Staging suspected pancreatic cancer depends on how the CT is acquired. Use a dedicated pancreatic protocol: thin-section multiphase imaging with a late arterial or pancreatic parenchymal phase, when the tumour is most conspicuous against enhancing pancreas, and a portal venous phase for the veins and liver. Neutral or water oral contrast helps outline the duodenum without obscuring the ampulla.
Report in a structured way: tumour size and location, contact with the superior mesenteric artery, coeliac axis and common hepatic artery in degrees, venous involvement of the portal and superior mesenteric veins, arterial variants, and any liver, peritoneal or nodal disease. Image before a biliary stent where possible, because stent-related inflammation can mimic or obscure tumour.
- Use a multiphase pancreatic protocol with a pancreatic parenchymal and a portal venous phase.
- Acquire thin sections and use multiplanar reformats for vessel contact.
- Report arterial and venous contact in degrees with a structured template.
- Describe arterial variants such as a replaced right hepatic artery.
- Image before biliary stenting where possible.
Why it matters
Resectability is decided from these images, and a single-phase scan cannot answer the question.
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