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Dynamic Sonography of Pancreatic Tumors

Comparison with Dynamic CT

Osamu Oshikawa1, Sachiko Tanaka1, Tatsuya Ioka1, Akihiko Nakaizumi1, Yoshihiro Hamada1 and Takashi Mitani2

1 Division of Digestive Organs, Department of Cancer Survey, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3, Nakamichi, Higashinari, Osaka, 537-8511, Japan.
2 Department of Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, 537-8511, Japan.



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Fig. 1. Graph shows contrast index of pancreatic tumors with dynamic sonography. Tumors are listed by type of disease, number of tumors, and contrast index (mean ± SD). IPM = inflammatory pancreatic mass, ICT = islet cell tumor, SCA = serous cystadenoma, SCT = solid and cystic tumor.

 


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Fig. 2A. 66-year-old man with pancreatic ductal adenocarcinoma. Graph shows time—intensity curve of pancreatic parenchyma (a) and tumor area (b). At 42 sec after contrast agent injection, intensity had maximum enhancement in both tumor and parenchyma.

 


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Fig. 2B. 66-year-old man with pancreatic ductal adenocarcinoma. Sonogram obtained before injection of Levovist (Schering, Berlin, Germany) shows hypoechoic mass lesion (arrows) in head of pancreas.

 


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Fig. 2C. 66-year-old man with pancreatic ductal adenocarcinoma. Dynamic sonogram obtained 42 sec after contrast agent injection shows intensity of parenchymal area is slightly increased but intensity of tumor (arrows) is not increased. Contours of tumor became clear.

 


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Fig. 2D. 66-year-old man with pancreatic ductal adenocarcinoma. Dynamic CT scan reveals hypodense mass (asterisk) at head of pancreas.

 


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Fig. 3A. 74-year-old woman with nonfunctioning islet cell tumor. Graph shows time—intensity curve of pancreatic parenchyma (a) and tumor area (b). Intensity had maximum enhancement in both tumor and parenchyma 37 sec after contrast agent injection.

 


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Fig. 3B. 74-year-old woman with nonfunctioning islet cell tumor. Sonogram obtained before injection of Levovist (Schering, Berlin, Germany) shows hypoechoic mass lesion (arrows) in uncinate portion of pancreas.

 


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Fig. 3C. 74-year-old woman with nonfunctioning islet cell tumor. Dynamic sonogram obtained 37 sec after contrast agent injection shows intensity of parenchymal area is slightly increased and intensity of tumor (arrows) is strongly increased.

 


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Fig. 3D. 74-year-old woman with nonfunctioning islet cell tumor. Dynamic CT scan reveals hyperdense mass (asterisk) at uncinate portion of pancreas.

 


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Fig. 4. Chart shows contrast enhancement of pancreatic solid tumors imaged by dynamic sonography versus dynamic CT in 43 patients. In 93% (40/43) of tumors, grade of enhancement on dynamic sonography was closely correlated with grade of enhancement on dynamic CT. • = adenocarcinoma, {circ} = inflammatory pancreatic mass, {blacksquare} = islet cell tumor, {square} = serous cystadenoma, {blacktriangleup} = solid and cystic tumor, {triangleup} = metastatic tumor.

 

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