1. Technologies for Imaging the Normal and Diseased Pancreas
Gregory A. Coté, Jeffrey Smith, Stuart Sherman, Kimberly Kelly 
Gastroenterology 
Volume 144, Issue 6, Pages e1 (May 2013)
DOI: /j.gastro
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2. Figure 1
ERP. (A) Normal pancreatic duct anatomy reveals a small-diameter (<4 mm) main pancreatic duct that smoothly tapers through its course from the pancreatic head to tail. Side branches can be seen with increased contrast injection and reveal a smooth, very fine structure. (B) In patients with severe chronic pancreatitis, the pancreatic duct is markedly irregular and often dilated, as shown in the pancreatic body upstream from a stricture. Visualized side branches are coarse and irregular. Intraductal stones or main pancreatic duct strictures could require endoscopic or surgical treatment.
Gastroenterology  , e1DOI: ( /j.gastro )
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3. Figure 2
New imaging applications via ERP. Technological advances in ERP-based diagnostics are expected to improve the evaluation of pancreatic duct strictures and pancreatic duct dilation. (A) High-resolution pancreatoscopes with enhanced white-light imaging techniques may differentiate main duct IPMN from other causes of pancreatic duct dilation and permit site-directed biopsies or therapy, such as tumor ablation. (B) Advanced imaging of the pancreatic duct may help identify a solid tumor or intraepithelial neoplasia in the setting of a pancreatic stricture or distinguish IPMN from chronic pancreatitis or other causes of pancreatic duct dilation. (C) Through pancreatic duct cannulation, optical endomicroscopy, optical coherence tomography, and intraductal ultrasonography may facilitate diagnosis through progressively deeper imaging of the pancreatic duct and adjacent tissue.
Gastroenterology  , e1DOI: ( /j.gastro )
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4. Figure 3
New imaging applications via EUS. Whereas ERP and ERP-based imaging are limited to the main pancreatic duct and adjacent tissue, EUS can be used to evaluate (A) the entire pancreatic parenchyma for cystic and solid tumors as well as chronic pancreatitis. Technological advances in EUS-based diagnostics are expected to improve the characterization of pancreatic cysts, permit earlier diagnosis of chronic pancreatitis, and reliably identify PanIN. (B) More flexible EUS needles can serve as catheters to deliver enhanced imaging probes to perform endomicroscopy, optical coherence tomography, or fluorescent cystoscopy after the administration of an agent specific for PDAC. (C) Advances in EUS needle technology may permit EUS-guided therapy to pancreatic cysts or PanIN lesions via injection of antitumor agents or radiofrequency ablation. Quantitative measures of fibrosis such as a strain ratio calculated from (D) elastography and (E) contrast-enhanced EUS may reduce the interobserver variability of standard EUS.
Gastroenterology  , e1DOI: ( /j.gastro )
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5. Figure 4
Visualization of chronic pancreatitis via EUS. (A) From the duodenal bulb, visualization of the pancreatic head using a linear echoendoscope shows the confluence of the portal vein and superior mesenteric vein. There are endosonographic changes consistent with severe chronic pancreatitis, particularly calcifications with shadowing, relative atrophy, and a lobular contour to the pancreatic head. Endosonographic imaging could fail to detect malignancies under these conditions, because calcifications with shadowing interfere with transmission of the ultrasound signal through the entire gland. This patient underwent pancreatoduodenectomy for refractory symptoms, which confirmed severe parenchymal fibrosis (B). Surgical pathologic analysis confirmed chronic pancreatitis, marked by typical features of perilobular chronic inflammation (small arrow), acinar loss with periductal fibrosis (large arrow), and sparing of islet cells (arrowhead) (original magnification 4×). psc, portosplenic confluence; smv, superior mesenteric vein.
Gastroenterology  , e1DOI: ( /j.gastro )
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6. Figure 5
In vivo imaging of Plec1 in orthotopic PDACs in mice. A contrast reagent that interacts with Plec1 was used for noninvasive in vivo imaging. Athymic nude mice with orthotopically implanted tumors grown form L3.6pl cells were given injections of 111In-tPTP and imaged via SPECT/computed tomography 4 hours later. This approach showed that tetrameric plectin targeted peptide accumulated in the PDAC, so the tumor could be imaged in the pancreas and peritoneal metastases. T, tumor; L, liver; rK, right kidney; lK, left kidney; M, peritoneal metastasis.
Adapted from Bausch et al.50
Gastroenterology  , e1DOI: ( /j.gastro )
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7. Elastography. In EUS analysis, a patient with pancreatic adenocarcinoma was found to have an enlarged celiac lymph node. Imaging with elastography revealed a homogeneous, dark-blue color that was consistent with diffusely increased stiffness in the node. These observations indicated that the patient had metastatic cancer to the affected node; EUS-FNA was used to confirm this diagnosis.
Image courtesy of Dr Mouen Khashab (Johns Hopkins University School of Medicine, Baltimore, MD).
Gastroenterology  , e1DOI: ( /j.gastro )
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8. Gastroenterology 2013 144, 1262-1271. e1DOI: (10. 1053/j. gastro. 2013
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9. Gastroenterology 2013 144, 1262-1271. e1DOI: (10. 1053/j. gastro. 2013
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10. Gastroenterology 2013 144, 1262-1271. e1DOI: (10. 1053/j. gastro. 2013
Copyright © 2013 AGA Institute Terms and Conditions

11. Gastroenterology 2013 144, 1262-1271. e1DOI: (10. 1053/j. gastro. 2013
Copyright © 2013 AGA Institute Terms and Conditions