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PubMed2002

[Technique and diagnostic value of musculoskelatal ultrasonography in rheumatology. Part 5: Ultrasonography of the shoulder].

Shoulder-related symptoms are very common in rheumatic diseases. For the evaluation of the diagnosis as well as for therapy and prognosis, an anatomic assignment is essential. Clinical investigations alone are often not capable to do this. Ultrasonography is a method to delineate bony surfaces as well as the soft tissues around the shoulder joints statically and even dynamically. For the purpose of rheumatic diseases, ultrasound standard scans help to detect the lesions at the biceps tendon, the bursae, the rotator cuff, the humeral head as well as in the acromial and sternoclavicular joints. Considering the limitations of the method (obesity, frozen shoulder, no findings under bony structures) and knowing the pitfalls and errors of the method, ultrasonography is a reliable, quick and low cost method for the diagnosis of rheumatic shoulder joint pathology. Compared to computer tomography and magnetic resonance imaging, ultrasonography should be used as a screening method. The following standard scans are suggested for sonographic evaluation of the shoulder: 1) anterior transverse scan and 2) anterior longitudinal scan at the bicipal groove to detect synovitis and tenosynovitis, 3) anterior transverse scan at the coracoacromiale window in the neutral position, 4) at maximal external rotation and 5) at maximal internal rotation to evaluate the rotator cuff, bursitis, synovitis and erosions, 6) anterior longitudinal scan at 90 degrees to the coracoacomiale window at maximal internal rotation to describe these findings in an additional dimension, 7) anterior-lateral longitudinal scan at the anterior lateral acromion to tuberculum majus to evaluate the distal part of the supraspinatus muscle, 8) posterior transverse scan at the fossa infraspinata lateral under the spina scapulae, 9) axillary longitudinal scan to evaluate synovitis, synovial proliferation, erosions at the humeral head, lesions at the glenoidale labrum, 10) anterior transverse scan at the acromioclavicular joint and 11) anterior oblique scan at the sternoclavicular joint to detect synovitis, synovial proliferation, erosion, osteophytes.

Acromioclavicular Joint↗

PubMed2005

Intrahepatic venous anastomosis formation of the right liver in living donor liver transplantation: evaluations by Doppler ultrasonography and pulse-inversion ultrasonography with Levovist.

BACKGROUND: Our aim was to investigate the development of intrahepatic venous anastomoses between the middle hepatic vein (MHV) and the right hepatic vein (RHV) in adult-to-adult, living donor, liver transplantation. METHODS: Using Doppler ultrasonography, we studied the formation of venous anastomoses between the MHV tributaries for segments 5 and 8 (V5, V8) and the RHV in the liver remnants of 7 donors of a left liver, including the MHV, and in the liver grafts of 8 recipients of a right liver, without including the MHV. In 1 donor and 5 recipients, we performed pulse-inversion ultrasonography with a microbubble contrast agent to evaluate hepatic parenchymal perfusion in the drainage region of the MHV. RESULTS: We observed 15 MHV tributaries of V5 and 13 of V8 among the 15 adult transplant patients. During the first postoperative week, we detected venous anastomosis between V5 and the RHV in 4 patients and in 10 patients between V8 and the RHV. After the 1st week, we observed the formation of anastomosis between V5 and the RHV in 10 patients, and between V8 and the RHV in 3. In both MHV tributaries, the mean flow velocities increased (P < .01). By the end of the 1st week, the formation rate in V8 was higher than in V5 (77% vs 27%, P < .03). In the parenchymal phase of the pulse-inversion ultrasonography with the microbubble contrast agent, the V5 drainage region had low intensities, while the V8 drainage territory revealed high intensities in 4 of 6 patients (66.7%). CONCLUSIONS: Functional venous anastomoses between either V5 or V8 and the RHV developed in most of the donors of left hepatic lobes and in recipients of right hepatic lobes; however, anastomoses developed earlier in V8 than in V5. Furthermore, perfusion was decreased in the drainage area of V5, compared with V8.

Adolescent↗

PubMed2000

Transthoracic ultrasonography is an alternative to subxyphoid ultrasonography for the diagnosis of hemopericardium in penetrating precordial trauma.

