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Otsuka Y, Minaga K, Hara A, Masuta Y, Takenaka M, Chikugo T, Kudo M. Detective flow imaging endoscopic ultrasound for locating optimal puncture site for a poorly vascularized pancreatic mass. Endosc Int Open 2024; 12:E1063-E1064. [PMID: 39268156 PMCID: PMC11392587 DOI: 10.1055/a-2405-1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 06/13/2024] [Indexed: 09/15/2024] Open
Affiliation(s)
- Yasuo Otsuka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Akane Hara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yasuhiro Masuta
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takaaki Chikugo
- Department of Pathology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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Gheorghiu MI, Seicean A, Pojoga C, Hagiu C, Seicean R, Sparchez Z. Contrast-enhanced guided endoscopic ultrasound procedures. World J Gastroenterol 2024; 30:2311-2320. [PMID: 38813054 PMCID: PMC11130571 DOI: 10.3748/wjg.v30.i17.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/10/2024] [Accepted: 04/15/2024] [Indexed: 04/30/2024] Open
Abstract
Contrast-enhanced endoscopic ultrasound (CH-EUS) can overcome the limitations of endoscopic ultrasound-guided acquisition by identifying microvessels inside inhomogeneous tumours and improving the characterization of these tumours. Despite the initial enthusiasm that oriented needle sampling under CH-EUS guidance could provide better diagnostic yield in pancreatic solid lesions, further studies did not confirm the supplementary values in cases of tissue acquisition guided by CH-EUS. This review details the knowledge based on the available data on contrast-guided procedures. The indications for CH-EUS tissue acquisition include isoechoic EUS lesions with poor visible delineation where CH-EUS can differentiate the lesion vascularisation from the surrounding parenchyma and also the mural nodules within biliopancreatic cystic lesions, which occur in select cases. Additionally, the roles of CH-EUS-guided therapy in patients whose pancreatic fluid collections or bile ducts that have an echogenic content have indications for drainage, and patients who have nonvisualized vessels that need to be highlighted via Doppler EUS are presented. Another indication is represented if there is a need for an immediate assessment of the post-radiofrequency ablation of pancreatic neuroendocrine tumours, in which case CH-EUS can be used to reveal the incomplete tumour destruction.
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Affiliation(s)
- Marcel Ioan Gheorghiu
- Department of Gastroenterology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Cluj, Romania
| | - Andrada Seicean
- Department of Gastroenterology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Cluj, Romania
| | - Cristina Pojoga
- Department of Gastroenterology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Cluj, Romania
- Department of Clinical Psychology and Psychotherapy, International Institute for Advanced Study of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca 400375, Cluj, Romania
| | - Claudia Hagiu
- Department of Gastroenterology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Cluj, Romania
| | - Radu Seicean
- The First Surgical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca 400006, Cluj, Romania
| | - Zeno Sparchez
- Department of Gastroenterology, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Cluj, Romania
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Wang L, Wang G, Wang P, Nie F. Pancreatic ductal adenocarcinoma: CEUS characteristics are correlated with pathological findings and help predict early recurrence after resection. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:230-240. [PMID: 38018362 DOI: 10.1002/jcu.23622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To identify characteristics of preoperative contrast-enhanced ultrasound (CEUS) that could predict early recurrence after curative resection of pancreatic ductal adenocarcinoma (PDAC). METHODS From January 2017 to September 2022, a total of 110 patients with PDAC (all confirmed by samples obtained via operation) who underwent CEUS within 1 month before surgery were enrolled. We proposed five CEUS enhancement patterns (Pattern I, homogeneous enhancement; Pattern II, heterogeneous enhancement without cystic components; pattern III, ring enhancement; Pattern IV, starry enhancement; Pattern V, heterogeneous enhancement with cystic components) of PDAC. Clinical-pathologic and CEUS characteristics for predicting early recurrence (recurrence within 1 year after curative resection) were analyzed. Important CEUS characteristics were compared with the pathological findings. RESULTS Tumor size and TNM stage were closely associated with early recurrence. Incomplete-enhancement and enhancement pattern III, IV and V at CEUS imaging were more prone to early recurrence. Incomplete-enhancement lesions had higher histological tumor grades, less frequent remaining acini, and more frequent necrosis within the tumor. PDACs with pattern I and II had lower histological tumor grades, and pattern III, IV and V had higher histological tumor grades. PDACs with pattern I, II and IV had less frequent intratumoral necrosis than PDACs with pattern III and V, and PDACs with pattern IV had lower MVD values. CONCLUSIONS PDACs with incomplete enhancement and enhancement pattern III, IV and V were more prone to early recurrence after attempted curative resection, and these important CEUS characteristics were closely related to the pathological findings of PDAC.
