New technique using intraductal ultrasonography for the diagnosis of diseases of the pancreatobiliary system

Abstract

Intraductal ultrasonography (IDUS), a new technique for visualizing arterial structures, operates at an ultra~ sound frequency of 30 MHz to produce high resolution, cross-sectional images in real time. The purpose of this study was to provide a basis for interpreting IDUS images in vitro. We also attempted to determine the clinical usefulness of the IDUS system in diagnosing pancreatobiliary diseases in vivo. IDUS echograms of both the bile duct (BD) and main pancreatic duct (MPD) from autopsy specimens of 15 patients demonstrated I ntraductal ultrasonography (IDUS) imaging has been developed as a new technique for visualizing arterial structures. 1 -4 Nonvascular use of intraluminal ultrasound technology has also been reported recently . .u This system operates at considerably higher frequencies than current ultrasonographic systems to produce high-resolution cross-sectional images in real time. We employed JDUS during endoscopy to visualize the bile duct (BD) and main pancreatic duct (MPD) both in vitro and in vivo. We specifically used a novel transpapillary approach that would not require endo- three distinct layers with a fine reticular pattern in the pancreas in vitro. In clinical cases, the MPD and BD of four patients could be scanned by inserting the IDUS catheter via the major papilla without requiring endoscopic sphincterotomy. We hope that IDUS will become routine in scanning the BD and MPD to achieve early and accurate diagnoses of pancreatobiliary diseases. KEY WORDS: Intraductal ultrasound; Bile duct; Main pancreatic duct; Ultrasound; Pancreas. scopic sphincterotomy, reducing the risk of retrograde infection.The purpose of this study was to provide a basis for interpreting sonograms by comparing them with corresponding histopathologic sections. We also at• tempted to determine the clinical usefulness of the IDUS system in diagnosing pancreatobiliary diseases in vivo.

Intraductal ultrasonography for the examination of duodenal papillary region.

“…Sonograms of the pancreatic parenchyma showed a fine reticular pattern, as previously reported. 3 A hypoechoic layer was visualized around the bile duct and the pancreatic duct, or the common duct on all sonograms of the papillary region when the ultrasonic gain was decreased. Echogenic layers could be visualized on both sides of In comparing the IDUS images with the findings for histopathologic sections, the hypoechoic layer corresponded to Oddi' s muscle, the inner echogenic layer to the mucosa of the bile duct or the common duct, and the outer echogenic layer to the duodenal submucosa (Fig.…”

“…We have reported the clinical usefulness of the IDUS system in various pancreatobiliary diseases. [3][4][5] In the present study, in vitro and in vivo studies were performed to clarify the normal anatomic structure of the papillary region visualized on IDUS.…”

Wall composition in intravascular ultrasound layered appearance of human coronary artery

“…We used a mechanical rotating imaging system with a 4.3Fr ultrasound catheter, operated at 30MHz with a rotation of 1800rpm (Cardiovascular Imaging Systems, Sunnyvale, CA, USA). The manufacturer's information indicated that the resolution of the ultrasound probe was similar to that used in previous studies; axial and lateral resolutions were set at 0.07mm and 0.20mm, with the focal distance at 1.8mm and the radius of penetration at <10mm [2,4,7,8].…”

The use of pancreatic ductoscopy in the operative management of benign and malignant pancreatic disorders

“…Ultrasound was used to identify the pancreatic duct prior to performing ductotomy in most of the cases in this series. The use of small intraluminal ultrasonic probes has been described in the biliary tree [2,4]. These probes may be passed endoscopically via the papilla or intraoperatively via a ductotomy.…”