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Imaging Correlation

  • Chapter
Ultrasonography of the Pancreas

Abstract

Ultrasonography (US), multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) often represent complementary imaging modalities, covering different roles in diagnosing focal or diffuse disease. US is an increasingly powerful imaging technique especially after intravenous injection of contrast agent for lesion characterization or with endoscopic approach for lesion detection. MDCT is still the modality of choice in studying solid tumors, and is mandatory for achieving adequate preoperative staging. On the other hand, MRI is the criterion standard for accurately evaluating both the ductal system and cystic lesions. Therefore, US and contrast-enhanced US (CEUS) could be seen to be at the center in choosing between MDCT and MRI, if a lesion is detected especially given that US is very often the first-line examination. This chapter provides a diagnostic algorithm based on US findings, and also discusses both the advantages and disadvantages of the US study compared to the other imaging modalities.

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References

  1. Prokesch RW, Chow LC, Beaulieu CF et al (2002) Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 224:764–768

    Article  PubMed  Google Scholar 

  2. D’Onofrio M, Gallotti A, Pozzi Mucelli R (2010) Imaging techniques in pancreatic tumors. Expert Rev Med Devices 7:257–273

    Article  PubMed  Google Scholar 

  3. Oshikawa O, Tanaka S, Ioka T et al (2002) Dynamic sonography of pancreatic tumors: comparison with dynamic CT. Am J Roentgenol 178:1133–1137

    Google Scholar 

  4. Martínez-Noguera A, D’Onofrio M (2007) Ultrasonography of the pancreas. 1. Conventional imaging. Abdom Imaging 32:136–149

    Article  PubMed  Google Scholar 

  5. Shapiro RS, Wagreich J, Parsons RB et al (1998) Tissue harmonic imaging sonography: evaluation of image quality compared with conventional sonography. Am J Roentgenol 171:1203–1206

    CAS  Google Scholar 

  6. Hohl C, Schmidt T, Honnef D et al (2007) Ultrasonography of the pancreas. 2. Harmonic imaging. Abdom Imaging 32:150–160. Review

    Article  PubMed  CAS  Google Scholar 

  7. Minniti S, Bruno C, Biasiutti C et al (2003) Sonography versus helical CT in identification and staging of pancreatic ductal adenocarcinoma. J Clin Ultrasound 31:175–182

    Article  PubMed  Google Scholar 

  8. D’Onofrio M, Zamboni G, Faccioli N et al (2007) Ultrasonography of the pancreas. 4. Contrast-enhanced imaging. Abdom Imaging 32:171–181

    Article  PubMed  Google Scholar 

  9. Bertolotto M, D’Onofrio M, Martone E et al (2007) Ultrasonography of the pancreas. 3. Doppler imaging. Abdom Imaging 32:161–170

    Article  PubMed  CAS  Google Scholar 

  10. D’Onofrio M, Mansueto GC, Falconi M et al (2004) Neuroendocrine pancreatic tumor: value of contrast enhanced ultrasonography. Abdom Imaging 29:246–258

    Article  PubMed  Google Scholar 

  11. D’Onofrio M, Malagò R, Zamboni G et al Contrast-enhanced ultrasonography better identifies pancreatic tumor vascularization than helical CT. Pancreatology 5:398–402

    Google Scholar 

  12. 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 35:1929–1937

    Article  PubMed  Google Scholar 

  13. Takeda K, Goto H, Hirooka Y et al (2003) Contrast-enhanced transabdominal ultrasonography in the diagnosis of pancreatic mass lesions. Acta Radiol 44:103–106

    Article  PubMed  CAS  Google Scholar 

  14. D’Onofrio M, Martone E, Faccioli N et al (2006) Focal liver lesions, sinusoidal phase of CEUS. Abdom Imaging 31:529–536

    Article  PubMed  Google Scholar 

  15. D’Onofrio M, Megibow AJ, Faccioli N et al (2007) Comparison of contrast-enhanced sonography and MRI in displaying anatomic features of cystic pancreatic masses. Am J Roentgenol 189:1435–1442

