Sonographische Pankreasdiagnose bei unklaren Oberbauchbeschwerden: Eine prospektive Studie

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Abstract
Sonographic pancreatic diagnoses were controlled in a prospective study in 448 patients by endoscopic retrograde pancreatography (ERP), computer assisted tomography (CAT), laboratory findings and laparotomy on autopsy. The sonographic diagnoses of 426 patients were evaluated. In 22 cases (4.9%), the pancreas could not be demonstrated by sonography. In 194 of 205 patients with sonographically normal pancreas, sonographic findings were confirmed (positive validity 94.6%). Sonographic exclusion of normal pancreas was successful in 150 of 221 patients with pancreatic disease (negative validity 67.8%). The sonographic diagnosis of acute pancreatitis was confirmed in 25 of 30 patients. The pancreas was not demonstrable because of abundant intestinal gas in the 5 sonographically undiagnosed cases. Pancreatic cysts were correctly diagnosed sonographically in 18 of 19 established cases. The sonographic diagnosis of chronic pancreatitis was confirmed by ensuing diagnostic methods in 78 of 125 patients (positive validity 62.4%). Pancreatitis was excluded correctly in 228 of 301 patients (negative validity 95.7%). In 47 patients with a sonographic diagnosis of pancreatic carcinoma, further diagnosis in 25 cases showed no evidence of a tumor (positive validity 46.8%). Among 379 patients, in whom there was no evidence of pancreatic neoplasms sonographically, there were 4 in whom further diagnostics revealed pancreatic carcinoma (negative validity 98.9%). Sonography can thus differentiate between normal and pathological pancreas highly successfully. For differential diagnoses further investigations are necessary.

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