Ultrasound of the pancreas: update and controversies

The pancreas is an organ that often presents difficulties for ultrasound ex ploration due to the interference of abdominal gas in the stomach and duode num. However, with technical experience and the use of a variety of examina tion techniques, such as filling the stomach with water or cellulose suspen sion, changing patient's position, or scanning at different moments of resp iration, such as suspended inspiration or expiration, it can be seen in its totality in a high percentage of patients. In our opinion, especially as n ew technical advances have been incorporated into US equipment (color power Doppler, harmonics, and US pulse inversion) and new contrast agents are av ailable, US can compete with CT in this field. Ultrasound can be as useful as CT in most patients with pancreatitis and pancreatic neoplasms. Furtherm ore, Endoscopic sonography (ES), as well as intraoperative and laparoscopic techniques, are also excellent for visualizing malignant pancreatic lesion s and have a special role in preoperative staging. Finally, US is a good te chnique to guide fine-needle biopsy of the pancreas and for aspiration of i nflammatory fluid collections and abscesses. Although CT has played a major role to date, US is presently the most widely available and economical mea ns to visualize the pancreas.