Pancreatic diseases represent a diagnostic challenge due to their deep anatomical location and nonspecific clinical presentation[1]. Pancreatic cancer is the seventh leading cause of cancer-related mortality worldwide, with a 5-year survival rate of less than 10%. Early diagnosis significantly improves outcomes; however, most patients present at an advanced stage[2]. Pancreatic lesions comprise a broad spectrum of inflammatory, benign, and malignant conditions, often presenting with nonspecific clinical symptoms such as abdominal pain, jaundice, weight loss, or back pain. Due to the retroperitoneal location of the pancreas and the late manifestation of symptoms, pancreatic diseases—particularly malignancies—are frequently diagnosed at an advanced stage. Pancreatic carcinoma remains one of the leading causes of cancer-related mortality worldwide, with a very poor overall prognosis, emphasizing the need for early and accurate diagnosis[3].

When assessing pancreatic pathology, imaging is essential. Although it is operator-dependent and constrained by intestinal gas, ultrasonography is frequently utilized as an initial screening method among the available modalities. Magnetic resonance imaging (MRI) offers excellent soft-tissue contrast but is less accessible and time consuming[4].

Rapid acquisition, excellent spatial resolution, and multiplanar reconstruction capabilities have made multidetector computed tomography (MDCT) the preferred imaging technology for pancreatic evaluation. In addition to identifying pancreatic tumors, MDCT evaluates lymphadenopathy, vascular involvement, and distant metastases—all of which are critical for staging and treatment planning [5]. The purpose of this study is to assess the diagnostic utility of MDCT in pancreatic lesions and examine imaging properties in various diseases. The preferred imaging technique for assessing pancreatic lesions is multidetector computed tomography (MDCT). MDCT enables thorough evaluation of pancreatic shape and disease because to its quick image acquisition, thin-section imaging, high spatial resolution, and multiplanar reconstruction capabilities. The best possible visualization of the pancreatic duct, parenchyma, surrounding vasculature, and surrounding structures is made possible by the adoption of multiphasic contrast-enhanced protocols [6-7].

Study Design: Prospective observational study. Study Population: The study included 100 consecutive patients referred to the Department of Radio diagnosis with clinical suspicion of pancreatic disease over a period of 01 Year. Inclusion Criteria 1. Patients with abdominal pain, jaundice, weight loss, or suspected pancreatic mass 2. Patients referred for CT evaluation of pancreas 3. Age >18 years Exclusion Criteria 1. Known allergy to iodinated contrast 2. Renal failure (eGFR <30 ml/min) 3. Pregnant patients 4. Previously diagnosed pancreatic malignancy under treatment CT Protocol All scans were performed on a 64-slice MDCT scanner using a dedicated pancreatic protocol: Non-contrast phase Pancreatic arterial phase (35–40 seconds) Portal venous phase (65–70 seconds) Contrast dose: 1.5 ml/kg of non-ionic contrast at 4 ml/sec. Reference Standard Final diagnosis was confirmed by: Histopathology or cytology (n = 72) Clinical and imaging follow-up (n = 28) Statistical Analysis Data were analyzed using descriptive statistics. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Table 1: Age and Sex Distribution of Patients (n = 100)

The age and sex distribution of the 100 patients included in the study. The study population consisted of 61 males and 39 females, showing a male predominance. The age of patients ranged from 21 years to over 60 years. The majority of patients belonged to the 51–60 years age group, accounting for 32% of cases, followed by the 41–50 years age group (24%). Patients above 60 years constituted 23% of the study population. The least number of patients were observed in the 21–30 years age group (7%). Overall, pancreatic lesions were more commonly observed in the middle-aged and elderly population, with a higher prevalence among males.

Table 2: Spectrum of Pancreatic Lesions on MDCT

The spectrum of pancreatic lesions detected on multidetector computed tomography. Malignant lesions constituted the majority of cases, with pancreatic adenocarcinoma being the most common diagnosis, seen in 48% of patients. Neuroendocrine tumors accounted for 6% of cases. Cystic pancreatic neoplasms were identified in 10% of patients. Inflammatory conditions comprised a significant proportion of cases, with acute pancreatitis and chronic pancreatitis each accounting for 14% of the study population. Metastatic lesions involving the pancreas were relatively uncommon, seen in 4% of cases. This distribution highlights the predominance of malignant pancreatic lesions in the study population.

Table 3: Anatomical Distribution of Pancreatic Lesions

The anatomical distribution of pancreatic lesions. The head of the pancreas was the most commonly involved site, accounting for 56% of cases. Lesions involving the body of the pancreas were seen in 26% of patients, while the tail was involved in 18% of cases. The predominance of lesions in the pancreatic head explains the frequent clinical presentation with obstructive jaundice observed in many patients. This anatomical distribution is consistent with previously reported studies.

