The pancreas: newer radiological methods of investigation.

THE visualization of the pancreas has not, as yet, become a routine procedure. The radiological diagnosis of pancreatic disease still depends, by and large, on indirect signs, whether these are shown on plain films or on barium examinations. The barium meal with special reference to the duodenal loop remains the sheet anchor of the average radiologist. The method and the signs of this examination have been considered in great detail by many authors, and are included in standard texts on the subject, whether radiological or clinical. Its accuracy is such as to leave much to be desired. It is estimated that only 20% of lesions of the head of the pancreas can be detected by this means. However, if the treatment of pancreatic diseases, especially neoplastic conditions, is to become effective, their diagnosis will have to be considerably earlier than is at present possible on the routine barium meal. The diagnostic procedures to be considered are summarized in Table 1. Most of these procedures are at present only used in special centres, but as the value of these procedures will become more widely appreciated, so their use will spread. Some of these procedures will, in the near future, become part and parcel of the average radiologist's armamentarium. This, to a large measure, will depend on the desire to achieve accurate and early pre-operative diagnosis, both by the surgeon and radiologist.