MRI for restaging pancreatic cancer

Pancreatic adenocarcinoma is a tumor with a dismal prognosis, as the majority of patients are diagnosed when the tumor is not resectable. Neoadjuvant treatment has significantly improved prognosis, but assessing treatment response can be challenging for radiologists. Given the fibrotic nature of the primary tumor, differentiating between residual viable tumor and fibrotic response can be difficult. MRI can have a role in reassessing the primary tumor and disease spread. In this review, we discuss MR techniques that can be used for this assessment, including routinely used sequences (e.g., DWI) and sequences that are not yet routinely included in pancreatic protocols (e.g., T1 mapping, ECV imaging, and USPIO contrast for nodal staging). KEY POINTS: Question Imaging assessment of the response of pancreatic adenocarcinoma to neoadjuvant treatment is difficult and still has limited accuracy. Findings Different MRI sequences and techniques have been suggested as possibly improving this assessment, reflecting on better patient management. Critical relevance statement We summarize the available evidence on MRI for restaging pancreatic carcinoma after neoadjuvant treatment.