• Moran Drucker Iarovich, Sara Apter, Eli Konen, Yael Inbar, Michal AmitaiMarrianneMDepartment of Radiology, Sheba Medical Center, Tel Hashomer, Israel., and Eyal Klang.
• Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel.
• Isr Med Assoc J. 2023 Oct 1; 25 (10): 692695692-695.

BackgroundComputed tomography (CT) is the main diagnostic modality for detecting pancreatic adenocarcinoma.ObjectivesTo assess the frequency of missed pancreatic adenocarcinoma on CT scans according to different CT protocols.MethodsThe medical records of consecutive pancreatic adenocarcinoma patients were retrospectively collected (12/2011-12/2015). Patients with abdominal CT scans performed up to a year prior to cancer diagnosis were included. Two radiologists registered the presence of radiological signs of missed cancers. The frequency of missed cancers was compared between portal and pancreatic/triphasic CT protocols.ResultsOverall, 180 CT scans of pancreatic adenocarcinoma patients performed prior to cancer diagnosis were retrieved; 126/180 (70.0%) were conducted using pancreatic/triphasic protocols and 54/180 (30.0%) used portal protocols. The overall frequency of missed cancers was 6/180 (3.3%) in our study population. The frequency of missed cancers was higher with the portal CT protocols compared to the pancreatic/triphasic protocols: 5/54 (9.3%) vs. 1/126 (0.8%), P = 0.01. CT signs of missed cancers included small hypodense lesions, peri-pancreatic fat stranding, and dilated pancreatic duct with a cut-off sign.ConclusionsThe frequency of missed pancreatic adenocarcinoma is higher on portal CT protocols. Physicians should consider the cancer miss rate on different CT protocols.

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