An update on pancreatic cancer imaging, staging, and use of the PACT-UK radiology template pre- and post-neoadjuvant treatment

Br J Radiol. 2025 Jan 1;98(1165):13-26. doi: 10.1093/bjr/tqae217.

Abstract

Pancreatic ductal adenocarcinoma continues to have a poor prognosis, although recent advances in neoadjuvant treatments (NATs) have provided some hope. Imaging assessment of suspected tumours can be challenging and requires a specific approach, with pancreas protocol CT being the primary imaging modality for staging with other modalities used as problem-solving tools to facilitate appropriate management. Imaging assessment post NAT can be particularly difficult due to a current lack of robust radiological criteria to predict response and differentiate treatment induced fibrosis/inflammation from residual tumour. This review aims to provide an update of pancreatic ductal adenocarcinoma with particular focus on three points: tumour staging pre- and post-NAT including vascular assessment, structured reporting with introduction of the PAncreatic Cancer reporting Template-UK (PACT-UK) radiology template, and the potential future role of artificial intelligence in the diagnosis and staging of pancreatic cancer.

Keywords: neoadjuvant; pancreatic cancer; pancreatic ductal adenocarcinoma; reporting template; staging.

Publication types

  • Review

MeSH terms

  • Carcinoma, Pancreatic Ductal / diagnostic imaging
  • Carcinoma, Pancreatic Ductal / pathology
  • Carcinoma, Pancreatic Ductal / therapy
  • Humans
  • Magnetic Resonance Imaging / methods
  • Neoadjuvant Therapy* / methods
  • Neoplasm Staging*
  • Pancreas / diagnostic imaging
  • Pancreas / pathology
  • Pancreatic Neoplasms* / diagnostic imaging
  • Pancreatic Neoplasms* / pathology
  • Pancreatic Neoplasms* / therapy
  • Tomography, X-Ray Computed / methods
  • United Kingdom