Ultrasonography of the Pancreas: Imaging and Pathologic Correlations

Ultrasonography (US) has long been considered an important diagnostic imaging modality for investigation of the pancreas despite certain significant and well-known limitations. Indeed, in many countries US represents the first step in the diagnostic algorithm for pancreatic pathologies. Recent years have witnessed major advances in conventional, harmonic, and Doppler imaging.

New technologies, softwares, and techniques, such as volumetric imaging, enhancement quantification, and fusion imaging, are increasing the diagnostic capabilities of US. The injection of microbubble contrast agents allows better tissue characterization with definitive differentiation between solid and cystic lesions. Contrast-enhanced US improves the characterization of pancreatic tumors, assists in local and liver staging, and can offer savings in both time and money. Acoustic radiation force impulse (ARFI) imaging is a promising new US method to test, without manual compression, the mechanical strain properties of deep tissues. Furthermore, the applications and indications for interventional, endoscopic, and intraoperative US have undergone significant improvement and refinement.

This book provides a complete overview of all these technological developments and their impact on the assessment of pancreatic pathologies. Percutaneous, endoscopic, and intraoperative US of the pancreas are discussed in detail, with precise description of findings and with informative imaging (CT and MRI) and pathologic correlations.

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 bySpringer 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.