• Mirko D’Onofrio
  • Anna Gallotti
  • Enrico Martone
  • Francesco Principe
  • Roberto Pozzi Mucelli
Part of the Medical Radiology book series (MEDRAD)


Diagnostic imaging plays a crucial role in the management of pancreatic ductal adenocarcinoma. Conventional ultrasonography is often the first diagnostic step in the evaluation of the pancreas. The introduction of Tissue Harmonic Imaging, that reduces artifacts increasing spatial and contrast resolution, increases its accuracy. Acoustic Radiation Force Impulse imaging is a new technique able to provide numerical measurements of the tissue stiffness, improving the tissue characterization. Doppler study assesses the patency and characteristics of vessel blood flow, mainly useful to distinguish between resectable and non-resectable lesions. Intrinsic limitations tend to be overcoming since the introduction of ultrasound blood pool contrast media, that through a dynamic real-time observation and high contrast and spatial resolution, allow the evaluation of the pancreatic tumor microvasculature. In some cases a fine-needle-aspiration or a core-biopsy could be necessary to achieve a definitive diagnosis. In the last paragraph, the typical US features of pancreatic ductal adenocarcinoma are also summarized.


Pancreatic Ductal Adenocarcinoma Shear Wave Speed Acoustic Radiation Force Impulse Image Adjacent Parenchyma Virtual Touch Tissue Quantification 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Angeli E, Venturini M, Vanzulli A et al (1997) Color-Doppler imaging in the assessment of vascular involvement by pancreatic carcinoma. AJR 168:193–197PubMedCrossRefGoogle Scholar
  2. Bertolotto M, D’Onofrio M, Martone E et al (2007) Ultrasonography of the pancreas. 3. Doppler imaging. Abdom Imaging 32(2):161–170PubMedCrossRefGoogle Scholar
  3. Chapman CS, Lazenby JC (1997) Ultrasound imaging system employing phase inversion subtraction to enhance the image. US patent 5,632,277Google Scholar
  4. Cosgrove D (2005) Advances in contrast agent imaging using Cadence contrast pulse sequencing technology (CPS) and SonoVue. Eur Rad 14(Suppl 8):P1–P3Google Scholar
  5. D’Onofrio M, Malagò R, Zamboni G et al (2005) Contrast-enhanced ultrasonography better identifies pancreatic tumor vascularization than helical CT. Pancreatology 5(4–5):398–402PubMedCrossRefGoogle Scholar
  6. D’Onofrio M, Martone E, Faccioli N et al (2006) Focal liver lesions: sinusoidal phase of CEUS. Abdom Imaging 31(5):529–536Google Scholar
  7. D’Onofrio M, Zamboni G, Faccioli N et al (2007a) Ultrasonography of the pancreas. 4. Contrast-enhanced imaging. Abdom Imaging 32:171–181PubMedCrossRefGoogle Scholar
  8. D’Onofrio M, Malagò R, Zamboni G et al (2007b) Ultrasonography of the pancreas. 5. Interventional procedures. Abdom Imaging 32(2):182–190PubMedCrossRefGoogle Scholar
  9. D’Onofrio M, Gallotti A, Martone E et al (2009) Solid appearance of serous cystadenoma diagnosed as cystic at ultrasound acoustic radiation force impulse imaging. JOP 10(5):543–546Google Scholar
  10. D’Onofrio M, Zamboni G, Malagò R et al (2009) Resectable pancreatic adenocarcinoma: is the enhancement pattern at Contrast-enhanced ultrasonography a pre-operative prognostic factor? Ultrasound Med Biol 35(12):1929–1937Google Scholar
  11. Desser TS, Jeffrey RB (2001) Tissue harmonic imaging techniques: physical principles and clinical applications. Semin Ultrasound CT MR 22:1–10PubMedCrossRefGoogle Scholar
  12. Faccioli N, D’Onofrio M, Zamboni G et al (2008) Resectable pancreatic adenocarcinoma: depiction of tumoral margins at contrast-enhanced ultrasonography. Pancreas 37(3):265–268PubMedCrossRefGoogle Scholar
  13. Fahley BJ, Palmeri ML, Trahey GE (2007) The impact of physiological motion on tissue tracking during radiation force imaging. Ultrasound Med Biol 33:1149–1166CrossRefGoogle Scholar
  14. Gallotti A, D’Onofrio M, Pozzi Mucelli R (2010) Acoustic radiation force impulse (ARFI) technique in the ultrasound study with Virtual Touch tissue quantification of the superior abdomen. Radiol Med [Epub ahead of print]Google Scholar
  15. Hohl C, Schmidt T, Haage P et al (2004) Phase-inversion tissue harmonic imaging compared with conventional B-mode ultrasound in the evaluation of pancreatic lesions. Eur Radiol 14:1109–1117PubMedCrossRefGoogle Scholar
  16. Hohl C, Schmidt T, Honnef D et al (2007) Ultrasonography of the pancreas. 2. Harmonic imaging. Abdom Imaging 32(2):150–160, ReviewPubMedCrossRefGoogle Scholar