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Affiliation(s)
- Lan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Guojuan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Peihua Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
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Wang L, Li M, Dong T, Li Y, Yin C, Nie F. Pancreatic Ductal Adenocarcinoma: The Characteristics of Contrast-Enhanced Ultrasound Are Correlated with the Hypoxic Microenvironment. Diagnostics (Basel) 2023; 13:3270. [PMID: 37892091 PMCID: PMC10606620 DOI: 10.3390/diagnostics13203270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
A hypoxic microenvironment is associated with an increased risk of metastasis, treatment resistance and poor prognosis of pancreatic ductal adenocarcinoma (PDAC). This study aimed to identify contrast-enhanced ultrasound (CEUS) characteristics that could predict the hypoxic microenvironment of PDAC. A total of 102 patients with surgically resected PDAC who underwent CEUS were included. CEUS qualitative and quantitative characteristics were analyzed. The expression of hypoxia-inducible factor-1α (HIF-1) and glucose transporter-1 (GLUT1) were demonstrated by immunohistochemistry. The associations between CEUS characteristics and the HIF-1α and GLUT1 expression of PDACs were evaluated. We found that HIF-1α-high PDACs and GLUT1-high PDACs had a larger tumor size and were more prone to lymph node metastasis. There was a significant positive linear correlation between the expression of HIF-1α and GLUT1. CEUS qualitative characteristics including completeness of enhancement and peak enhancement degree (PED) were related to the expression of HIF-1α and GLUT1. A logistic regression analysis showed that tumor size, lymph node metastasis, incomplete enhancement and iso-enhancement of PED were independent predictors for HIF-1α-high PDACs and GLUT1-high PDACs. As for quantitative characteristics, HIF-1α-high PDACs and GLUT1-high PDACs showed higher peak enhancement (PE) and wash-in rate (WIR). CEUS can effectively reflect the hypoxia microenvironment of PDAC, which may become a noninvasive imaging biomarker for prognosis prediction and individualized treatment.
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Affiliation(s)
- Lan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China; (L.W.); (M.L.); (T.D.); (Y.L.); (C.Y.)
| | - Ming Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China; (L.W.); (M.L.); (T.D.); (Y.L.); (C.Y.)
| | - Tiantian Dong
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China; (L.W.); (M.L.); (T.D.); (Y.L.); (C.Y.)
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou 730030, China
| | - Yuanyuan Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China; (L.W.); (M.L.); (T.D.); (Y.L.); (C.Y.)
| | - Ci Yin
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China; (L.W.); (M.L.); (T.D.); (Y.L.); (C.Y.)
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China; (L.W.); (M.L.); (T.D.); (Y.L.); (C.Y.)
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou 730030, China
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Otsuka Y, Kamata K. A review of contrast-enhanced harmonic endoscopic ultrasonography for pancreatic solid tumors. J Med Ultrason (2001) 2023:10.1007/s10396-023-01346-3. [PMID: 37584780 DOI: 10.1007/s10396-023-01346-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/15/2023] [Indexed: 08/17/2023]
Abstract
Endoscopic ultrasonography (EUS) is superior to other imaging modalities in the detection of pancreatic masses, although differentiating the types of pancreatic masses detected on EUS remains challenging. However, the value of contrast-enhanced harmonic EUS (CH-EUS) using ultrasound contrast agents for this differentiation has been reported. CH-EUS plays a pivotal role in analysis of small lesions that can only be detected with EUS. Recently, CH-EUS was used for staging and/or determining the resectability of pancreatic cancer in several clinical trials. In addition, it is used to estimate the response of pancreatic cancer to chemotherapy and to determine the prognosis in cases of pancreatic cancer and pancreatic neuroendocrine neoplasms. It is also postulated that CH-EUS improves the diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) through complementary diagnoses using CH-EUS and EUS-FNAB, or CH-EUS-guided EUS-FNAB. Thus, CH-EUS has been employed for various qualitative diagnoses, including differentiation of pancreatic masses. Second-generation contrast agents such as Sonazoid are used clinically for ultrasound diagnostic imaging of liver and breast disease. The positioning of CH-EUS with Sonazoid as a test for the diagnosis of solid pancreatic tumors is an issue for further studies.
