Pancreatic adenocarcinoma is the fourth leading cause of death due to malignant disease in adults. Even with the most effective standard therapies, the overall five-year survival rate is poor.While radical surgery offers the only potentially curative treatment, less than 20% of all patients are candidates for curative resection. At initial presentation, 40% of patients have extensive local disease and 40–55% have evidence of metastases. Those with locally advanced and metastatic pancreatic cancer have a median survival of approximately 10–12 months and 4–6 months, respectively. Following resection, patients with residual disease (positive surgical margins) have survival rates similar to those treated non-operatively. Although 80% of primary adenocarcinomas arise in the pancreatic head, those located in the body, tail and uncinate process carry a worse prognosis, as they tend to present later with symptoms of extensive local disease rather than obstructive jaundice. Accurate imaging studies are helpful in preo erative staging and may minimize unnecessary operations.

Historically, pancreatic imaging modalities have included computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS). Recent advances in imaging technologies have had a substantial impact on the accuracy of pancreatic imaging in the diagnosis and staging of pancreatic malignancies. Multi-detector row spiral CT (MDCT) technology has led to a significant improvement in the speed and quality of CT imaging. Magnetic resonance cholangiopancreatography (MRCP) allows for noninvasive definition of the pancreatic and biliary ducts. While conventional transabdominal ultrasound has largely been replaced by CT and MRI for pancreatic imaging, advances in echo-enhanced contrast ultrasonography has improved the ability to assess tumor vascularity. Positron emission tomography (PET) is increasingly being used for the staging of pancreatic cancer, and the combination of the functional results of PET with the anatomic structural etail of CT (PET/CT fusion) enhances the evaluation of small pancreatic tumors. Established technologies include:

• CT imaging;
• MRI and MRCP;
• EUS;
• PET; and
• Echo-enhanced ultrasonography.