Role of contrast-enhanced ultrasound in clinical staging of pancreatic cancer.

Pancreatic carcinoma (PC) is an aggressive disease that represents the fifth cancer-related cause of death in Spain. Surgery is the only potentially curative treatment, but in about 80% of patients the tumor is unresectable at diagnosis. Due to its accessibility, safety and profitability, abdominal ultrasound is usually the first imaging technique to be performed when a PC is suspected. The main limitations of ultrasound in pancreatic assessment are the presence of bowel gas, obesity, operator dependency and low reproducibility. However, with experienced hands, ultrasound examination at the bedside can provide signs of advanced disease, such as ascites and/or hepatic metastasis. The incorporation of contrast-enhanced ultrasound (CEUS) into clinical practice has improved the accuracy of ultrasound in PC diagnosis. Moreover, CEUS is a technique with few adverse effects that can be used in patients with renal failure or iodinated contrast allergy and it is less expensive than CT and MRI.