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Affiliation(s)
- Yasuo Otsuka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511, Japan.
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Ashida R, Kitano M. Endoscopic ultrasound-guided tissue acquisition for pancreatic ductal adenocarcinoma in the era of precision medicine. Dig Endosc 2022; 34:1329-1339. [PMID: 35488448 DOI: 10.1111/den.14344] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/27/2022] [Indexed: 12/13/2022]
Abstract
Endoscopic ultrasound-guided tissue acquisition (EUS-TA) currently plays a central role in the diagnosis of pancreatic ductal adenocarcinoma (PDAC). Although fine-needle aspiration has been the gold standard, novel biopsy needles for fine-needle biopsy (FNB) were developed to overcome its limitations, which include low tumor cellularity and the inability to retain cellular architecture. Following recent improvements in FNB needles, the pathological diagnosis has shifted from cytology to histology and now to genetic diagnosis. Genetic analysis using EUS-TA samples began with a search for the presence of K-ras mutations. However, the introduction of next-generation sequencers has dramatically changed genetic analysis and led to the gradual elucidation of the mechanism of PDAC, enabling personalized medicine by performing multiple gene analyses simultaneously. Comprehensive genomic profiling is currently applied in the clinical setting and there is an increasing need for gene analysis using EUS-TA samples. Although target genome sequencing is feasible even with cytological specimens, it can be difficult to proceed with full genetic analysis including whole-exome sequence or whole-genome sequence if the samples are too small. Genetic analysis will become highly important in determining indications for personalized medicine such as poly (ADP-ribose) polymerase inhibitors or immune checkpoint inhibitors. Therefore, the endosonographer must always take gene analysis into consideration when collecting samples for diagnosis and further improvement of the puncture technique and needle development are anticipated in the future.
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Affiliation(s)
- Reiko Ashida
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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Yuan Z, Yan H, Ling W, Luo Y. Contrast-enhanced ultrasound of pancreatic melanoma: A case report and literature review. Front Oncol 2022; 12:989638. [PMID: 36147915 PMCID: PMC9485595 DOI: 10.3389/fonc.2022.989638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Melanoma is a malignant tumor that originates from melanocytes, most of which are of cutaneous origin. Most melanomas identified in the pancreas are metastatic, and primary pancreatic melanoma is extremely rare and has rarely been discussed. The correct preoperative diagnosis of pancreatic metastatic melanoma, especially primary melanoma, is challenging. Herein, we report a 43-year-old man who presented to our hospital due to unexplained left abdominal distension and pain. Abdominal ultrasound examination demonstrated multiple space-occupying lesions of the pancreas, and hypoechoic masses partially filled the splenic vein behind the pancreatic body. In the contrast-enhanced ultrasound (CEUS), all of these lesions showed iso-enhancement to slight hypo-enhancement in the arterial phase and hypo-enhancement in the venous phase. Masses in the splenic vein also showed hypo-enhancement. Imaging features suggested that the pancreatic lesions were malignant tumors. The tumor markers carcinoembryonic antigen, carbohydrate antigen 125 and carbohydrate antigen 19-9 were within normal limits. Based on clinical symptoms, imaging findings and incidence of pancreatic tumors, the patient’s clinical diagnosis was pancreatic carcinoma. Surgery was performed for the patient, while postoperative pathology confirmed malignant melanoma of the pancreas. Therefore, it is significant to identify the clinical and imaging manifestations of pancreatic melanoma in order to better manage the disease. Herein, we reported this case and reviewed the literature from 2000 to 2021 on the clinical and imaging features of 26 patients with pancreatic melanoma. It may improve clinicians’ awareness of the clinical and imaging performance of pancreatic melanoma, resulting in improved diagnosis, differential diagnosis, treatment, and outcomes.