Table 4: Diagnostic Accuracy of MDCT

The diagnostic performance of multidetector computed tomography in evaluating pancreatic lesions. MDCT demonstrated a high sensitivity of 94% and a specificity of 88% in differentiating malignant from non-malignant lesions. The positive predictive value was 91%, while the negative predictive value was 92%. The overall diagnostic accuracy of MDCT in this study was 92%, indicating that MDCT is a reliable and accurate imaging modality for the detection and characterization of pancreatic lesions.

Pancreatic adenocarcinoma was the most common lesion in this study, predominantly involving the pancreatic head, consistent with published literature. MDCT demonstrated high sensitivity in detecting pancreatic masses, particularly lesions larger than 2 cm[8].

Malignant lesions typically appeared as hypoenhancing masses with irregular margins and associated pancreatic duct dilatation. Vascular involvement was accurately assessed using arterial and portal venous phase imaging, which is essential for determining surgical resectability[9].

Inflammatory lesions, particularly chronic pancreatitis, posed diagnostic challenges due to overlapping features with malignancy. However, features such as calcifications, ductal irregularity, and homogeneous enhancement favored inflammatory etiology.

Cystic lesions were well characterized on MDCT based on morphology, septations, mural nodules, and enhancement patterns, aiding differentiation between benign and premalignant entities[10].

Overall, MDCT proved to be a reliable modality for comprehensive evaluation of pancreatic lesions.

Inflammatory pancreatic conditions, including acute and chronic pancreatitis, constituted a significant proportion of cases. Acute pancreatitis was characterized by pancreatic enlargement, heterogeneous enhancement, peripancreatic fat stranding, and fluid collections. Chronic pancreatitis demonstrated features such as pancreatic atrophy, ductal irregularity, and parenchymal calcifications[11]. Differentiating focal pancreatitis from pancreatic carcinoma remains challenging; however, MDCT provided valuable morphological clues that aided in diagnosis when interpreted in conjunction with clinical and laboratory findings.

Cystic pancreatic lesions were effectively evaluated using MDCT, with attention to lesion size, wall thickness, septations, calcifications, and presence of mural nodules. These features helped differentiate benign cysts from potentially malignant cystic neoplasms, facilitating appropriate patient management and follow-up.

The diagnostic performance of MDCT in the present study showed high sensitivity and specificity in distinguishing malignant from non-malignant pancreatic lesions, comparable to results reported in previous studies. The high diagnostic accuracy reinforces MDCT as a reliable first-line imaging modality for pancreatic evaluation[12].

Multidetector computed tomography is a highly effective imaging modality for the evaluation of pancreatic lesions. It provides excellent lesion detection, characterization, staging, and assessment of operability. MDCT should remain the first-line imaging investigation in patients with suspected pancreatic pathology.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17–48.
2. Balthazar EJ. Pancreatic imaging: Current concepts. Radiol Clin North Am. 2002;40(6):1223–1242.
3. Prokesch RW, Chow LC, Beaulieu CF, Bammer R, Jeffrey RB. Isoattenuating pancreatic adenocarcinoma at multidetector CT. Radiology. 2002;224(3):764–768.
4. Tamm EP, Bhosale PR, Vikram R, de Almeida Marcal LP, Balachandran A. Imaging of pancreatic ductal adenocarcinoma. AJR Am J Roentgenol. 2013;201(3):W347–W357.
5. Manfredi R, Graziani R, Motton M, et al. Main pancreatic duct intraductal papillary mucinous neoplasms. Radiology. 2009;253(1):106–115.
6. Sahani DV, Bonaffini PA, Catalano OA, Guimaraes AR, Blake MA. State-of-the-art PET/CT of the pancreas. Radiographics. 2012;32(4):1133–1158.
7. Kalra MK, Maher MM, Sahani DV, et al. Pancreatic carcinoma: MDCT imaging. AJR Am J Roentgenol. 2004;183(6):1555–1566.
8. Takahashi N, Fletcher JG, Hough DM, et al. Autoimmune pancreatitis. Radiographics. 2009;29(1):93–108.
9. Kim T, Murakami T, Takahashi S, et al. Pancreatic tumors: Differentiation with contrast-enhanced CT. Radiology. 1999;211(3):747–753.
10. Megibow AJ, Zhou XH, Rotterdam H, et al. Pancreatic adenocarcinoma: CT versus MRI. Radiology. 1995;195(2):327–332.
11. Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer. AJR Am J Roentgenol. 1997;168(6):1437–1442.
12. Horton KM, Fishman EK. Multidetector CT of pancreatic carcinoma. Radiographics. 2001;21(3):595–612.