Multimodality imaging features of malignant and benign FDG-avid pancreatic lesions and their impact on clinical management

Learning Objectives 1. To present a pictorial review of malignant and benign pancreatic lesions, with emphasis on distinguishing features of each on complementary imaging modalities. 2. To correlate imaging findings with histopathological results. 3. For malignant lesions, to provide a review of staging criteria and suitability for surgical resection.

FDG PET/CT is useful in evaluation and management of patients with pancreatic malignancies and is utilized for their staging/restaging work up and to evaluate treatment response. Lesions found on PET/CT may be further characterized by other imaging modalities, increasing diagnostic yield with additional benefit to referring clinicians in their management decisions. This exhibit provides a pictorial review of FDG PET/CT findings of malignant and benign pancreatic lesions, highlights the distinguishing characteristics and patterns of spread for each lesion on comparative imaging (CT, MR, MRCP, Tc99m bone scan, and In-111 OctreoScan). Multimodality imaging findings are validated with histopathological results. An overview of surgical appropriateness criteria and staging is reviewed for each malignant neoplasm. Cases include primary pancreatic neoplasms (adenocarcinoma, intraductal papillary mucinous neoplasm, pancreatic neuroendocrine tumor), metastatic neoplasms to the pancreas, lymphoma, and benign processes. Post-surgical appearances, complications, and patterns of disease recurrence will also be shown. After completing this exhibit, the viewer will be familiarized with the imaging characteristics of a wide spectrum of pancreatic pathology, with special attention to PET/CT findings. The viewer will also educated in a number of benign mimics and imaging pitfalls that may be encountered in clinical practice so that one may arrive at a confident diagnosis.