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Huang J, Chen J, Xu M, Zheng Y, Lin M, Huang G, Xie X, Xie X. Contrast-Enhanced Ultrasonography Findings Correlate with Pathologic Grades of Pancreatic Neuroendocrine Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2097-2106. [PMID: 33934943 DOI: 10.1016/j.ultrasmedbio.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/22/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
The correlation of sonographic findings with pathologic grades of pancreatic neuroendocrine tumors (PNETs) remains unclear. This study aimed to evaluate the usefulness of sonographic features in diagnosing the pathologic grade of PNETs. Conventional and contrast-enhanced ultrasonography findings of PNETs diagnosed by surgical pathology from July 2010 to June 2020 were retrospectively reviewed. Sonographic features were compared among three pathologic grades of PNETs according to the World Health Organization 2010 classification. Ordinal regression models were constructed to evaluate the usefulness of the sonographic features in diagnosing the pathologic grade of PNETs. This study enrolled 93 participants with PNETs: 50 grade 1, 31 grade 2 and 12 grade 3. Multivariate ordinal regression analysis suggested that tumor size ≥2 cm (odds ratio [OR], 0.110; 95% confidence interval [CI], 0.020-0.606; p = 0.011), dilation of the main pancreatic duct (OR, 0.103; 95% CI, 0.025-0.430; p = 0.002), hepatic metastases (OR, 0.250; 95% CI, 0.072-0.869; p = 0.029) and hyper-enhancement in arterial phase (OR, 4.676; 95% CI, 1.656-13.206; p = 0.004) were significantly associated with the pathologic grades of PNETs. The accuracy of the ordinal logistic regression model in identifying grade 1, 2 and 3 PNETs was 77.4%, 67.7% and 90.3%, respectively. The findings suggest that sonographic features, including tumor size, pancreatic duct dilation and hepatic metastasis, as well as the enhancement level in arterial phase, may help identify different pathologic grades of PNETs.
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Affiliation(s)
- Jingzhi Huang
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanling Zheng
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Manxia Lin
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guangliang Huang
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaohua Xie
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Itonaga M, Kitano M, Kojima F, Hatamaru K, Yamashita Y, Tamura T, Nuta J, Kawaji Y, Shimokawa T, Tanioka K, Murata SI. The usefulness of EUS-FNA with contrast-enhanced harmonic imaging of solid pancreatic lesions: A prospective study. J Gastroenterol Hepatol 2020; 35:2273-2280. [PMID: 32529685 DOI: 10.1111/jgh.15144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Few studies have investigated endoscopic ultrasound-guided fine-needle aspiration with contrast-enhanced harmonic imaging (EUS-FNA-CHI) for diagnosing and adequately sampling pancreatic lesions. This study aimed to investigate the efficacy of EUS-FNA-CHI compared with that of endoscopic ultrasound-guided fine-needle aspiration with fundamental B mode imaging (EUS-FNA-FBI) for diagnosing solid pancreatic lesions. METHODS Consecutive patients with solid pancreatic lesions were enrolled prospectively (UMIN 000024467). Only samples obtained during the first needle pass (EUS-FNA-FBI) and second needle pass (EUS-FNA-CHI) were used to compare the accuracy rate for diagnosing pancreatic lesions and rate of adequate sampling for histological evaluation. In patients with hypo-enhancing lesions on contrast-enhanced harmonic EUS (CH-EUS), subgroup analyses were performed. Patients were classified into those with a heterogeneous area in the whole lesion (whole group), those with a heterogeneous area with a non-enhancing area (non-enhancing group), and those with a heterogeneous area with a homogeneous area (homogeneous group). RESULTS Ninety-three patients were enrolled. Overall, the rates of adequate sampling and sensitivity were significantly higher with EUS-FNA-CHI than with EUS-FNA-FBI (84.9% vs 68.8%, P = 0.003 and 76.5% vs 58.8%, P = 0.011, respectively). The adequate sampling rate and sensitivity were significantly higher with EUS-FNA-CHI than with EUS-FNA-FBI when the mass was > 15 mm. In the non-enhancing and homogeneous groups, the adequate sampling rate and sensitivity were significantly higher with EUS-FNA-CHI than with EUS-FNA-FBI. CONCLUSIONS CH-EUS enables improved observation of pancreatic lesions and helps identify the target of EUS-FNA among different pathological areas of the lesions particularly of > 15 mm.
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Affiliation(s)
- Masahiro Itonaga
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Fumiyoshi Kojima
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
| | - Keiichi Hatamaru
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasunobu Yamashita
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tamura
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Junya Nuta
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuki Kawaji
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Kensuke Tanioka
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
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Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) with Image Enhancement. Diagnostics (Basel) 2020; 10:diagnostics10110888. [PMID: 33143258 PMCID: PMC7692599 DOI: 10.3390/diagnostics10110888] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023] Open
Abstract
Although endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is useful in the differential diagnosis of solid pancreatic lesions, lymph nodes, and liver lesions, inadequate sampling may result in an incorrect pathological diagnosis. The accuracy of EUS for the evaluation of pancreatobiliary lesions may be increased by image enhancement technologies, including contrast-enhanced harmonic (CH)-EUS and EUS-elastography. These methods can provide information that complement EUS-FNA for the diagnosis and staging of pancreatobiliary cancer, and can help to identify the EUS-FNA target, reducing the requirement for repeat FNA.