BACKGROUND: Surgeon-performed ultrasonography is increasingly becoming part of the initial evaluation of patients after blunt or penetrating trauma. Currently, most institutions obtain a subxyphoid or subcostal view of the heart and pericardial space, and a three-view ultrasonogram of the abdomen to detect blood in the pericardial sac or in three dependent abdominal areas. METHODS: A left parastemal standard transverse transthoracic view is described in addition to the aforementioned views. This facilitates the visualization of the pericardial sac when a subxyphoid or subcostal view cannot be obtained because of anatomical reasons (narrow subxyphoid space) or local factors (pain, fractures, subcutaneous emphysema, or chest wall contusion). RESULTS: The transthoracic view can be useful in patients where the subxyphoid view is difficult to obtain through the conventional approach. In most patients an excellent view of the pericardial sac and ventricles can be obtained and, therefore, expedites the diagnosis and treatment of patients with hemopericardium. CONCLUSION: Surgeon-performed ultrasonography has become the diagnostic test of choice for patients suspected of having hemopericardium and cardiac tamponade. Transthoracic ultrasonography is an excellent alternative for those patients where a subxyphoid or subcostal view to visualize the pericardial sac and heart cannot be obtained owing to local or anatomical factors.

Abdominal Injuries↗

PubMed1981

[Intravenous urography- v.s.- ultrasonography or intravenous urography +/- ultrasonography (author's transl)].

The author warns against the abusive use of renal ultrasonography in urological disorders without previous intravenous urography investigations. It is also of fundamental importance to obtain perfect tomography images of the kidneys before requesting ultrasonography examinations, in patients with renal insufficiency. In urological practice, ultrasonography can only be correctly interpreted by the aid of anatomical data from radiological investigations, of which intravenous urography is by far the most important.

Diagnostic Errors↗

PubMed1994

Ultrasonography of the umbilicus in calves. Part 2: Ultrasonography, diagnosis and treatment of umbilical diseases.

In 80 calves presented with clinical signs of umbilical disease, the umbilicus was examined by palpation and by ultrasonography using a 5 Mhz or a 7.5 Mhz sector scanner. Diagnosis was confirmed during surgery or at post mortem examination. The various diseases of the intraabdominal umbilical structures found in these calves and the therapeutic procedures performed are described in detail by use of schematic representations, photographs of anatomical preparations, and ultrasonograms. In 29 calves with an enlarged extraabdominal umbilicus, ultrasonographic examination provided additional information to determine the choice of therapy, and it was particularly helpful in calves with irreducible hernias and with umbilical abscesses. In 51 calves with diseases of the intraabdominal umbilical structures, an exact description of the extent of the disease and of the involvement of other structures, as the liver and the urinary bladder, was made possible by ultrasonography. In calves with omphalitis, early recognition of the involvement of intraabdominal umbilical structures could be determined. Umbilical ultrasonography can be performed easily and is a very reliable and informative aid not only in the diagnosis of umbilical disease but also in determining the choice of therapy. Additionally, the owner can be informed in advance about the expense and the prognosis of the planned therapy.

Animals↗

PubMedDate not supplied

Prospective evaluation of endoscopic ultrasonography in the diagnosis of biliary microlithiasis in patients with normal transabdominal ultrasonography.

Prior investigators have proposed microlithiasis as a causative factor for occult gallbladder diseases. Endoscopic ultrasonography (EUS) is potentially far more sensitive than transabdominal ultrasonography (TUS) in visualizing small stones. The aim of this study was to investigate the role of endoscopic ultrasonography (EUS) in the diagnosis of microlithiasis in patients with upper abdominal pain and normal TUS. Thirty-five patients with biliary-type abdominal pain and normal TUS results were prospectively studied. All patients underwent radial EUS by means of a GF UM-20 echoendoscope (Olympus Optical, Tokyo, Japan). Of 35 patients, 33 were revealed to have gallbladder sludge or small stones, and 21 had CBD sludge or microlithiasis. Nine patients were not available for follow-up; of the remaining patients, 13 underwent combined endoscopic biliary sphincterotomy and cholecystectomy, 10 underwent cholecystectomy, and 3 underwent biliary sphincterotomy alone. In a postoperative follow-up at 9.2 months, 25 patients (96.2%) were symptom free. EUS is an important diagnostic tool in patients with unexplained biliary colic. Cholecystectomy with or without EUS is an effective treatment modality in these settings.

Abdomen↗

PubMed2004

Comparative study of novel endoluminal ultrasonography and conventional transurethral ultrasonography in staging of bladder cancer.

