Ultrasonography in diagnosing chronic pancreatitis: New aspects

Abstract

The course and outcome is poor for most patients with pancreatic diseases. Advances in pancreatic imaging are important in the detection of pancreatic diseases at early stages. Ultrasonography as a diagnostic tool has made, virtually speaking a technical revolution in medical imaging in the new millennium. It has not only become the preferred method for first line imaging, but also, increasingly to clarify the interpretation of other imaging modalities to obtain efficient clinical decision. We review ultrasonography modalities, focusing on advanced pancreatic imaging and its potential to substantially improve diagnosis of pancreatic diseases at earlier stages. In the first section, we describe scanning techniques and examination protocols. Their consequences for image quality and the ability to obtain complete and detailed visualization of the pancreas are discussed. In the second section we outline ultrasonographic characteristics of pancreatic diseases with emphasis on chronic pancreatitis. Finally, new developments in ultrasonography of the pancreas such as contrast enhanced ultrasound and elastography are enlightened.

Acoustic Cluster Therapy (ACT) enhances the therapeutic efficacy of paclitaxel and Abraxane® for treatment of human prostate adenocarcinoma in mice

“…A particularly interesting indication for ACT could be treatment of locally advanced, non-resectable pancreatic adenocarcinoma. These tumors are quite easily imaged by US [44], and the current standard of care for this condition (gemcitabine, optionally in combination with nab-paclitaxel) shows very limited clinical utility and could gain significantly from a combination regime with ACT. Alternatively, locally advanced, hormone-refractory prostate adenocarcinoma, often treated with taxanes, could represent an interesting clinical indication for ACT, as could triple negative breast cancer treated with doxorubicin or liver metastases from colon rectal cancer.…”

The pursuit of normal reference values of pancreas stiffness by using Acoustic Radiation Force Impulse (ARFI) elastography.

“…Abdominal ultrasonography (US) is the imaging method used per primam in pancreatic evaluation and related pathology (inflammatory and tumoral), being considered as a non-invasive, reproducible and accuracy technique [1]. Elastography is an imaging technique for assessing tissue stiffness with extensive applications in the evaluation of the breast, thyroid, lymph nodes, and skin [2].…”

Approach to Patients With Suspected Chronic Pancreatitis

“…However, there is no clear consensus for such diagnosis in early CP. 25 Findings on ERCP using a scoring system known as the Cambridge Classification had traditionally been used as the imaging criterion standard for diagnosing CP with sensitivities ranging from 75% to 90%. For instance, although CT is fairly sensitive for advanced CP with calcifications, atrophy, fat replacement, and ductal dilation (75%-80%), its overall sensitivity for all CP is 47%, with a specificity of 90%.…”