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Seo W, Kim YC, Min SJ, Lee SM. Enhancement parameters of contrast-enhanced computed tomography for pancreatic ductal adenocarcinoma: Correlation with pathologic grading. World J Gastroenterol 2020; 26:4151-4158. [PMID: 32821076 PMCID: PMC7403799 DOI: 10.3748/wjg.v26.i28.4151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/08/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDA) is a malignancy with a high mortality rate and short survival time. The conventional computed tomography (CT) has been worldwide used as a modality for diagnosis of PDA, as CT enhancement pattern has been thought to be related to tumor angiogenesis and pathologic grade of PDA.
AIM To evaluate the relationship between the pathologic grade of pancreatic ductal adenocarcinoma and the enhancement parameters of contrast-enhanced CT.
METHODS In this retrospective study, 42 patients (Age, mean ± SD: 62.43 ± 11.42 years) with PDA who underwent surgery after preoperative CT were selected. Two radiologists evaluated the CT images and calculated the value of attenuation at the aorta in the arterial phase and the pancreatic phase (VAarterial and VApancreatic) and of the tumor (VTarterial and VTpancreatic) by finding out four regions of interest. Ratio between the tumor and the aorta enhancement on the arterial phase and the pancreatic phase (TARarterial and TARpancreatic) was figured out through dividing VTarterial by VAarterial and VTpancreatic by VApancreatic. Tumor-to-aortic enhancement fraction (TAF) was expressed as the ratio of the difference between attenuation of the tumor on arterial and parenchymal images to that between attenuation of the aorta on arterial and pancreatic images. The Kruskal-Wallis analysis of variance and Mann-Whitney U test for statistical analysis were used.
RESULTS Forty-two PDAs (23 men and 19 women) were divided into three groups: Well-differentiated (n = 13), moderately differentiated (n = 21), and poorly differentiated (n = 8). TAF differed significantly between the three groups (P = 0.034) but TARarterial (P = 0.164) and TARpancreatic (P = 0.339) did not. The median value of TAF for poorly differentiated PDAs (0.1011; 95%CI: 0.01100-0.1796) was significantly higher than that for well-differentiated PDAs (0.1941; 95%CI: 0.1463-0.3194).
CONCLUSION Calculation of TAF might be useful in predicting the pathologic grade of PDA.
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Affiliation(s)
- Woorim Seo
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do 18450, South Korea
| | - Young Chul Kim
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do 18450, South Korea
| | - Seon Jeong Min
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do 18450, South Korea
| | - Sang Min Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Gyeonggi-do 14068, South Korea
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Xu M, Li XJ, Zhang XE, Pan FS, Tan Y, Huang TY, Hong Y, Huang GL, Xie XY. Application of Contrast-Enhanced Ultrasound in the Diagnosis of Solid Pseudopapillary Tumors of the Pancreas: Imaging Findings Compared With Contrast-Enhanced Computed Tomography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3247-3255. [PMID: 31179567 DOI: 10.1002/jum.15036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/28/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the characterization and usefulness of contrast-enhanced ultrasound (CEUS) for diagnosing solid pseudopapillary tumors of the pancreas (SPTP) and compare the enhancement patterns with contrast-enhanced computed tomography (CECT). METHODS Forty-three SPTP lesions proved by pathologic findings in 42 patients examined with CEUS and CECT were included in this study. The enhancement characteristics and typical CEUS features of the tumors were investigated. These characteristics were compared according to lesion sizes. The enhancement patterns of CEUS were compared with CECT. RESULTS The most common enhancement levels of SPTP in the early phase and late phase for CEUS were isoenhancement (19 of 43 [44.2%]) and hypoenhancement (32 of 43 [74.4%]), respectively. The 4 most common enhancement patterns were hypo-hypo (16 of 43 [37.2%]), iso-iso (11 of 43 [25.6%]), hyper-hypo (8 of 43 [18.6%]), and iso-hypo (8 of 43 [18.6%]) enhancement. For the 43 SPTP lesions, typical CEUS features such as lesion membrane, intralesional vessel, and intralesional compartmentalization enhancements were detected in 30 (69.8%), 27 (62.8%), and 10 (23.2%) cases. Compared with CECT, isoenhancement during the early phase and hypoenhancement during the late phase were the most common imaging characteristics of CEUS. CONCLUSIONS Lesion membrane, intralesional vessel, and intralesional compartmentalization enhancements are typical CEUS features of SPTP, especially for large lesions (lesion size ≥3.0 cm). Isoenhancement during the early phase and hypoenhancement during the late phase are the most common imaging characteristics of CEUS and CECT, making CEUS a viable alternative diagnostic method that is noninvasive.