BACKGROUND: Recent advances in ultrasonic techniques have improved the image quality and diagnostic accuracy for staging of bladder cancer. The aim of this study was to assess the feasibility and usefulness of endoluminal ultrasonography (ELUS) in staging of bladder cancer, and to compare them with those of conventional transurethral ultrasonography (TUUS). METHODS: From 2000 to 2002, 19 patients with bladder cancer were evaluated by ELUS and TUUS before transurethral resection or biopsy. Clinical staging using ELUS, TUUS, computed tomography (CT) and magnetic resonance imaging (MRI) was compared with the results of pathological staging. RESULTS: In 16 of 19 patients, both ELUS and TUUS were able to diagnose tumor stage. In the remaining three patients, both methods were unable to evaluate stage of tumor. In two of these patients, this inability to evaluate tumor state was caused by a difficulty in depicting the tumor base in rectangular scanning. In the remaining patient, the inability to evaluate tumor stage was caused by a difficulty in recognizing the normal muscularis because of edema around the tumor base. Both diagnostic accuracies of ELUS and TUUS were 84%, which were superior to those of CT (44%) and MRI (82%). CONCLUSIONS: Endoluminal ultrasonography and TUUS were equally useful for staging diagnosis of bladder cancer. Because the ELUS probe is very small in diameter and can be manipulated under direct vision, it is superior to the TUUS in safety and in fine visualization. However, the main limitations of ELUS include an inability to evaluate the depth of invasion of large tumors and an inability to visualize the tumor base in the position of the bladder neck.

Aged↗

PubMed1996

Combined endoscopic ultrasonography and laparoscopic ultrasonography in the pretherapeutic assessment of resectability in patients with upper gastrointestinal malignancies.

BACKGROUND: Even though endoscopic ultrasonography (EUS) has improved the pretherapeutic staging and assessment of resectability in patients with upper gastrointestinal (GI) tract malignancies, a considerable number of patients still have to undergo unnecessary explorative laparotomy to obtain the final assessment of resectability. The aim of the present study was to evaluate laparoscopic ultrasonography (LUS) and the combination of EUS and LUS in the pretherapeutic study of these patients with special reference to resectability. METHODS: Each of 44 patients with esophageal, gastric, or pancreatic cancer was assigned to a treatment-related resectability group based on five different imaging modalities: computer tomography (CT) + ultrasonography (US), EUS, laparoscopy, LUS, and EUS + LUS. The findings with these imaging modalities were compared with intraoperative findings. RESULTS: Overall group assignment accuracy showed significantly better results for EUS, LUS, and EUS + LUS than for CT + US and laparoscopy. EUS + LUS identified all non-resectable patients, whereas the sensitivity of CT + US, laparoscopy, and EUS were 14%, 36%, and 79%, respectively. Median time consumption for each EUS, laparoscopy, or LUS procedure was less than 25 min, and no complications were seen during or after the EUS, laparoscopy, or LUS procedures. CONCLUSION: Preliminary experience with the combination of EUS and LUS for pretherapeutic assessment of upper GI tract malignancies showed that this combination was superior to CT + US, laparoscopy, and EUS. EUS + LUS correctly identified all non-resectable patients, but two overstaged patients also indicated the need for larger prospective studies to identify the indications and the limitations of this new approach.

Endosonography↗

PubMed2000

Advances in the imaging of common duct stones using magnetic resonance cholangiography, endoscopic ultrasonography, and laparoscopic ultrasonography.

Advances in magnetic resonance cholangiography (MRC) have resulted in consistently high sensitivity and specificity for the detection of common duct stones by MRC. There are multiple advantages to using MRC over endoscopic retrograde cholangiography (ERC) in the diagnosis of common duct stones, thereby reserving the use of ERC mainly as a therapeutic tool. Endoscopic ultrasonography has emerged as a modality capable of common duct stone detection and, when available, will compete with MRC and ERC for the diagnosis of common duct stones. However, its ability to image intrahepatic or proximal common duct stones would seem to be limited. Laparoscopic ultrasonography helps shorten operative time and costs less compared with intraoperative cholangiography. As more surgeons gather experience with laparoscopic ultrasonography and it becomes widely available, it has the promise to substitute for intraoperative cholangiography.

Cholangiography↗

PubMed1999

Patient satisfaction and quality of care at four diagnostic imaging procedures: mammography, double-contrast barium enema, abdominal ultrasonography and vaginal ultrasonography.