  17. Klöppel G, Schlüter E (1999) Pathology of the pancreas. In: Baert AL, Delorme G, Van Hoe L (eds) Radiology of the pancreas, 2nd edn. Springer-Verlag, Berlin, pp 69–100CrossRefGoogle Scholar
  18. Koito K, Namieno T, Nagakawa T et al (2001) Pancreas: imaging diagnosis with color/power-Doppler ultrasonography, endoscopic ultrasonography, and intraductal ultrasonography. Eur J Radiol 38:94–104PubMedCrossRefGoogle Scholar
  19. Martinez-Noguera A, D’Onofrio M (2007) Ultrasonography of the pancreas. 1. Conventional imaging. Abdom Imaging 32:136–149PubMedCrossRefGoogle Scholar
  20. McAleavey SA, Menon M, Orszulak J (2007) Shear-modulus estimation by application of spatially-modulated impulsive acoustic radiation force. Ultrason Imaging 29(2):87–104PubMedCrossRefGoogle Scholar
  21. Nagase M, Furuse J, Ishii H et al (2003) Evaluation of contrast enhancement patterns in pancreatic tumors by coded harmonic sonographic imaging with a microbubble contrast agent. J Ultrasound Med 22(8):789–795PubMedGoogle Scholar
  22. Nightingale KR, Palmeri ML, Nightingale RW et al (2001) On the feasibility of remote palpation using acoustic radiation force. J Acoustic Soc Am 110(1):625–634CrossRefGoogle Scholar
  23. Nightingale KR, Bentley R, Trahey G (2002a) Observations of tissue response to acoustic radiation force: opportunities for imaging. Ultrason Imaging 24(3):129–138PubMedCrossRefGoogle Scholar
  24. Nightingale K, Soo MS, Nightingale R et al (2002b) Acoustic radiation force impulse imaging: in vivo demonstration of clinical feasibility. Ultrasound Med Biol 28(2):227–235PubMedCrossRefGoogle Scholar
  25. Nightingale K, McAleavey SA, Trahey G (2003) Shear-wave generation using acoustic radiation force: in vivo and ex vivo results. Ultrasound Med Biol 29(12):1715–1723PubMedCrossRefGoogle Scholar
  26. Numata K, Ozawa Y, Kobayashi N et al (2005) Contrast-enhanced sonography of pancreatic carcinoma: correlations with pathological findings. J Gastroenterol 40:631–640PubMedCrossRefGoogle Scholar
  27. Oktar SO, Yucel C, Ozdemir H et al (2003) Comparison of conventional sonography, real-time compound sonography, tissue harmonic sonography, and tissue harmonic compound sonography of abdominal and pelvic lesions. AJR 181:1341–1347PubMedCrossRefGoogle Scholar
  28. Sahani DV, Shan ZK, Catalano OA et al (2008) Radiology of pancreatic adenocarcinoma: current status of imaging. J Gastroenterol Hepatol 23(1):23–33, ReviewPubMedCrossRefGoogle Scholar
  29. Schoelgens C (1998) Native tissue harmonic imaging. Radiology 38:420–423Google Scholar
  30. Seo Y, Baba H, Fukuda T et al (2000) High expression of vascular endothelial growth factor is associated with liver metastasis and poor prognosis for patients with ductal adenocarcinoma. Cancer 88:2239–2245PubMedCrossRefGoogle Scholar
  31. Shan B, Pelegri AA, Maleke C et al (2008) A mechanical model to compute elastic modulus of tissue for harmonic motion imaging. J Biomech 41(10):2150–2158PubMedCrossRefGoogle Scholar
  32. Shapiro RS, Wagreich J, Parsons RB et al (1998) Tissue harmonic imaging sonography: evaluation of image quality compared with conventional sonography. AJR 171:1203–1206PubMedCrossRefGoogle Scholar
  33. Sumi C (2008) Regularization of tissue shear modulus reconstruction using strain variance. IEEE Trans Ultrason Ferroelectr Freq Control 55(2):297–307PubMedCrossRefGoogle Scholar
  34. Ueno N, Tomiyama T, Tano S et al (1997) Color-Doppler ultrasonography in the diagnosis of portal vein invasion in patients with pancreatic cancer. J Ultrasound Med 16:825–830PubMedGoogle Scholar
  35. Yassa NA, Yang J, Stein S et al (1997) Gray-scale and color flow sonography of pancreatic ductal adenocarcinoma. J Clin Ultrasound 25:473–480PubMedCrossRefGoogle Scholar
  36. Zamboni GA, D’Onofrio M, Principe F et al (2010) Focal pancreatic lesions: accuracy and complications of US-guided fine-needle aspiration cytology. Abdom Imaging 35(3): 362–366Google Scholar
  37. Zhai L, Palmeri ML, Bouchard RR et al (2008) An integrated indenter-ARFI imaging system for tissue stiffness quantification. Ultrason Imaging 30(2):95–111PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Mirko D’Onofrio
    • 1
  • Anna Gallotti
    • 1
  • Enrico Martone
    • 1
  • Francesco Principe
    • 1
  • Roberto Pozzi Mucelli
    • 1
  1. 1.Department of Radiology, GB Rossi University Hospital VeronaUniversity of VeronaVeronaItaly

Personalised recommendations