A pancreatic cancer was suspected in a 73-year-old man with diabetes of recent onset and moderately elevated serum CA19-9. Dilation of the pancreatic duct in the body and tail, but no parenchymal lesion, was detected by Xray CT. The dilation of the pancreatic duct proximal to a high-grade stenosis in the neck, with a bead-like appearance of the pre-stenotic duct (arrow), was confirmed at MR cholangiopancreatography (a) and T2-weighted MRI (b). No pancreatic mass was detectable with gadoliniumenhanced MRI. An area of increased FDG uptake in the mid-abdomen was demonstrated by PET. PET/MRI fusion (c) localised the FDG uptake (arrowhead) just distal to the MRI-detected dilation of the pancreatic duct (arrow). A pancreatic adenocarcinoma was confirmed by intra-operative biopsies. The final pathological diagnosis following pancreatico-duodenectomy with extensive lymph node resection was pT3pN1R1 pancreatic ductal adenocarcinoma. PET/MRI fusion is useful when MRI provides only indirect evidence of pancreatic cancer, such as dilation and stenosis of the pancreatic duct but no visible pancreatic mass. Compared with PET/CT [1], the use of PET/MRI permits more accurate localisation of the FDG uptake in relation to the pancreatic ductal system.