    Article  Google Scholar 

  16. Claudon M, Cosgrove D, Albrecht T et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) — update. Ultraschall Med 29:28–44

    Article  PubMed  CAS  Google Scholar 

  17. Numata K, Ozawa Y, Kobayashi N et al (2005) Contrast-enhanced sonography of pancreatic carcinoma, correlation with pathological findings. J Gastroenterol 40:631–640

    Article  PubMed  Google Scholar 

  18. Sofuni A, Iijima H, Moriyasu F et al (2005) Differential diagnosis of pancreatic tumors using ultrasound contrast imaging. J Gastroenterol 40:518–525

    Article  PubMed  Google Scholar 

  19. 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 22:789–795

    PubMed  Google Scholar 

  20. D’Onofrio M, Zamboni G, Tognolini A et al (2006) Massforming pancreatitis: value of contrast-enhanced ultrasonography. World J Gastroenterol 12:4181–4184

    PubMed  Google Scholar 

  21. Kitano M, Kudo M, Maekawa K et al (2004) Dynamic imaging of pancreatic diseases by contrast enhanced coded phase inversion harmonic ultrasonography. Gut 53:854–859

    Article  PubMed  CAS  Google Scholar 

  22. Hocke M, Schmidt C, Zimmer B et al (2008) Contrast enhanced endosonography for improving differential diagnosis between chronic pancreatitis and pancreatic cancer. Dtsch Med Wochenschr 133:1888–1892

    Article  PubMed  CAS  Google Scholar 

  23. D’Onofrio M, Barbi E, Dietrich CF et al (2011) Pancreatic multicenter ultrasound study (PAMUS). Eur J Radiol doi:10.1016/j.ejrad.2011.01.053

    Google Scholar 

  24. Zamboni GA, D’Onofrio M, Idili A et al (2009) Ultrasoundguided percutaneous fine-needle aspiration of 545 focal pancreatic lesions. Am J Roentgenol 193:1691–1695

    Article  Google Scholar 

  25. Schima W, Ba-Ssalamah A, Kölblinger C et al (2007) Pancreatic adenocarcinoma. Eur Radiol 17:638–649

    Article  PubMed  Google Scholar 

  26. Procacci C, Biasiutti C, Carbognin G et al (2001) Pancreatic neoplasms and tumor-like conditions. Eur Radiol 11[Suppl 2]:S167–S192

    Google Scholar 

  27. Sahani DV, Shah ZK, Catalano OA et al (2008) Radiology of pancreatic adenocarcinoma, current status of imaging. J Gastroenterol Hepatol 23:23–33

    Article  PubMed  Google Scholar 

  28. Park HS, Lee JM, Choi HK et al (2009) Preoperative evaluation of pancreatic cancer: comparison of gadolinium-enhanced dynamic MRI with MR cholangiopancreatography versus MDCT. J Magn Reson Imaging 30:586–595

    Article  PubMed  Google Scholar 

  29. Kartalis N, Lindholm TL, Aspelin P et al (2009) Diffusion-weighted magnetic resonance imaging of pancreas tumours. Eur Radiol 19:1981–1990

    Article  PubMed  Google Scholar 

  30. Miller FH, Rini NJ, Keppke AL (2006) MRI of adenocarcinoma of the pancreas. Am J Roentgenol 187:365–374

    Article  Google Scholar 

  31. Malagò R, D’Onofrio M, Zamboni GA et al (2009) Contrast-enhanced sonography of nonfunctioning pancreatic neuroendocrine tumors. Am J Roentgenol 192:424–430

    Article  Google Scholar 

  32. Procacci C, Carbognin G, Accordini S et al (2001) Nonfunctioning endocrine tumors of the pancreas: possibilities of spiral CT characterization. Eur Radiol 11:1175–1183

