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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2016; 22(14): 3712-3724
Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3712
Elastography for the pancreas: Current status and future perspective
Natsuko Kawada, Sachiko Tanaka
Natsuko Kawada, Department of Gastroenterology, Nissay Hospital, Osaka 550-0012, Japan
Sachiko Tanaka, Osaka Center for Cancer and Cardiovascular Diseases Prevention, Osaka 550-0012, Japan
Author contributions: Kawada N analyzed literature and wrote the manuscript; Tanaka S checked and approved the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Natsuko Kawada, MD, Department of Gastroenterology, Nissay Hospital, 6-3-8 Itachibori Nishi, Osaka 550-0012, Japan. natz.kawada@gmail.com
Telephone: +81-6-65433581 Fax: +81-6-65326482
Received: December 25, 2015
Peer-review started: December 29, 2015
First decision: January 28, 2016
Revised: February 19, 2016
Accepted: March 13, 2016
Article in press: March 14, 2016
Published online: April 14, 2016
Processing time: 95 Days and 0.9 Hours
Abstract

Elastography for the pancreas can be performed by either ultrasound or endoscopic ultrasound (EUS). There are two types of pancreatic elastographies based on different principles, which are strain elastography and shear wave elastography. The stiffness of tissue is estimated by measuring the grade of strain generated by external pressure in the former, whereas it is estimated by measuring propagation speed of shear wave, the transverse wave, generated by acoustic radiation impulse (ARFI) in the latter. Strain elastography is difficult to perform when the probe, the pancreas and the aorta are not located in line. Accordingly, a fine elastogram can be easily obtained in the pancreatic body but not in the pancreatic head and tail. In contrast, shear wave elastography can be easily performed in the entire pancreas because ARFI can be emitted to wherever desired. However, shear wave elastography cannot be performed by EUS to date. Recently, clinical guidelines for elastography specialized in the pancreas were published from Japanese Society of Medical Ultrasonics. The guidelines show us technical knacks of performing elastography for the pancreas.

Keywords: Elastography; Pancreas; Strain; Shear wave

Core tip: Elastography for the pancreas had been considered to be difficult to perform with adequate accuracy and reproducibility because the pancreas is a small organ located deep in center of the human body. This review introduces the recent innovation of elastography for the pancreas, and makes recommendations on how to use various elastographic modalities for the pancreas. The review also shows us what we can know by performing elastography for the pancreas. Elastography may be a promising imaging modality for differential diagnosis between malignant and benign pancreatic tumors, for early diagnosis of chronic pancreatitis, and for identifying high-risk patients for pancreatic cancer.