The role of fluorodeoxyglucose and positron emission tomography in the evaluation of pancreatic disease

Background. The difficulties involved in the timely and accurate diagnosis of pancreatic disease are well known. The usual imaging modalities usually identify abnormalities but may not always differentiate malignancy from other condition such as scar tissue or chronic inflammation. The purpose of our study was to determine if fluorodeoxyglucose positron emission tomography (FDG PET) can accurately diagnose pancreatic disease. Methods. The records of 15 patients presenting with pancreatic disease were retrospectively reviewed. The diagnosis suspected by imaging modalities was compared with the final tissue diagnosis. Two patients were excluded because no tissue was obtained. Results. Adenocarcinoma was diagnosed in 9 patients. A mass consistent with this diagnosis was seen in 8 of 9, 6 of 9, 6 of 8, and 5 of 5 patients by PET, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS), respectively. Chronic pancreatitis (CP) was diagnosed in 2 patients. The unique appearance on FDG PET made the diagnosis in both these patients. Both patients with CP were thought to have a malignancy by CT and EUS and 1 of 2 by ERCP. Neuroendocrine tumors were diagnosed in 2 other patients. One of 2 was seen by FDG PET and both by CT. Conclusions. FDG PET can accurately differentiate a pancreatic adenocarcinoma from chronic pancreatitis in a patient with a suspicious pancreatic mass. Thus, FDG PET may help in establishing a diagnosis and subsequently managing a patient with pancreatic disease.