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Affiliation(s)
- Ming Xu
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xiao-Ju Li
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Er Zhang
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Fu-Shun Pan
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang Tan
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Tong-Yi Huang
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yu Hong
- University of Texas at Dallas, Richardson, Texas, USA
| | - Guang-Liang Huang
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Sofuni A, Tsuchiya T, Itoi T. Ultrasound diagnosis of pancreatic solid tumors. J Med Ultrason (2001) 2019; 47:359-376. [PMID: 31420821 DOI: 10.1007/s10396-019-00968-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Advances and widespread use of various diagnostic imaging modalities have dramatically improved our ability to visualize and diagnose pancreatic diseases. In particular, ultrasonography in pancreatic diseases plays an important role from screening to diagnosis as a simple and safe examination method. METHODS The basic scanning method of transabdominal pancreatic ultrasonography, characterization, and differential diagnosis by ultrasonography including contrast-enhanced ultrasonography (CEUS) for solid pancreatic tumors are reviewed with reference to various papers. RESULTS In recent years, the ability to visualize and diagnose pancreatic mass lesions has been dramatically improved with advances in ultrasound equipment. In particular, CEUS using an ultrasound contrast agent has made it possible to evaluate hemodynamics in organs or lesions as well as in the flow signal of arterial blood vessels, and it has played an important role not only in diagnosis of the presence of a lesion but also in the qualitative diagnosis. The enhancement behavior and pattern with CEUS of pancreatic solid tumors is shown in text and Fig. 9. Moreover, the flow chart for diagnosing pancreatic solid tumors with CEUS classifying the enhancement behavior and pattern for pancreatic solid tumors on CEUS is shown (Fig. 10). In meta-analyses, the pooled sensitivity in the differential diagnosis of pancreatic adenocarcinomas and other pancreatic focal masses with CEUS was 86-90%, and the pooled specificity was 75-88%. CONCLUSION CEUS is a minimally invasive and useful diagnostic method that can be used to make a simple and quick qualitative diagnosis of pancreatic diseases. CEUS provides a lot of information important for diagnosis, and has led to changes in the conventional diagnostic systems in pancreatic diseases.
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Affiliation(s)
- Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Tanaka H, Kamata K, Takenaka M, Yoshikawa T, Ishikawa R, Okamoto A, Yamazaki T, Nakai A, Omoto S, Minaga K, Yamao K, Sakurai T, Watanabe T, Nishida N, Chiba Y, Kitano M, Kudo M. Contrast-enhanced harmonic endoscopic ultrasonography for evaluating the response to chemotherapy in pancreatic cancer. Dig Liver Dis 2019; 51:1130-1134. [PMID: 31006543 DOI: 10.1016/j.dld.2019.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is used for the diagnosis of pancreatic cancer (PC). Here, we examined the usefulness of CH-EUS for evaluating therapeutic responses in PC. METHODS The study included 23 patients with PC who received chemotherapy. Patients underwent contrast-enhanced computed tomography (CE-CT) and CH-EUS before chemotherapy and at the time of evaluation of the therapeutic response. Patients with a ≧50% reduction in serum carbohydrate antigen 19-9 levels after chemotherapy were defined as "super responders". The incidence of an avascular area in the tumor on CH-EUS after chemotherapy was compared between "super responders" and non-super responders. RESULTS Nine patients were included in the "super responders" group.Tumor reduction rates did not differ significantly between CE-CT and CH-EUS in the "super responders". The appearance of an avascular area was detected in 7 of 9 super responders (77.8%) and in 4 of 14 non-super responders (28.6%), and the difference was significant (P = 0.036). The mean survival time of patients with an avascular area after chemotherapy was longer than that of without an avascular area. CONCLUSIONS Detection of avascular areas by CH-EUS after chemotherapy may predict long-term survival of patients with PC.
