title: Gray-scale and color flow sonography of pancreatic ductal adenocarcinoma.
abstract: OBJECTIVE
  Current sonographic technology has enhanced imaging. This study analyzes the sonographic findings in a large series of patients with pancreatic ductal adenocarcinoma.
  
  
  METHODS
  The sonograms of 62 patients with pathologically confirmed pancreatic ductal adenocarcinoma were 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 the head of the pancreas, 1 (2%) at the junction of the head and body, and 16 (26%) in the body or tail; 2 lesions (3%) were diffuse. Tumors were ovoid or spherical in 37 patients (60%) and irregular in 25 (40%). Forty tumors (65%) markedly deformed the shape of the gland. Six lesions (10%) caused no glandular contour abnormality and were visualized only because tumor echogenicity differed from that of the normal pancreas. Thirty-four tumors (55%) were homogeneously hypoechoic compared with the normal pancreas, 2 (3%) were homogeneously hyperechoic, 1 (2%) was isoechoic, and 25 (40%) had heterogeneous echotextures. Many of the heterogeneous tumors were predominantly hypoechoic with areas of varied echogenicity. Calcifications were noted in 4 patients (6%) and small intratumoral cystic areas in 9 patients (15%). Postobstructive pseudocysts were found in 4 patients (6%). Color Doppler flow information was available for 19 patients; internal flow was detected in only 1 tumor (5%). Vascular occlusion was found in 3 patients and circumferential vascular encasement in 8; the tumors in these patients were unresectable. Tumors were noted to touch vessels in another 6 patients.
  
  
  CONCLUSIONS
  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 staging and treatment decisions.
authors.affiliation: Department of Radiology, University of Southern California School of Medicine, Los Angeles 90033, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Yassa
authors.forename: J
authors.initials: J
authors.lastname: Yang
authors.forename: S
authors.initials: S
authors.lastname: Stein
authors.forename: M
authors.initials: M
authors.lastname: Johnson
authors.forename: P
authors.initials: P
authors.lastname: Ralls
mesh_terms: D001783:Blood Flow Velocity; D018270:Carcinoma, Ductal, Breast / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color