    Article  PubMed  CAS  Google Scholar 

  33. D’Assignies G, Couvelard A, Bahrami S et al (2009) Pancreatic endocrine tumors: tumor blood flow assessed with perfusion CT reflects angiogenesis and correlates with prognostic factors. Radiology 250:407–416

    Article  PubMed  Google Scholar 

  34. Kamisawa T, Takuma K, Anjiki H et al (2010) Differentiation of autoimmune pancreatitis from pancreatic cancer by diffusion-weighted MRI. Am J Gastroenterol 105:1870–1875

    Article  PubMed  Google Scholar 

  35. Ichikawa T, Sou H, Araki T et al (2001) Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 221:107–116

    Article  PubMed  CAS  Google Scholar 

  36. Song SJ, Lee JM, Kim YJ et al (2007) Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. Magn Reson Imaging 26:86–93

    Article  Google Scholar 

  37. Yoon LS, Catalano OA, Fritz S et al (2009) Another dimension in magnetic resonance cholangiopancreatography: comparison of 2-and 3-dimensional magnetic resonance cholangiopancreatography for the evaluation of intraductal papillary mucinous neoplasm of the pancreas. J Comput Assist Tomogr 33:363–368

    Article  PubMed  Google Scholar 

  38. Choi JY, Lee JM, Lee MW et al (2009) Magnetic resonance pancreatography: comparison of two-and three-dimensional sequences for assessment of intraductal papillary mucinous neoplasm of the pancreas Eur Radiol 19:2163–2170

    Article  PubMed  Google Scholar 

  39. Sainani NI, Saokar A, Deshpande V et al (2009) Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. Am J Roentgenol 193:722–731

    Article  Google Scholar 

  40. Waters JA, Schmidt CM, Pinchot JW et al (2008) CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg 12:101–109

    Article  PubMed  Google Scholar 

  41. Rickes S, Wermke W (2004) Differentiation of cystic pancreatic neoplasms and pseudocysts by conventional and echoenhanced ultrasound. J Gastroenterol Hepatol 19:761–766

    Article  PubMed  Google Scholar 

  42. Masaki T, Ohkawa S, Amano A et al (2005) Noninvasive assessment of tumor vascularity by contrast-enhanced ultrasonography and the prognosis of patients with nonresectable pancreatic carcinoma. Cancer 103:1026–1035

    Article  PubMed  Google Scholar 

  43. Tawada K, Yamaguchi T, Kobayashi A et al (2009) Changes in tumor vascularity depicted by contrast-enhanced ultrasonography as a predictor of chemotherapeutic effect in patients with unresectable pancreatic cancer. Pancreas 38:30–35

    Article  PubMed  Google Scholar 

  44. Kobayashi A, Yamaguchi T, Ishihara T et al (2005) Evaluation of vascular signal in pancreatic ductal carcinoma using contrast enhanced ultrasonography: effect of systemic chemotherapy. Gut 54:1047

    Article  PubMed  CAS  Google Scholar 

  45. Schmidt CM, White PB, Waters JA et al (2007) Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg 246:644–651

    Article  PubMed  Google Scholar 

  46. Manfredi R, Graziani R, Motton M et al (2009) Main pancreatic duct intraductal papillary mucinous neoplasms: accuracy of MR imaging in differentiation between benign and malignant tumors compared with histopathologic analysis. Radiology 253:106–115

    Article  PubMed  Google Scholar 

  47. Inan N, Arslan A, Akansel G et al (2008) Diffusion-weighted imaging in the differential diagnosis of cystic lesions of the pancreas. Am J Roentgenol 191:1115–1121

    Article  Google Scholar 

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Correspondence to Marie-Pierre Vullierme .

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© 2012 Springer-Verlag Italia

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Vullierme, MP., Martone, E. (2012). Imaging Correlation. In: D’Onofrio, M. (eds) Ultrasonography of the Pancreas. Springer, Milano. https://doi.org/10.1007/978-88-470-2379-6_11

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  • DOI: https://doi.org/10.1007/978-88-470-2379-6_11

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2378-9

  • Online ISBN: 978-88-470-2379-6

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