The objective of this study was to measure patient satisfaction and to investigate the practical implications of monitoring the quality of care at four radiology procedures. A survey was conducted immediately after the examinations in eight radiology departments: 550 patients attending for mammography, 110 for double-contrast barium enema (DCBE), 97 for abdominal ultrasonography and 90 for vaginal ultrasonography. Outcome measures were seven questionnaire scales: pain, emotional distress, information received, staff's punctuality and technical ability, facilities, and general satisfaction. Response rate was 87 %. Multivariate regression analysis showed significant differences between procedures on all scales (p < 0.001). Differences considered to be of practical importance, i. e. >/= 7 scale points, were detected on five of the scales. Mammography and DCBE caused the most pain, and vaginal US and DCBE caused the most distress. The US procedures entailed dissatisfaction with information about the procedures. The DCBE patients recorded dissatisfaction with the staff's lack of punctuality, and these and the mammography patients recorded dissatisfaction with the facilities. The findings indicate a potential for improving patients' experiences. Several aspects of care, i. e. pain management, attention to the patient's emotional concerns, explanation of procedures, punctuality and quality of the facilities, can be improved.

Abdomen↗

PubMed1996

Transvaginal ultrasonography of pelvic masses: evaluation of B-mode technique and Doppler ultrasonography.

OBJECTIVE: The purpose of this study was to evaluate pelvic masses by B-mode and Doppler ultrasonography for identification of ovarian malignancies. STUDY DESIGN: A previously described scoring system for pelvic masses was applied in 310 women, and the lesions were classified into four groups according to the ultrasonographic structure. Pulsatility index values of vessels within the tumor and the contralateral ovary and of both uterine arteries were determined. RESULTS: A total of 259 masses were benign and 51 were malignant. The scoring system and classification into morphologic groups revealed similar sensitivity, specificity, and positive and negative predictive values. Intratumoral and opposite ovarian blood flow and ipsilateral and contralateral uterine blood flow did not differ in benign and malignant masses except in cases of benign lesions in postmenopausal women. In malignant lesions a lower pulsatility index (0.94 +/- 0.4) was measured than in benign lesions (1.06 +/- 0.4, p < 0.05), although a remarkable overlap was found. CONCLUSION: The results suggest that further refinement of assessment of pelvic masses with Doppler ultrasonography is needed.

Adnexal Diseases↗

PubMed1993

Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma. Results of a prospective study with comparison to ultrasonography and CT scan.

Endoscopic ultrasonography (EUS) was compared to ultrasonography (US) and CT scan (CT) in order to evaluate its role in the diagnosis and the locoregional spread assessment of pancreatic cancer. Sixty-four patients suspected of pancreatic cancer were studied prospectively, and the results of imaging techniques were compared to histology and surgical exploration. There were 49 cases of pancreatic adenocarcinoma, 11 of pancreatitis, 2 of common bile duct carcinoma, 1 lymphoma and 1 hepatocellular carcinoma with peripancreatic metastatic lymph nodes. EUS was significantly more accurate (91%) than CT (66%) and US (64%) for diagnosis of pancreatic cancer. EUS was able to image all 7 cancers less than 25 mm in diameter, US and CT only one. There were 4 false positives with EUS which were all cases of pseudotumorous pancreatitis. For detecting lymph node involvement, EUS was significantly more sensitive (62%) and accurate (74%) than US (8% and 37%) and CT (19% and 42%), respectively. Invaded lymph nodes adjacent to large tumors and micrometastatic involvement were responsible for this lack of sensitivity. EUS was significantly more sensitive (100%) than CT (71%) and US (17%) for detecting venous involvement. The specificity of EUS was lower (67%) because of duodenal bulb stenosis and large tumors. In conclusion, this prospective and comparative study confirms that EUS is an accurate tool for diagnosis and locoregional spread assessment of pancreatic cancer when performed in a reference center. EUS is of particular interest for small tumours. However, EUS does not enable differentiation of pseudotumorous pancreatitis from adenocarcinoma.

Adenocarcinoma↗

PubMed2005

Crohn's disease: a comparative prospective study of transabdominal ultrasonography, small intestine contrast ultrasonography, and small bowel enema.