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Affiliation(s)
- Hidekazu Tanaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan.
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Tomoe Yoshikawa
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Rei Ishikawa
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Ayana Okamoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Tomohiro Yamazaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Atsushi Nakai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Kentaro Yamao
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Hospital, Osaka-sayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
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15
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Ishikawa T, Hirooka Y, Kawashima H, Ohno E, Hashizume K, Funasaka K, Nakamura M, Miyahara R, Watanabe O, Ishigami M, Goto H. Multiphase evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic solid lesions. Pancreatology 2018; 18:291-297. [PMID: 29449151 DOI: 10.1016/j.pan.2018.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/12/2018] [Accepted: 02/08/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Time-intensity curve (TIC) under contrast-enhanced EUS (CE-EUS) allows continuous and quantitative evaluation of targeted area in the pancreas. However, TIC is not always available and the procedure is complicated. We aimed to propose a simplified method by evaluating multiple phases of CE-EUS in the diagnosis of pancreatic solid lesions. METHODS We retrospectively reviewed 210 patients with pancreatic solid lesions including 142 with pancreatic ductal cancer (PDAC), 31 with pancreatic neuroendocrine neoplasm, 13 with solid pseudopapillary neoplasm and 24 with mass-forming pancreatitis who underwent CE-EUS and achieved final diagnoses. The CE-EUS images were continuously recorded for 60 s, and each image at 20, 40 and 60 s was used for the evaluation. The images were classified into three patterns as hypoechoic, hyperechoic and isoechoic vascular patterns compared with the surrounding pancreas, and the relevance between the multiphase evaluation of CE-EUS and each disease group was investigated. RESULTS In PDAC group, majority of the lesions showed hypovascular pattern at 20 or 40 s after injection of contrast medium following early enhancement. The sensitivity, specificity and accuracy of PDAC pattern in the differentiation of PDAC from other lesions was 83.1%, 86.8% and 84.3%, respectively. On histopathological analysis, significant differences were seen in histologic types, infiltration (INF), and neural invasion (ne) between those who showed PDAC pattern and those who didn't. CONCLUSIONS Multiphase evaluation of CE-EUS is convenient and useful method for the differentiation of pancreatic solid lesions which can be alternatively used for TIC.
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Affiliation(s)
- Takuya Ishikawa
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Hirooka
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
| | - Hiroki Kawashima
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kiyotaka Hashizume
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Funasaka
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Watanabe
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidemi Goto
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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16
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Wang Y, Yan K, Fan Z, Ding K, Yin S, Dai Y, Yang W, Wu W. Clinical Value of Contrast-Enhanced Ultrasound Enhancement Patterns for Differentiating Focal Pancreatitis From Pancreatic Carcinoma: A Comparison Study With Conventional Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:551-559. [PMID: 28850742 DOI: 10.1002/jum.14363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We explored the clinical value of using contrast-enhanced ultrasound (US) enhancement patterns for the differential diagnosis of focal pancreatitis from pancreatic carcinoma. METHODS A total of 136 solid pancreatic lesions with final diagnoses from January 2010 to February 2016 were enrolled in this study. Twenty-five cases were focal pancreatitis; 86 cases were pancreatic carcinoma; and 25 cases were other types. All of the patients received conventional and contrast-enhanced US examinations. Two experienced US physicians analyzed the contrast-enhanced US enhancement patterns and made diagnoses according to the conventional and contrast-enhanced US manifestations. The inter-rater agreement for the contrast enhancement patterns between the readers was analyzed. The diagnostic efficiency of contrast enhancement patterns for differentiating focal pancreatitis from pancreatic carcinoma was analyzed and compared with that of conventional US. RESULTS The κ test showed good concordance for contrast enhancement patterns between the readers (P < .05). The diagnostic sensitivity, specificity, and accuracy of isoenhancement or isoenhancement with focal hypoenhancement in both the early and late phases for diagnosing focal pancreatitis were 72.0%, 95.5%, and 91.2%, respectively. The diagnostic sensitivity of isoenhancement or isoenhancement with focal hypoenhancement in both the early and late phases greatly increased for diagnosing focal pancreatitis in comparison with isoenhancement (72.0% versus 32.0%; P < .05). The diagnostic accuracy of contrast-enhanced US was greatly increased over that of conventional US (85.6% versus 49.5%; P < .001). CONCLUSIONS Contrast-enhanced US is a valuable tool for differentiating focal pancreatitis from pancreatic carcinoma and can greatly increase the diagnostic accuracy over conventional US.
