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DOI: 10.1055/s-0033-1335175
The Pancreatic Head is Larger than often Assumed
Der Pankreaskopf ist größer als man denktPublikationsverlauf
20. Januar 2013
23. Februar 2013
Publikationsdatum:
12. April 2013 (online)
Abstract
Reference values for B-mode abdominal ultrasound are controversially discussed in the literature mainly due to the lack of data and non-standardized examination techniques. A cohort of 100 patients was prospectively examined. Patients with hepatobiliary diseases including gallstones, acute or chronic pancreatitis (n = 13) and non-adequate visualization (n = 10) were excluded from statistical analysis. Therefore, 77 patients were analyzed including 52 female and 25 male healthy subjects regarding the biliopancreatic system (median age ± SD: 56 ± 18 years [minimum: 22 and maximum 93 years]). The mean value of the cranio-caudal diameter of the pancreatic head was 49 ± 10 [26 – 77] mm(mean ± SD [minimum − maximum]) which is larger than usually reported except in one study. The size of the pancreatic head is often larger than assumed which is of importance to know to exclude pancreatic pathology below the level of the common bile duct.
Zusammenfassung
Normwerte in der Sonografie werden kontrovers diskutiert. Dies liegt einerseits an fehlenden Studien aber andererseits auch an zu unterschiedlichen Untersuchungstechniken, um einen Vergleich zu ermöglichen. In der vorliegenden Studie wurden 100 konsekutive Patienten prospektiv untersucht. Patienten mit hepatobiliären Erkrankungen wurden ausgeschlossen (Gallensteinleiden, Pankreatitis, n = 13). Des Weiteren wurde Patienten exkludiert, die keine adäquate Beurteilbarkeit des gesamten Pankreaskopfs und seiner umgebenden Strukturen zuließen (n = 10). Somit konnten 77 Patienten ausgewertet werden (mittleres Alter ± Standardabweichung 56 ± 18 Jahre [22 – 93 Jahre], 52 weiblich und 25 männlich). Der mittlere kraniokaudale Diameter des Pankreaskopfs betrug 49 ± 10 [26 – 77] mm. Diese Werte sind deutlich höher als in der Literatur (mit einer Ausnahme) angegeben. Der Pankreaskopf ist in seinen kraniokaudalen Dimensionen häufiger größer als angenommen. Dies ist von Bedeutung, um kaudal gelegene Pankreasneoplasien zu detektieren, die den kranial davon gelegenen Gallengang (noch nicht) infiltrieren.
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References
- 1 Sienz M, Ignee A, Dietrich CF. [Reference values in abdominal ultrasound – biliopancreatic system and spleen]. Z Gastroenterol 2011; 49: 845-870
- 2 Sienz M, Ignee A, Dietrich CF. [Reference values in abdominal ultrasound – liver and liver vessels]. Z Gastroenterol 2010; 48: 1141-1152
- 3 Sienz M, Ignee A, Dietrich CF. [Sonography today: reference values in abdominal ultrasound: aorta, inferior vena cava, kidneys]. Z Gastroenterol 2012; 50: 293-315
- 4 Pochhammer KF, Szekessy T, Frentzel-Beyme B et al. [Craniocaudad extension of the head of the pancreas]. Digitale Bilddiagn 1984; 4: 118-120
- 5 Saif MW. Pancreatic neoplasm in 2011: an update. JOP 2011; 12: 316-321
- 6 Abam RO, Nwankwo NC. Sonographic measurement of the antero-posterior diameter of the head of the pancreas in normal adult population in Port Harcourt, South-South Nigeria. JMMS 2011; 2: 1162-1170
- 7 Bhutani MS, Gress FG, Giovannini M et al. The No Endosonographic Detection of Tumor (NEST) Study: a case series of pancreatic cancers missed on endoscopic ultrasonography. Endoscopy 2004; 36: 385-389
- 8 Klapman JB, Chang KJ, Lee JG et al. Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastroenterol 2005; 100: 2658-2661
