A clinical algorithm for the assessment of pancreatic lesions: utilization of 16- and 64-section multidetector CT and endoscopic ultrasound

Pancreatic masses may be solid or cystic, benign or malignant, and their characterization can often be difficult as there is considerable overlap in their imaging features. Multidetector computed tomography (MDCT) with multiplanar reconstructions offers improved resolution and optimum visualization of the peripancreatic vasculature, which has improved the accuracy in predicting surgical resectability. Endoscopic ultrasound (EUS) is valuable in the detection of tumours not identified on CT. It is also accurate in identifying vascular involvement, which complements MDCT in predicting resectability. In cases of diagnostic uncertainty, EUS-guided fine-needle aspiration (FNA) can be used to obtain tissue samples from solid lesions and fluid aspirates from cystic lesions, allowing histological, cytological, and biochemical analysis to determine the nature of the lesion. This article focuses on the MDCT and EUS appearances of common pancreatic malignancies, highlighting their relative advantages and their complementary role in detecting and characterizing pancreatic masses. A clinical algorithm for the assessment of pancreatic malignancy, as practised in our institution, is outlined.