E1147. Can’t Miss GI and Pancreatic Cancer on CT: Pearls and Pitfalls for Residents
  1. Gabriella Kaddu; University of Illinois College of Medicine Chicago
  2. Charlie Pierce; University of Illinois College of Medicine Chicago
  3. Karen Xie ; University of Illinois College of Medicine Chicago
Gastric adenocarcinoma is the fifth most common cause of cancer-related death worldwide, with esophageal cancer coming in sixth place and pancreatic cancer taking seventh place. The common ground among these malignancies is a substantial increase in the 5 year survival rate with early detection. Early gastrointestinal (GI) and pancreatic cancers can be slow growing with nonspecific symptoms leading to a late diagnosis and poor prognosis. Subtle findings may be detected on CT, frequently as incidental findings. However, making the calls can pose a challenge to residents in training. We sought to present cases of early GI and pancreatic cancers to review concerning CT findings that can be recognized which warrant appropriate further work-up.

Educational Goals / Teaching Points
Our presentation will discuss biological, pathological, and clinical characteristics of GI and pancreatic cancers that contribute to challenges in CT assessment. Focus will be placed on reviewing classical, atypical, and nonspecific CT imaging features with the goal of providing a systematic interpretive approach and important imaging pearls and pitfalls. Imaging modalities such as MRI and PET-CT can be problem solving and aid in guiding appropriate management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The background will cover biological and clinical correlations of GI and pancreatic cancers and their presentation on CT. Secondly, we will look at CT findings, encompassing the classical, atypical and nonspecific features, differential diagnoses and important pearls to help detection which include: mucosal/wall thickening, contour changes, air fluid levels/obstructions, fat stranding/tumor infiltration, reginal lymphadenopathy, hypodense solid mass vs cyst. The final section will be an evaluation of appropriate tools for problem solving such as MRI (DWI, MRCP), PET-CT, fluoroscopy, and EUS.

Recognition of key CT findings is critical to early detection of GI and pancreatic cancers. Although these findings are often subtle, being vigilant will help prevent missing concerning findings which can make a substantial impact on the patient’s management and outcome.