GRAY-SCALE AND COLOR-FLOW SONOGRAPHY OF PANCREATIC DUCTAL ADENOCARCINOMA

Purpose. Current sonographic technology has enhanced imaging. This stu dy analyzes the sonographic findings in a large series of patients wit h pancreatic ductal adenocarcinoma. Methods. The sonograms of 62 patie nts with pathologically confirmed pancreatic ductal adenocarcinoma wer e retrospectively analyzed. Results. Tumors were an average of 4.5 x 3 .5 cm in cross section. The largest lesion was 14.0 x 9.0 cm, and the smallest was 1.8 x 1.1 cm. Forty-three tumors (69%) were located in th e head of the pancreas, 1 (2%) at the junction of the head and body, a nd 16 (26%) in the body or tail; 2 lesions (3%) were diffuse. Tumors w ere ovoid or spherical in 37 patients (60%) and irregular in 25 (40%). Forty tumors (65%) markedly deformed the shape of the gland. Six lesi ons (10%) caused no glandular contour abnormality and were visualized only because tumor echogenicity differed from that of the normal pancr eas. Thirty-four tumors (55%) were homogeneously hypoechoic compared w ith the normal pancreas, 2 (3%) were homogeneously hyperechoic, 1 (2%) was isoechoic, and 25 (40%) had heterogeneous echotextures. Many of t he heterogeneous tumors were predominantly hypoechoic with areas of va ried echogenicity. Calcifications were noted in 4 patients (6%) and sm all intratumoral cystic areas in 9 patients (15%). Postobstructive pse udocysts were found in 4 patients (6%). Color Doppler flow information was available for 19 patients; internal flow was detected in only 1 t umor (5%). Vascular occlusion was found in 3 patients and circumferent ial vascular encasement in 8; the tumors in these patients were unrese ctable. Tumors were noted to touch vessels in another 6 patients. Conc lusions. Current sonographic equipment allows the demonstration of new findings in pancreatic carcinoma. Color Doppler sonography can define tumor involvement of blood vessels and potentially affect clinical st aging and treatment decisions. (C) 1997 John Wiley & Sons, Inc.