BACKGROUND: Small intestine contrast ultrasonography (SICUS), when performed after distention of the small bowel lumen with an iso-osmolar polyethylene glycol electrolyte-balanced solution, shows high sensitivity (100%) and specificity (97%) in detecting small bowel abnormalities in patients who have not received a diagnosis but in whom there is a suspicion of intestinal diseases. The diagnostic yield of SICUS remains to be established in detecting small bowel lesions in patients with proven Crohn's disease (CD) in comparison with transabdominal ultrasonography (TUS), and in relationship to the experience of the operator, using small bowel enema (SBE) as the "gold standard." AIM: The aim of this study was to evaluate the diagnostic value of SICUS, when performed by a sonologist with 1 year of experience, and TUS, when performed by a sonologist with 10 years of experience, compared to SBE in the assessment of the site, extension, and stenosis of small intestinal lesions in CD patients. PATIENTS AND METHODS: A total of 28 consecutive patients (men, 16; women, 12; age range, 21 to 60 yr) with a diagnosis of CD underwent TUS and SICUS, which were performed by 2 sonologists who were unaware of the radiologic findings, on the same day. SICUS was performed after the ingestion of 375 mL of a polyethylene glycol contrast solution. A standard SBE was performed on a different day by an expert radiologist who was unaware of the sonographic findings. RESULTS: Sensitivities in the detection of small bowel lesions were 96% for TUS and 100% for SICUS. Compared with SBE, SICUS detected the presence of 4 lesions in the jejunum that had been missed by TUS. The mean (+/-SD) extent of the ileal disease was 22 +/- 12.5 cm when measured during SBE, 14.5 +/- 8.6 cm when measured during TUS, and 19.5 +/- 12.5 cm when measured during SICUS [P = 0.05 (SICUS versus SBE)]. The correlation of the extension of the lesions between SICUS and SBE (r = 0.88) was better than that between TUS and SBE (r = 0.64). The sensitivities of TUS and SICUS in the detection of at least 1 stricture were 76% and 94%, respectively. Sensitivity and specificity in assessing prestenotic dilatation were 50% and 100%, respectively, at TUS, and 100% and 90%, respectively, at SICUS. CONCLUSION: In inexperienced hands, SICUS is a more accurate technique for assessing CD lesions, and the accuracy is better than that of TUS performed by an expert sonologist. The use of SICUS, instead of SBE, could be indicated for the follow-up of patients with CD.

Abdomen↗

PubMed2006

Usefulness of contrast-enhanced ultrasonography with abdominal virtual ultrasonography in assessing therapeutic response in hepatocellular carcinoma treated with radiofrequency ablation.

OBJECTIVE: Contrast-enhanced computed tomography (CECT) is regarded as the gold standard for assessing the efficacy of radiofrequency ablation (RFA) against hepatocellular carcinoma (HCC). We evaluated the efficacy of virtual ultrasonography (VUS) with contrast-enhanced ultrasonography (CEUS) vs. CECT for assessing the response to RFA. MATERIALS AND METHODS: Study 1: The therapeutic responses in 22 patients with 26 HCC nodules were assessed by CEUS with VUS as well as by CECT. The efficacy of treatment was based on whether the safety margin was greater than 5 mm after RFA. Study 2: In seven patients with seven HCC nodules, the nodules were treated by RFA and the therapeutic efficacy was assessed by CEUS with VUS. The number of RFA sessions was assessed. RESULTS: Compared with CECT, CEUS with VUS had a specificity of 77%, a sensitivity of 91.6%, and an accuracy of 84%. When the therapeutic response to RFA was analyzed by CECT only, 1.86 +/- 0.69 assessments (mean) were required, while when response was assessed by CEUS with VUS, 1.14 +/- 0.38 CECT assessments were required (P = 0.03). CONCLUSION: CEUS with VUS is effective in assessing the therapeutic response to RFA of HCC. Moreover, the number of CECT scans required is reduced by this approach.

Abdomen↗

PubMed1986

Comparison of blind transrectal ultrasonography with endoscopic transrectal ultrasonography in assessing rectal and perirectal diseases.

Blind transrectal ultrasonography (BUS) and endoscopic transrectal ultrasonography (EUS) were performed in 10 patients with rectal cancer, in 5 with rectal adenomas, and in 5 with benign perirectal disease. BUS and EUS were equally accurate in staging advanced rectal cancer. EUS was more accurate than BUS in assessing small tumors localized in the mucosa and/or submucosa. Adjacent lymph node abnormality was more clearly visualized with EUS because of the high resolution of this instrument, using a 7.5-MHz ultrasonic beam. In contrast, distant lymph node involvement was more readily seen with BUS because of the penetration depth of this 5-MHz beam. Differentiating rectal adenoma from rectal adenoma with malignancy was easier with EUS than with BUS. Perirectal disease was more accurately visualized with BUS than with EUS. Further studies in a larger number of patients are necessary to document fully the accuracy and limitations of both new diagnostic modalities.

