MRI using tailored pulse sequences and gadolinium administration on high field systems has a crucial role to play in the investigation of malignant disease of the pancreatic head. Breath hold spoiled gradient echo images after gadolinium administration in the capillary phase of enhancement and fat suppressed images are particularly effective MR techniques. This review highlights specific MRI findings in a spectrum of malignant tumors of the head of the pancreas. Emphasis is given to the ability of MRI to differentiate ductal adenocarcinomas from chronic pancreatitis and islet cell tumors. Improved detection and characterization of small, non organ deforming tumors and the recent implementation of MR cholangiography are also addressed.
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