Fig. 4. A 67-year-old woman with pancreatic adenocarcinoma.

A. On a conventional B-mode image, the lesion appears as an illdefined hypoechoic mass (left image). On a virtual touch tissue imaging elastographic image, the lesion appears to be stiffer than the surrounding pancreatic parenchyma (echogenicity score, 4; right image). The shear wave velocity of the lesion and surrounding pancreatic parenchyma was 4.85 m/sec and 2.23 m/sec, respectively. B, C. Axial computed tomography scans show an ill-defined hypodense mass in the pancreatic body, distal p-duct dilatation, and parenchymal atrophy, suggesting pancreatic cancer.