A New Method for the Roentgenologic Opacification of the Pancreas

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Abstract
The roentgen diagnosis of pancreatic disease depends mainly on secondary evidence. In a recent study by Eyler et al. (7), of 100 cases of carcinoma of the pancreas, the correct diagnosis of pancreatic enlargement was established in only 24 cases on the first evaluation of the films, although in a retrospective study of the roentgenograms the diagnosis could be confirmed in 57 cases. This high incidence of false negatives, even on the second evaluation, demonstrates clearly the inadequacy of the secondary roentgen signs of pancreatic enlargement. A step toward the direct roentgen visualization of the pancreas was made by the introduction of the pneumoretroperitoneum technic by Ruiz Rivas (15) in Spain, and de Gennes (4, 5) in France. This method allows the delineation of the retroperitoneal structures and was successfully employed by Macarini and Oliva (10) and by Cocchi (3) to visualize the pancreas. The large volume of up to 2,000 ml. of gas commonly insufflated into the retroperitoneal space and excessive distension of the stomach has, however, the disadvantage of disturbing the normal anatomic relationship of the abdominal organs including the pancreas, making correct diagnosis difficult. In addition, with the increased gas volume in the abdomen, there is a corresponding increase of the scattered roentgen rays, producing indistinct outlines of the organs. Even such elaborate methods as the pneumoretroperitoneal pancreatography and splenoportography described by Moseley do not always yield conclusive results (13). The major problem in pancreatic roentgen diagnosis is the failure of conventional contrast medium to accumulate sufficiently in the organ to produce opacification. In animal studies, halogenated zinc compounds were observed to be concentrated selectively in the pancreas (Shapiro, 16). Unfortunately, however, both the halogen and heavy metal components of this substance are too toxic for use in man and, in addition, the compound is not sufficiently stable. Pancreatic secretory activity is controlled by two factors, viz., the vagus nerve and the hormones pancreozymin (Harper, 8) and secretin (Bayliss and Starling, 1) produced by the duodenal mucous membrane, primarily in response to acid stimulation. This is elicited, among other factors, by stomach distension. Vagus stimulation and pancreozymin produce a secretion rich in proteins and ferments, mainly by the acinar cells, whereas secretin produces a watery, alkaline fluid chiefly from the isthmus cells and, in addition, increases the blood flow to the pancreas (Becker,2). Intravenous secretin increases the volume of duodenal fluid sixfold, and the bicarbonate concentration by a factor of 6 to 7, so that the total alkaline secretion may exceed the fasting values forty-fold (Wright, 17). Such an enormous increase of the secretory activity can only be achieved by a parallel increase of the blood flow through the organ (Rein and Schneider, 14).

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