Abscess↗

PubMed2005

[The assessment of arteriolosclerosis by serum lipids data, and carotid ultrasonography and pulse wave velocity, and its evaluation as a tool for preventive medicine: II. Carotid ultrasonography and pulse wave velocity for hyperlipemia and diabetes mellitus].

We studied the test results of carotid ultrasonography and pulse wave velocity against a sample of hyperlipemia and diabetes mellitus. Sixty four hyperlipemia samples (HL), 85 diabetes mellitus samples (DS), and 27 complicated samples (CS) were compared with 56 healthy samples (HS). Hyperlipemia samples were selected from cholesterol under 300 mg/dl, and neutral fat under 300 mg/dl. Diabetes mellitus samples were selected from fasting plasma glucose (FBS) under 200 mg/dl. Samples from severe conditions with various disease were excluded. Ratio over 1.1 mm intima-media thickness (IMT) was 0% in HS, 48% in HL, 40% in DS and 33% in CS. PWV value was max 1896cm/s in CS. There was no significant correlation within IMT, serum lipid(Total Cholesterol, Neutral Fat, HDL-Cholesterol, LDL-Cholesterol) and FBS. For early treatment or accurate diagnosis of arteriosclerosis in hyperlipemia or diabetes mellitus patients, who are at high risk of developing arteriosclerosis, to vital function tests (carotid ultrasonography and pulse wave velocity) should be performed, in addition to normal blood tests.

Adult↗

PubMedDate not supplied

[Evaluation of 3-year ultrasound screening in congenital hip dysplasia. Comparison of clinical examination, risk factors and ultrasonography. Interpretation of Graf type IIA grading and the most suitable age for 1st ultrasonography].

2237 infants (1210 females, 1027 males) aged two days-six months were screened by ultrasound for congenital dysplasia of the hip (CDH). 21 infants (0.93%) were detected having CDH by ultrasound examination. We have evaluated the concordance between ultrasonography, clinical examination (Ortolani's examination) and risk factors. Of the 21 infants with CDH, 10 (47.6%) had a positivity of Ortolani's examination, 13 (61.9%) had at least one risk factor, 3 (14.2%) had a negative clinical evaluation and no risk factors. Our data indicates the superiority of ultrasonography as compared with physical examination alone, for the diagnosis of CDH. Infants presenting any risk factors for CDH and/or a positive Ortolani's examination should have an early ultrasound evaluation in order to allow initiation of treatment early on, while in infants with negative clinical findings and no risk factors, it should be postponed to avoid the frequent finding of physiological immaturity of the hip. The finding of a high rate of infants that presented a grade IIA in the Graf's grading system during their first month of life and that evolved favourably in the absence of risk factors, and which required further sonograms, indicates the period between the second and the third month as the most desirable for ultrasound screening of CDH.

Age Factors↗

PubMed1995

Endoscopic ultrasonography in chronic pancreatitis: a comparative prospective study with conventional ultrasonography, computed tomography, and ERCP.

The usefulness and accuracy rate of endoscopic ultrasonography (EUS) in the diagnosis of chronic pancreatitis (CP) were prospectively evaluated in 81 patients with suspected pancreatic disease. All underwent EUS, abdominal ultrasonography (AUS), and computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) was performed in 55 of the cases. The diagnosis of CP was established in 44 patients (CP group) including 24 with a calcified form. No pancreatic disease was observed in 18 patients (control group), and 19 patients had a pancreatic tumor. In the CP group AUS was less accurate than EUS in visualizing the pancreas, performances of CT scan being identical to EUS in this respect. A good correlation was observed between EUS and ERCP for visualization and measurement of the Wirsung duct. The most significant changes observed by EUS in the CP group were dilatation of the main pancreatic duct, heterogeneous echogenicity of the pancreatic parenchyma, and cysts < 20 mm in size even in noncalcified CP or with normal pancreatograms. Sensitivity of EUS for diagnosis of CP was 88% (AUS, 58%; ERCP, 74%; CT scan, 75%), the specificity being 100% for ERCP and EUS, 95% for CT scan, and 75% for AUS. The good performances of EUS allow early diagnosis of CP in symptomatic patients since heterogeneous echogenicity of the pancreatic parenchyma seems to be almost specifically associated with the disease.

Adult↗