Ultrasonography of the Pancreas. with Imaging and Pathologic Correlations

DESCRIPTION

For many years, ultrasonography (US) of the pancreas has been considered an important diagnostic imaging modality, although with significant well-known limitations. Major advances have occurred in conventional, harmonic, and Doppler imaging. Currently, US represents the first step in the diagnostic algorithm of pancreatic pathologies. The injection of microbubble contrast agents allows a better tissue characterization with a definitive differentiation between solid and cystic lesions. Contrast-enhanced ultrasonography (CEUS) improve the characterization of pancreatic tumors together with local and liver staging. So the immediate use of CEUS in the same ultrasound section in the work up of a pancreatic lesion detected by means of ultrasound can be therefore proposed to save time (faster diagnosis, i.e. immediate diagnosis of ductal adenocarcinoma) and money (move directly to MRI for cystic tumors).

Furthermore, the applications and indications for interventional, endoscopic, and intraoperative US have significantly improved in the last year, as a result of technological advances.

New technologies, softwares and techniques such as volumetric imaging, enhancement quantification, fusion imaging nowadays are increasing the diagnostic capabilities of ultrasound. Moreover there has been increasing interest in the study of the viscoelastic properties of tissues over the last few decades. Acoustic radiation force impulse (ARFI) imaging is a promising new ultrasound method to test, without manual compression, the mechanical strain properties of deep tissues.

All these technological developments in the field of ultrasound justify a complete overview and precise description, as is given in this book that is focused on ultrasonography (percutaneous, endoscopic, intraoperative) of the pancreas with imaging (CT and MRI) and pathologic correlations.

All these technological developments in the field of ultrasound justify a complete overview and precise description, as is given in this book that is focused on ultrasonography (percutaneous, endoscopic, intraoperative) of the pancreas with imaging (CT and MRI) and pathologic correlations.

TABLE OF CONTENTS

• Introduction.

1. Imaging / Methods.
2. Conventional Imaging.
3. Harmonic Imaging.
4. Doppler Imaging.
5. Elastosonography and Acoustic Radiation Force Impulse (ARFI) Imaging.
6. Contrast-enhanced Ultrasound.

Techniques and Procedures.

1. Percutaneous Ultrasound.
2. Intraoperative Ultrasound.
3. Endoscopic Ultrasound.
4. Ultrasound-guided Interventional Procedures.

Imaging and Pathological Correlations.

Normal Anatomy.

Pancreatitis.

Solid Exocrine Tumors.

Solid Endocrine Tumors.

Cystic Exocrine Tumors.

Cystic Endocrine Tumors.

Rare Tumors.

• References

AUTHORS

G. B. Rossi University Hospital is a referral center specialized in pancreatic diseases. In 2006, the Department of Radiology performed more than 900 contrast-enhanced ultrasound examinations, half of which were for pancreatic pathologies, and 200 ultrasound-guided biopsies for pancreatic masses. Dr D’Onofrio has renowned international experience in pancreatic disease management and in the use of contrast-enhanced ultrasound. All ultrasound studies of pancreatic lesions need to be correlated with the findings of other imaging modalities in order to reach a final diagnosis. A complete description of the correlations between ultrasound-imaging and ultrasound-pathologic findings will lead to an improvement of the diagnostic capability of ultrasound in studying pancreatic pathologies. Dr D’Onofrio has been working since 2004 as a university researcher in the Department of Radiology at the University of Verona in the University Hospital of G. B. Rossi. He has been an associate of SIRM (Italian Society of Medical Radiology) and AISP (Italian Association for the Study of the Pancreas) since 2002 and is a member of the editorial board of the official journal of SIRM. He has been a faculty member of IBISCUS (International Bracco Imaging School for Contrast-Enhanced Ultrasound) since 2003. He is an associate of SIUMB (Italian Society of Ultrasound in Medicine and Biology) and EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) and a member of ESGAR (European Society of Gastrointestinal and Abdominal Imaging). He is the chairman for pancreatic applications of contrast-enhanced ultrasound in the EFSUMB guidelines and for the good clinical practice recommendation in contrast-enhanced ultrasound meetings update 2007. Dr D’Onofrio is author of more than 40 original papers in Italian and international medical journals and of 7 book chapters; he is also the author of the book Ecografia e procedure interventistiche percutanee, published by Springer in 2008. In addition, he is a reviewer for AJR. American Journal of Roentgenology, Pancreas, CMAJ: Canadian Medical Association Journal, BMC Cancer, and La Radiologia Medica.