From the Guidelines
For long-term follow-up of pancreatic cancer, CT scan of the abdomen is the preferred imaging modality. After initial treatment of pancreatic cancer, patients require regular surveillance to monitor for disease recurrence, and CT scanning is the preferred imaging modality 1. Typically, follow-up CT scans are performed every 3-6 months for the first 2 years after treatment, then every 6-12 months thereafter. CT scans provide detailed cross-sectional images that can detect small recurrent tumors, metastases, and complications. They offer superior visualization of the pancreas, surrounding structures, lymph nodes, liver, and other potential sites of metastasis compared to X-rays or ultrasound.
Some key points to consider when using CT scans for pancreatic cancer follow-up include:
- Technical optimization is essential for high-quality CT images, including multiphase thin-section images and intravenous iodinated non-ionic contrast agent injection 1
- CT scans should be carried out in the 4 weeks before starting therapy to assess the extent of disease 1
- The use of standardized reporting templates is recommended to ensure that all necessary information is included in the imaging report 1
X-ray abdomen lacks sensitivity for pancreatic lesions and cannot adequately visualize soft tissue structures. Ultrasound abdomen has limited utility for pancreatic cancer follow-up due to technical limitations including bowel gas interference and difficulty visualizing the entire pancreas, especially in patients with obesity or post-surgical changes. CT scanning also allows for objective measurement of tumor response using standardized criteria, making it the standard of care for pancreatic cancer surveillance.
Other imaging modalities, such as MRI and PET-CT, may be used in certain situations, but CT scanning remains the preferred imaging modality for long-term follow-up of pancreatic cancer 1. For example, MRI may be used when CT is inconclusive or when a contrast-enhanced CT is contraindicated, while PET-CT may be considered for staging in the presence of non-metastatic disease on CT for patients who will receive local cancer treatment. However, the use of these modalities should be determined on a case-by-case basis, taking into account the individual patient's needs and circumstances.
From the Research
Imaging Modalities for Long-Term Follow-Up of Pancreatic Cancer
The preferred imaging modality for long-term follow-up of pancreatic cancer can be determined by examining the available evidence.
- Computed Tomography (CT) scan of the abdomen is widely used for follow-up, as it can detect recurrences in the form of metastatic disease 2, 3, 4, 5.
- X-ray of the abdomen is not typically used for follow-up of pancreatic cancer, as it is not sensitive enough to detect small recurrences or metastases.
- Ultrasound of the abdomen may be used in some cases, but it is not as widely used as CT scans for follow-up of pancreatic cancer 2.
Use of CT Scans in Follow-Up
CT scans are commonly used for follow-up of pancreatic cancer, as they can detect recurrences in the remnant pancreas or in distant organs such as the liver 2, 3, 4, 5.
- CT scans can detect mass lesions, cystic lesions, and pancreatic duct dilatation, which can be indicative of recurrence 2.
- The sensitivity of CT scans can be improved by combining them with other diagnostic modalities, such as endoscopic ultrasonography (EUS) or tumor marker testing 2, 4.
Combination of Diagnostic Modalities
Combining CT scans with other diagnostic modalities, such as tumor marker testing or EUS, can improve the detection of recurrences and allow for earlier intervention 2, 4, 5.