HYDROSONOGRAPHY OF THE PANCREAS - PRELIMI NARY-RESULTS OF A PILOT-STUDY

Purpose: To evaluate a new ultrasonographic imaging technique of the p ancreas (hydrosonography), based on a combination of chemical intestin al paralysis and water distension of the stomach and duodenum, regardi ng its significance for tumor detection, staging and assessment of tum or resectability. Material and methods: In an open prospective study 5 1 patients with suspected pancreatic neoplasm were examined between Ju ly 1995 and October 1995. The technique of hydrosonography included in travenous injection of 40 mg N-butylscopolaminiumbromid (Buscopan) and maximum gastric and duodenal wall distension by oral administration o f an average of 11 warm tap water (0.5-1.51). A detailed evaluation fo rm was used to assess (1) overall imaging quality; (2) accuracy of ide ntification of the pancreas in its various anatomic regions and of per ipancreatic vessel structures relevant for resectability, such as sple nic, superior mesenteric, and portal veins, celiac trunk, and superior mesenteric, splenic and hepatic arteries; and (3) tumor size, sonogra phic structure and level of organ and vessel infiltration. As gold sta ndards for positive tumor detection and description, surgery and micro scopic diagnosis were used, and for negative tumor detection, event-fr ee survival of 6 months. Results: All examinations were diagnostic. Id entification of the pancreas was complete in all 51 patients with an e xcellent overall imaging quality in 53%. In 86% of cases the various e xamined organ and vessel structures were depicted with either good or average imaging quality. In 48 of the 51 patients diagnosis positive f or tumor or other organ pathology was made. A total of 16 pancreatic c arcinomas and 5 benign tumors were diagnosed. Twenty-seven patients ha d pathology not related to a pancreatic neoplasm. For tumor detection, sensitivity was 82% and specificity 100%. For correct assessment of t umor resectability, sensitivity was 86% and specificity 100%. Conclusi on: The new technique of hydrosonography combines the value of routine non-invasive abdominal ultrasound with increased sensitivity and spec ificity for tumor detection and assessment of resectability by improve d imaging accuracy.