A computed tomography (CT) scan provides detailed images of the pancreas. An “abnormal” result can be concerning, so this article explains what these findings may mean and outlines the next steps in the diagnostic process.
The Purpose of a Pancreas CT Scan
A doctor may recommend a pancreas CT scan to investigate symptoms suggesting a problem with the organ, or to assess for tumors, injuries, and infections when other exams are inconclusive. Symptoms that may prompt a scan include:
- Persistent abdominal pain that may radiate to the back
- Unexplained weight loss
- Jaundice (yellowing of the skin and eyes)
- Persistent nausea or appetite loss
- Recent onset of diabetes
The CT scanner is a large, donut-shaped machine that uses X-rays and computer technology to generate images. During the scan, you lie on a table that moves through the machine as it rotates and takes X-rays from different angles. A computer processes these images to create detailed, cross-sectional views (slices) of the pancreas and surrounding tissues, allowing doctors to see the organ’s structure with high clarity.
To enhance image quality, a contrast dye is often administered either as a drink, an injection, or both. This material highlights blood vessels and organs, making it easier to distinguish between normal pancreatic tissue and potential abnormalities. Specific techniques, known as pancreatic protocols, use a multiphase contrast approach to obtain the highest quality images of the pancreas and its blood supply.
Interpreting Abnormal Findings
An abnormal finding on a pancreas CT scan can encompass a range of observations. A radiologist analyzes the images and provides a report describing the size, shape, and texture of the pancreas, noting any areas that deviate from the norm.
Inflammation and swelling are common abnormal findings. On a CT scan, this can make the pancreas appear enlarged with hazy borders, a characteristic sign of pancreatitis (either acute or chronic). The surrounding fat may also show inflammatory changes.
The scan may identify a mass or lesion, which can be solid or cystic (fluid-filled). The presence of a mass does not automatically mean it is cancerous. Solid masses can be pancreatic adenocarcinoma (the most common pancreatic cancer), neuroendocrine tumors, or benign growths.
Cystic (fluid-filled) masses are also frequent. These can be pseudocysts, which are fluid collections often resulting from pancreatitis, or other types of cysts. Some cysts, like intraductal papillary mucinous neoplasms (IPMNs), are monitored closely as they can become malignant. The cyst’s features on the scan, like its size and complexity, help the radiologist assess it.
Abnormalities can also involve the pancreatic duct, which carries digestive enzymes. The CT scan may show the duct is dilated (widened), suggesting a blockage from a gallstone, scar tissue, or a tumor. A stricture (narrowing) of the duct can also be a sign of disease.
The scan may also reveal calcifications, which are small, dense deposits in the pancreatic tissue. These are a hallmark sign of chronic pancreatitis. Over time, inflammation can cause parts of the organ to be replaced by this hard, calcium-based material, indicating long-standing damage.
Diagnostic Follow-Up Procedures
An abnormal CT scan is often the starting point for a more detailed diagnostic process. The initial findings help your medical team determine which follow-up tests are needed to get a definitive diagnosis and learn more about the abnormality.
The next step often involves more advanced imaging. A Magnetic Resonance Imaging (MRI) scan provides a detailed view of soft tissues, while a specific type called MRCP is effective for imaging the pancreatic and bile ducts. Another procedure is an Endoscopic Ultrasound (EUS), where an ultrasound probe on a flexible tube is passed through the mouth to get high-resolution images of the pancreas.
Blood tests may be ordered to provide more information, such as testing for tumor markers like CA 19-9. These markers are not definitive for pancreatic cancer, as other conditions can cause them to rise, and some people with cancer do not have elevated levels. Therefore, these tests are used as just one piece of the diagnostic puzzle.
For many masses or suspicious lesions, a biopsy is the only way to make a definitive diagnosis. This procedure is often performed during an EUS, where a doctor uses ultrasound images for guidance. A fine-needle aspiration (FNA) needle is passed through the stomach or intestine wall directly into the suspicious area to collect cells for a pathologist to examine.
The Role of Your Medical Team
Navigating the diagnostic process involves a team of medical professionals. The radiologist’s report is sent to your referring physician, who could be your primary care doctor or the specialist who ordered the test. This doctor will discuss the results with you and coordinate the next steps.
Depending on the findings, you may be referred to a gastroenterologist, a specialist in digestive system diseases. This doctor will plan and perform further tests, such as an EUS. If a tumor is suspected or confirmed, a surgeon or an oncologist will join the team to discuss treatment options.
This multidisciplinary approach is a collaborative effort to determine the most accurate diagnosis and course of action. As a patient, it is helpful to write down questions before your appointments. Having an open conversation with your doctors will help you understand your results and the recommended plan.