RadteraCT Pancreas (Dual-Phase Pancreatic Protocol)
CT+ ContrastAbdomen & Pelvis
Indications
- Pancreatic adenocarcinoma detection and staging/resectability (vascular involvement)
- Pancreatitis and complications; cystic pancreatic lesions (IPMN)
- Neuroendocrine tumor evaluation
Patient prep
- NPO 4 h
- Water as neutral oral contrast to distend duodenum/stomach (avoid positive oral contrast that obscures vessels)
- 18-20G IV; renal function check
- Arms up
Contrast
Agentiodinated (iohexol 350 / iopamidol 370)
RouteIV (+ oral water)
Dose~1.5 mL/kg or 100-150 mL at 4-5 mL/s + saline chase
TimingPancreatic parenchymal/late-arterial phase ~40-45 s (peak gland enhancement, tumor conspicuity) and portal venous ~65-70 s (venous involvement, liver mets); non-contrast optional
Technique
- Supine, arms up; coverage liver dome through pancreas/abdomen (pelvis if staging)
- Neutral oral contrast (water) for duodenal distention
- Bolus tracking; dual phase—pancreatic parenchymal (~40-45 s) and portal venous (~65-70 s)
- 120 kV (100 kV thin); thin recon 0.75-3 mm
- Curved/oblique reformats along SMA/SMV/celiac for vascular encasement; coronal reformats
Series / Sequences
| # | Series / Sequence | Plane | Thickness | Notes |
|---|---|---|---|---|
| 1 | Pancreatic parenchymal axial | axial | 0.75-3 mm | Peak gland enhancement; tumor hypodensity, arterial involvement |
| 2 | Portal venous axial | axial | 2.5-3 mm | SMV/portal/splenic vein involvement, liver mets |
| 3 | Curved MPR (vessels) | oblique | thin | Arterial/venous encasement (resectability) |
| 4 | Coronal reformat | coronal | 2-3 mm | Ductal/overview |
Key points
- Pancreatic (late arterial ~40-45 s) phase maximizes tumor-to-gland contrast; tumors are typically hypoenhancing
- Report resectability per NCCN: arterial (celiac, SMA, CHA) and venous (SMV, PV) contact/encasement
- Neutral oral water improves duodenal/ampullary and vascular assessment
- Thin recon enables multiplanar vascular reformats
- Look for secondary signs: ductal dilation, abrupt cutoff, parenchymal atrophy
References
• ACR-SAR-SPR Practice Parameter for CT of the Abdomen
• RadioGraphics / SAR-AGA consensus on pancreatic ductal adenocarcinoma CT reporting
• Radiopaedia: pancreatic CT protocol ( link
• RadioGraphics / SAR-AGA consensus on pancreatic ductal adenocarcinoma CT reporting
• Radiopaedia: pancreatic CT protocol ( link
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.