Liver MRI before pancreatic resection, and what a screen-detected nodule says about its histology

The edition in brief

The ACR has updated its Appropriateness Criteria for diffuse lung disease, covering initial imaging, suspected acute exacerbation and surveillance; the record does not give the individual ratings, so check the document before changing protocols. A NELSON trial analysis of 213 screen-detected lung cancers found adenocarcinomas smaller, slower growing and more often upper-lobe or pleural-based than other subtypes, with a model sensitive but not specific for adenocarcinoma. The practice-changer is a meta-analysis of 40 studies that imaged suspected pancreatic cancer with at least two modalities: CT, MRI and endoscopic ultrasound detected the primary equally, but MRI was more sensitive for liver metastases (0.89 vs 0.60), while CT was more specific for resectability (0.88 vs 0.63) and better for vascular invasion. That supports adding liver MRI to CT before potentially curative surgery.