Ultrasonography may be used as the initial screening method in patients with jaundice and upper abdominal pain and might determine that a pancreatic tumor causes the symptoms, but helical computed tomography (CT), especially multi detector-row helical CT (MDCT), with its superb spatial resolution, is considered the imaging method of choice for detecting neoplastic changes in the pancreas [1-5]. Generally, magnetic resonance imaging (MRI) is used in patients with suspected small pancreatic tumors and as a problem-solving modality that may help to clarify internal architecture, particularly in patients with cystic lesions when CT is equivocal [6-8]. Nevertheless, improved MR sequence design has led to higher tissue contrast and faster scanning that has resulted in more accurate detection and staging of pancreatic neoplasms, particularly of small adenocarcinomas, small islet cell tumors and cystic neoplasms [9]. Endoscopic ul-trasonography (EUS) also can detect small pancreatic tumors [10-12] and characterize pancreatic lesions, especially for patients with cystic masses [13]. EUS has shown excellent results in cyst aspiration and biopsies of the pancreas, but is not universally accepted [14, 15]. The role of MRI and CT vis-a-vis EUS needs further definition through exploration of a large series of small pancreatic tumors. Furthermore, it is expected that new EUS instruments with increased resolution and deeper penetration will be developed. A wider acceptance of EUS for the pancreas will depend on training a large number of operators that can provide reproducible results based on standard techniques and possibly, on the use of an intravenous contrast material [16]. In recent years, positron emission tomography (PET), particularly PET/CT, has been increasingly used for assessing patients with suspected pancreatic tumors. However, its ultimate role still needs further definition, as the published results are somewhat conflicting [17-20]. Also, somatostatin receptor scintigraphy has gained popularity in recent years for neuroendocrine tumor detection [21]. This discussion will focus on diagnosing and staging the various pancreatic neoplasms with CT and MRI and will also mention EUS, PET/CT and so-matostatin receptor scintigraphy where appropriate.

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