- 9 De Angelis C, Repici A, Carucci P et al. Pancreatic cancer imaging: the new role of endoscopic ultrasound. JOP 2007; 8 (01) 85-97
- 10 Dietrich CF, Jenssen C. [Evidence based endoscopic ultrasound]. Z Gastroenterol 2011; 49: 599-621
- 11 Dietrich CF, Hocke M, Jenssen C. [Interventional endosonography]. Ultraschall in Med 2011; 32: 8-22, quiz
- 12 Afschrift M, Mets T, Verdonk G. Real-time ultrasonography of the normal pancreas in young adults: advantage of the erect position. Acta Clin Belg 1979; 34: 32-35
- 13 Afschrift M, Mets T, Verdonk G. Ultrasonography of pancreas. Lancet 1978; 1 (8056) 149
- 14 Dietrich CF, Braden B, Hocke M et al. Improved characterisation of solitary solid pancreatic tumours using contrast enhanced transabdominal ultrasound. J Cancer Res Clin Oncol 2008; 134: 635-643
- 15 Dietrich CF, Chichakli M, Hirche TO et al. Sonographic findings of the hepatobiliary-pancreatic system in adult patients with cystic fibrosis. J Ultrasound Med 2002; 21: 409-416
- 16 de Graaff CS, Taylor KJ, Simonds BD et al. Gray-scale echography of the pancreas. Re-evaluation of normal size. Radiology 1978; 129: 157-161
- 17 Guerra M, Gutierrez L, Carrasco R et al. [Size and echogenicity of the pancreas in Chilean adults: echotomography study in 261 patients]. Rev Med Chil 1995; 123: 720-726
- 18 Donovan PJ. Technique of examination and normal pancreatic anatomy. Contemp Iss Comput Tomogr 1983; 1-32
- 19 Kreel L, Haertel M, Katz D. Computed tomography of the normal pancreas. J Comput Assist Tomogr 1977; 1: 290-299
- 20 Syed AB, Mahal RS, Schumm LP et al. Pancreas size and volume on computed tomography in normal adults. Pancreas 2012; 41: 589-595
- 21 Stocksley M. Abdominal Ultrasound. Chapter 5. The Pancreas: Greenwich Medical Media; 2001
- 22 Deziel DJ, Machi J. Transabdominal ultrasound: Liver, biliary tract, and pancreas. In: Machi J, Staren ED, editors Ultrasound for Surgeons. : Lippincott Williams & Wilkins; 2005: 193-232
- 23 Sirli R, Sporea I. Ultrasound examination of the normal pancreas. Med Ultrason 2010; 12: 62-65
- 24 Rubens DJ. The pancreas. In: Dogra V, Rubens DJ, editors Ultrasound Secrets. Philadelphia: Hanley and Belfus; 2004: 183-192
- 25 Cuntz U, Frank G, Lehnert P et al. Interrelationships between the size of the pancreas and the weight of patients with eating disorders. Int J Eat Disord 2000; 27: 297-303
- 26 El-Hodhod MA, Nassar MF, Hetta OA et al. Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery. Eur J Clin Nutr 2005; 59: 467-473
- 27 Haber K, Freimanis AK, Asher WM. Demonstration and dimensional analysis of the normal pancreas with gray-scale echography. Am J Roentgenol Am J Roentgenol 1976; 126: 624-628
- 28 Zimmermann W, Frank N, Weiss-Simon C et al. [The normal pancreas. Demonstration in the sonogram in relation to age]. Fortschr Med 1981 99: 1178-1182
- 29 Kolmannskog F, Vatn MH, Swensen T et al. Computer tomography of the abdomen in patients with uncharacteristic abdominal disturbances. Scand J Gastroenterol 1983; 18: 225-227
- 30 Niederau C, Sonnenberg A, Muller JE et al. Sonographic measurements of the normal liver, spleen, pancreas, and portal vein. Radiology 1983; 149: 537-540
- 31 Silva ME, Vezozzo DP, Ursich MJ et al. Ultrasonographic abnormalities of the pancreas in IDDM and NIDDM patients. Diabetes Care 1993; 16: 1296-1297
- 32 Capaccioli L, Stecco A, Vanzi E et al. Ultrasonographic study on the growth and dimensions of healthy children and adults organs. Ital J Anat Embryol 2000; 105: 1-50