Although MRCP has not yet completely replaced ERCP in patients with suspected pancreatic cancer in all centers, it is routinely used in patients with high

grade stenosis of the gastric outlet or proximal duodenum or in those with certain post-surgical anatomy (e.g., Billroth II, Roux-en Y biliary bypass), which make the biliary ductal system difficult to access by ERCP (26). Chronic pancreatitis can be difficult to differentiate from pancreatic adenocarcinoma on MRI since both show low signal intensity on T1-weighted images and both may be associated with pancreatic Inhibitors,research,lifescience,medical and/or biliary ductal obstruction. Dynamic gadolinium-enhanced MRI cannot differentiate chronic pancreatitis and PaCa on the basis of degree and time of enhancement (27). MRCP images may be more helpful in distinguishing between chronic pancreatitis and pancreatic adenocarcinoma especially if the duct-penetrating sign signifying a non-obstructed main pancreatic duct is present (28). Positron Emission Tomography (PET) Inhibitors,research,lifescience,medical Imaging Positron emission tomography(PET) scanning with the tracer 18-fluorodeoxyglucose (FDG)

relies upon functional activity to differentiate metabolically active proliferative lesions such as cancers, most of which are FDG-avid lesion such as cancers from benign lesions, most of which do not accumulate FDG with the exception Inhibitors,research,lifescience,medical of inflammatory lesions such as chronic pancreatitis. The utility of PET in the diagnostic and staging evaluation of suspected PaCa remains uncertain and there is still no consensus on whether PET provides information beyond Inhibitors,research,lifescience,medical that obtained by contrast-enhanced CT (29). As PET imaging is usually performed after the initial CT, the sensitivity and specificity of PET varied depending on the CT result. Sensitivity and specificity after a positive CT was 92% (87 to 95) and 68% (51 to 81); after a negative CT, the corresponding values were 73% Inhibitors,research,lifescience,medical (50 to 88) and 86% (75 to 93). Elevated serum blood glucose levels increase the number of false negative PET scans. Data published on the use of PET scans in PaCa are conflicting. Some studies suggest

that PET is useful for identifying metastatic disease that is missed by CT (30), while others reported that PET often misses small volume metastases within the peritoneum and check details elsewhere, including the liver (31). before More recent studies have investigated the value of integrated PET/CT, which has better spatial resolution as compared to PET scans. In one case series, the sensitivity and specificity of PET/CT for the diagnosis of PaCa compared with CT alone was 89% versus 93% and 69% versus 21% respectively (32). PET/CT is also superior to conventional imaging (MDCT, CT angiography, EUS) used for tumor staging and detection of distant metastases (sensitivity and specificity rates were 89 versus 56 and 100 versus 95 percent, respectively).