, 2011, 31(3): E47-E64.
41. Matsuki M, Inada Y, Nakai G, et al. Diffusion-weighed MR imaging of pancreatic carcinoma. Abdom Imaging, 2007, 32(4): 481-483.
42. Muraoka N, Uematsu H, Kimura H, et al. Apparent diffusion coefficient in pancreatic cancer: characterization and histopathological correlations. J Magn Reson Imaging, 2008, 27(6): 1302-1308.
43. Niu X, Das SK, Bhetuwal A, et al. Value of diffusion-weighted imaging in distinguishing pancreatic carcinoma from mass-forming chronic pancreatitis: a meta-analysis. Chin Med J (Engl), 2014, 127(19): 3477-3482.
44. Hong BZ, Li XF, Lin JQ. Differential diagnosis of pancreatic cancer by single-shot echo-planar imaging diffusion-weighted imaging. World J Gastroenterol, 2015, 21(20): 6374-6380.
45. 林麗麗, 黃子星, 宋彬. 磁共振波譜成像在胰腺癌診斷中的應用進展. 中國普外基礎與臨床雜志, 2013, 20(10): 1179-1182.
46. Ma X, Zhao X, Ouyang H, et al. The metabolic features of normal pancreas and pancreatic adenocarcinoma: preliminary result of in vivo proton magnetic resonance spectroscopy at 3.0 T. J Comput Assist Tomogr, 2011, 35(5): 539-543.
47. Kaplan O, Kushnir T, Askenazy N, et al. Role of nuclear magnetic resonance spectroscopy (MRS) in cancer diagnosis and treatment: 31P, 23Na, and 1H MRS studies of three models of pancreatic cancer. Cancer Res, 1997, 57(8): 1452-1459.
48. Cho SG, Lee DH, Lee KY, et al. Differentiation of chronic focal pancreatitis from pancreatic carcinoma by in vivo proton magnetic resonance spectroscopy. J Comput Assist Tomogr, 2005, 29(2): 163-169.
49. Sperti C, Pasquali C, Decet G,et al. F-18-fluorodeoxyglucose positron emission tomography in differentiating malignant from benign pancreatic cysts: a prospective study. J Gastrointest Surg, 2005, 9(1): 22-28; discussion 28-29.
50. Singer E, Gschwantler M, Plattner D, et al. Differential diagnosis of benign and malign pancreatic masses with 18F-fluordeoxyglucose-positron emission tomography recorded with a dual-head coincidence gamma camera. Eur J Gastroenterol Hepatol, 2007, 19(6): 471-478.
51. Bang S, Chung HW, Park SW, et al. The clinical usefulness of 18-fluorodeoxyglucose positron emission tomography in the differential diagnosis, staging, and response evaluation after concurrent chemoradiotherapy for pancreatic cancer. J Clin Gastroenterol, 2006, 40(10): 923-929.
52. Nishiyama Y, Yamamoto Y, Monden T, et al. Evaluation of delayed additional FDG PET imaging in patients with pancreatic tumour. Nucl Med Commun, 2005, 26(10): 895-901.
53. Lytras D, Connor S, Bosonnet L,et al. Positron emission tomography does not add to computed tomography for the diagnosis and staging of pancreatic cancer. Digestive surgery, 2005, 22(1-2): 55-61; discussion 62.
54. Tang S, Huang G, Liu J, et al. Usefulness of 18F-FDG PET, combined FDG-PET/CT and EUS in diagnosing primary pancreatic carcinoma: a meta-analysis. Eur J Radiol, 2011, 78(1): 142-150.
55. Rijkers AP, Valkema R, Duivenvoorden HJ, et al. Usefulness of F-18-fluorodeoxyglucose positron emission tomography to confirm suspected pancreatic cancer: a meta-analysis. Eur J Surg Oncol, 2014, 40(7): 794-804.
56. Wu LM, Hu JN, Hua J, et al. Diagnostic value of diffusion-weighted magnetic resonance imaging compared with fluorodeoxyglucose positron emission tomography/computed tomography for pancreatic malignancy: a meta-analysis using a hierarchical regression model. J Gastroenterol Hepatol, 2012, 27(6): 1027-1035.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The imaging diagnosis of pancreatic cancer: recent advances

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