An update on pancreatic cancer imaging, staging and use of the PACT-UK radiology template pre- and post-neoadjuvant treatment.

Abstract

Pancreatic ductal adenocarcinoma continues to have a poor prognosis, although recent advances in neoadjuvant treatments have provided some hope. Imaging assessment of suspected tumours can be challenging and requires a specific approach, with pancreas protocol CT being the primary imaging modality for staging with other modalities used as problem-solving tools to facilitate appropriate management. Imaging assessment post neoadjuvant treatment can be particularly difficult due to a current lack of robust radiological criteria to predict response and differentiate treatment induced fibrosis/inflammation from residual tumour. This review aims to provide an update of pancreatic ductal adenocarcinoma with particular focus on three points: tumour staging pre- and post-neoadjuvant treatment including vascular assessment, structured reporting with introduction of the PACT-UK radiology template (PAncreatic Cancer reporting Template-UK), and the potential future role of artificial intelligence in the diagnosis and staging of pancreatic cancer.