Roxana Șirli

By Roxana Șirli and Alina Popescu

Transabdominal ultrasound (US) is the first‐line imaging method used to diagnose pancreatic lesions, but contrast techniques are needed to differentiate among inflammatory and malignant lesions, as well as between pseudocysts and cystic tumors. Contrast‐enhanced (CE) ultrasonography has been proven to be a useful tool in this regard with performance similar to contrast‐enhanced computer tomography/magnetic resonance imaging (CT/MRI), being also safer and nonirradiant. According to the EFSUMB guidelines on the nonhepatic use of contrast‐enhanced ultrasound (CEUS), this method is useful to improve characterization of ductal adenocarcinoma; to differentiate between pseudocysts and cystic tumors; to differentiate vascular (solid) from avascular (liquid/necrotic) components of a lesion; to better define the dimensions and margins of a lesion, including its relationship with adjacent vessels; and to help the choice for a next imaging technique.

Part of the book: Challenges in Pancreatic Pathology

By Roxana Șirli, Iulia Rațiu and Ioan Sporea

Liver cirrhosis, regardless of its etiology, is an important health problem with a chronic evolution, characterized by the possibility of developing several important complications. The best management of these patients implies the correct and early diagnosis of the disease and of its complications. A major complication of cirrhosis is portal hypertension. The reference method for its diagnosis is the direct measurement of hepatic vein portal gradient, an invasive procedure. In the last years, several noninvasive techniques for the evaluation of liver fibrosis were developed, such as biological tests and elastographic methods. Ultrasound-based and MRI-based elastographic techniques have been assessed as predictive tools for the presence and severity of portal hypertension. This paper reviews published data regarding the value of ultrasound and MRI-based elastography (liver, spleen, or both) for the evaluation of portal hypertension.

Part of the book: Elastography

By Ioan Sporea, Raluca Lupușoru and Roxana Șirli

The number of NAFLD patients is increasing in the developed world and non-invasive modalities for their evaluation are needed. Ultrasound-based methods are very useful for this approach, starting with standard ultrasound used for steatosis detection, and continuing with new modalities for steatosis, fibrosis, and inflammation quantification. Modern ultrasound systems can quantify all these parameters in NAFLD patients, thus making ultrasound a real Multiparameter Ultrasound (MPUS). The performance of ultrasound-based methods is very well documented with liver stiffness assessment as a marker of fibrosis, and more recently, for quantification of steatosis and viscoelastic properties as a marker of inflammation.

Part of the book: Elastography