The aim of the present study is to describe the pancreatic applications of ARFI, a new technique able to distinguish tissues on the basis of their stiffness.

TECHNOLOGY Elastography is a new technique applied to US imaging [1]. The challenge of this new technique is to distinguish different tissues on the basis of their specific consistency (Fig. 1), reflected by the deformation generated in the tissue itself by an imparted force on the target organ [2,3]. ARFI imaging is able to qualitatively and quantitatively define the tissue stiffness with no need for an external compression, so reducing the interobesrver variability. It exploits short duration acoustic radiation forces to generate localized tissue displacements...

SOLID LESIONS As well known, pancreatic ductal adenocarcinoma is a firm mass, stiffer than the adjacent parenchyma [10], owing to the presence of fibrosis and marked desmoplasia, and therefore it is characterized by a higher wave velocity value (Fig. 4 and Fig. 5). A wide range of values results also from our personal experience and only few data have been reported in the literature. Our latest unpublished data identify a velocity cut-off value (4 m/s) with 100% specificity and 100% positive predictive value (Tab) in...

ARFI is a promising technique for the differentiation of tissues: it can be useful in the diagnosis of pancreatic diseases and in choosing the correct patients management and follow-up.

1. Piscaglia F, Salvatore V, Di Donato R, et al. Accuracy of Virtual Touch acoustic radiation force impulse (ARFI) imaging for the diagnosis of cirrhosis during liver ultrasonography. Ultraschall Med 2011;32(2):167-175. 2. Hoyt K, Parker KJ, Rubens DJ, et al. Real-time shear velocity imaging using sonoelastographic techniques. Ultrasound Med Biol 2007;33:1086-1097. 3. Nightingale K, Bentley R, Trahey G. Observations of tissue response to acoustic radiation force: opportunities for imaging. Ultrason Imaging 2002;24:129-138. 4. Nightingale K, Soo MS, Nightingale R, et al. Acoustic radiation force impulse...