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Background: Positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) is increasingly used in the preoperative diagnosis and management of pancreatic cancer. Its anatomic utility is limited however, and the quality of standard imaging continues to improve. We evaluated the effect of PET on the management of patients referred for treatment of pancreatic cancer. Methods: We evaluated all patients referred to our center between January 2006 and September 2010 with a final diagnosis of pancreatic ductal adenocarcinoma and examined the role of PET in their diagnostic workup and management. Patients who had PET following successful surgical resection or to stage metastatic disease were excluded. PET “positivity” was determined by radiologist interpretation. Results: Between January 2006 and September 2010, 636 patients were diagnosed with pancreatic ductal adenocarcinoma and 52% went on to resection. PET was utilized in thirty with resectable disease and in thirty-four with locally advanced carcinoma. PET failed to identify three metastatic lesions in two patients (two liver metastases, one peritoneal metastasis) and one primary lesion. In five patients, PET produced a false positive result leading to additional imaging and procedures that delayed surgery by an average of three weeks. PET identified liver metastases in three patients preoperatively. Two were confirmed by diagnostic laparoscopy, thus there was no deviation from standard protocol. PET altered the surgical or medical management of ten (15%) patients. One patient with liver metastases did not proceed to surgery. In two patients, the identification of liver metastases by PET altered chemotherapy goals from neoadjuvant to palliative. In one patient, PET revealed a synchronous colon cancer which was resected at the time of the patient’s pancreaticoduodenectomy. In four cases of diagnostic uncertainty, PET resulted in an earlier diagnosis of pancreatic adenocarcinoma and shorter time to surgical resection. In two patients, PET was performed to follow lymphoma and resulted in a secondary diagnosis of pancreatic adenocarcinoma. One patient proceeded to surgical resection, and the other had metastatic disease. Conclusions: In cases of known pancreatic adenocarcinoma, PET rarely altered clinical management and resulted in additional tests and procedures. In our series, PET was most useful in cases of diagnostic uncertainty.