Ultrasonography in diagnosing chronic pancreatitis: New aspects

The course and outcome is poor for most patients with pancreatic diseases.Advances in pancreatic imaging are important in the detection of pancreatic diseases at early stages.Ultrasonography as a diagnostic tool has made,virtually speaking a technical revolution in medical imaging in the new millennium.It has not only become the preferred method for first line imaging,but also,increasingly to clarify the interpretation of other imaging modalities to obtain efficient clinical decision.We review ultrasonography modalities,focusing on advanced pancreatic imaging and its potential to substantially improve diagnosis of pancreatic diseases at earlier stages.In the first section,we describe scanning techniques and examination protocols.Their consequences for image quality and the ability to obtain complete and detailed visualization of the pancreas are discussed.In the second section we outline ultrasonographic characteristics of pancreatic diseases with emphasis on chronic pancreatitis.Finally,new developments in ultrasonography of the pancreas such as contrast enhanced ultrasound and elastography are enlightened.     

Intragastric maldistribution of a liquid meal in children with recurrent abdominal pain assessed by three-dimensional ultrasonography

BACKGROUND: Using two-dimensional (2D) ultrasonography, we previously found indications of impaired adaptive relaxation of the proximal stomach in children with recurrent abdominal pain (RAP). In the present study, we applied a new three-dimensional (3D) ultrasonographic method to investigate intragastric volumes and distribution of a liquid meal in another group of children with RAP. METHODS: Twenty patients with RAP (age 10-15 years) and 20 healthy subjects (age 11-15 years) underwent ultrasonographic measurements of the stomach. A position sensor was used based on magnetic scanhead tracking for acquisition of 3D images after a liquid meal. The children scored abdominal symptoms before and after the meal. RESULTS: Expressed as a fraction of ingested volume, the patients had a smaller volume of the proximal stomach and a larger antral volume at 2 min postprandially compared to healthy subjects (P = 0.03 and P = 0.001, respectively). The patients also showed a decreased proximal to distal gastric volume ratio at 2 min postprandially (P = 0.001). Patients experienced more pain in response to the meal than healthy subjects (P = 0.04), but there was no correlation between pain and proximal or distal gastric volumes. CONCLUSIONS: RAP in children may be associated with an early intragastric maldistribution of a meal.