Pancreas protocol CT (pancreatic protocol CT, dual-phase thin-slice CT with structured reporting)

NICE NG85 asks for a pancreatic protocol CT before the bile duct is drained in people with obstructive jaundice and suspected pancreatic cancer (1.1.1), for people with pancreatic abnormalities without jaundice (1.1.4), as an option for cysts (1.1.7), and, covering chest, abdomen and pelvis, for every newly diagnosed patient who has not had one (1.3.1); a stent placed first causes inflammation and artefact that can obscure the tumour and its relation to the vessels. The scan acquires thin (about 1 mm) slices in a late arterial or pancreatic parenchymal phase, when the gland enhances brightly and a hypo-enhancing adenocarcinoma stands out and the arteries are opacified, and a portal venous phase for the veins and liver. The Society of Abdominal Radiology and the American Pancreatic Association published a consensus reporting template so that every report states the tumour's size and location, the degrees of contact with the superior mesenteric artery, coeliac axis and common hepatic artery, contact, narrowing or occlusion of the superior mesenteric and portal veins, variant arterial anatomy, and the presence of metastases, because incomplete free-text reports were a common reason for wrong resectability decisions (Al-Hawary 2014). Those measurements feed the resectability classes. When the diagnosis remains unclear NG85 adds FDG PET-CT and or endoscopic ultrasound with tissue sampling (1.1.2, 1.1.5), and for staging MRI of the liver, EUS for nodes and laparoscopy for small-volume peritoneal disease (1.3.3). Cancer Research UK notes that when the scan shows a removable tumour a biopsy is often not taken before surgery.