Fig. 4
A 54-year-old woman with pancreatic cancer. Axial portal venous phase image of the baseline contrast-enhanced computed tomography (CECT) scan (A) demonstrates a 3 cm-sized pancreatic head cancer, contacting the superior mesenteric vein with vein contour irregularity (arrow). On arterial phase image of post-neoadjuvant therapy (NAT) CT scan (B), the size of pancreatic cancer decreased to 1.7 cm, but contour irregularity of the superior mesenteric vein was still noted (arrow). CECT resectability score was 3 (indeterminate resectability) according to the three reviewers in consensus. Diffusion restriction was seen at the tumor-vessel contact on diffusion-weighted imaging (DWI) (arrow) (C) and fluorodexyglucose (FDG) avidity at tumor-vessel contact was not seen on. 18F-fluorodexyglucose (FDG)-positron emission tomography (PET) (D) of PET/MRI. Carbohydrate antigen level (CA) 19–9 was 245U/mL at initial diagnosis, which reduced to 30 U/mL after NAT. The reviewers assigned resectability score 3 on CT plus PET/MRI set and score 4 on CT plus PET plus CA 19–9. The patient underwent Whipple’s surgery, and pathologic analysis showed College of American Pathologists grade 2 (moderate response) with ypT0N0