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Affiliation(s)
- Yanjie Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhihui Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ke Ding
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shanshan Yin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ying Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Wei Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
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Fukuda J, Tanaka S, Ishida N, Ioka T, Ikezawa K, Takakura R, Nakao M, Ohkawa K, Katayama K, Nagata S. A case of stage IA pancreatic ductal adenocarcinoma accompanied with focal pancreatitis demonstrated by contrast-enhanced ultrasonography. J Med Ultrason (2001) 2018; 45:617-622. [PMID: 29470686 DOI: 10.1007/s10396-018-0870-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/21/2018] [Indexed: 01/28/2023]
Abstract
A patient with slight dilatation of the main pancreatic duct was followed-up with ultrasonography every 6 months as a high-risk case of pancreatic cancer. Twelve years later, a faint hypoechoic area 13 mm in diameter was first detected on the body of the pancreas. Contrast-enhanced ultrasonography revealed a well-demarcated hypoenhanced area 8 mm in diameter and a hyperenhanced area with an unclear margin. The former was suspected to be a small pancreatic cancer lesion, and the latter to be focal pancreatitis accompanying cancer. However, contrast-enhanced dynamic CT did not suggest any tumor, diagnosis of adenocarcinoma was confirmed with pancreatic juice cytology through endoscopic retrograde pancreatography. Surgical resection was performed, and the lesion was pathologically diagnosed as invasive ductal carcinoma as follows: pTS1 (1.0 cm), infiltrative type (pT1), stage IA. When comparing the images from contrast-enhanced ultrasonography with the pathological findings, the hypoenhanced area corresponded to ductal adenocarcinoma, and the hyperenhanced area to focal pancreatitis. Contrast-enhanced ultrasonography was able to reveal detailed information on the focal lesion in the pancreas, and it was effective for the early diagnosis of pancreatic cancer.
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Affiliation(s)
- Junko Fukuda
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Sachiko Tanaka
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
| | | | - Tatsuya Ioka
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Kenji Ikezawa
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Rena Takakura
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Miho Nakao
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Kazuyoshi Ohkawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuhiro Katayama
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan
| | - Shigenori Nagata
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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18
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Kamata K, Takenaka M, Omoto S, Miyata T, Minaga K, Yamao K, Imai H, Sakurai T, Nishida N, Chikugo T, Chiba Y, Matsumoto I, Takeyama Y, Kudo M. Impact of avascular areas, as measured by contrast-enhanced harmonic EUS, on the accuracy of FNA for pancreatic adenocarcinoma. Gastrointest Endosc 2018; 87:158-163. [PMID: 28619244 DOI: 10.1016/j.gie.2017.05.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS EUS-guided FNA (EUS-FNA) is used for the diagnosis of pancreatic adenocarcinoma, but sometimes the method results in a false negative. Occasionally, an avascular area may be observed within the pancreatic adenocarcinoma tumor during contrast-enhanced harmonic EUS (CH-EUS). The aim of this study was to evaluate whether the diagnostic sensitivity of EUS-FNA for pancreatic adenocarcinoma was affected by the presence of avascularity on CH-EUS. METHODS Two hundred ninety-two patients with pancreatic adenocarcinoma who presented at Kindai University Hospital for EUS-FNA and CH-EUS between June 2009 and August 2013 were retrospectively evaluated. This was a single-center retrospective analysis of prospectively collected data held in a registry. The overall sensitivity of EUS-FNA for the diagnosis of pancreatic adenocarcinoma was calculated. The sensitivities of cytology, histology, and the combination of cytology and histology were also evaluated. These variables were individually evaluated according to the presence or absence of an avascular area on CH-EUS to assess whether the diagnostic sensitivity of EUS-FNA for pancreatic adenocarcinoma was related to the presence of an avascular area within the tumors. RESULTS The overall sensitivity of EUS-FNA was 90.8% (265/292). The sensitivities of EUS-FNA for lesions with and without an avascular area were 72.9% (35/48) and 94.3% (230/244), respectively, with the difference being statistically significant (P < .001). CONCLUSIONS EUS-FNA has lower sensitivity for pancreatic adenocarcinoma with avascular areas on CH-EUS.
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Affiliation(s)
- Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Takeshi Miyata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Kentaro Yamao
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Hajime Imai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Takaaki Chikugo
- Department of Pathology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Hospital, Osaka-sayama, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
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Gilabert M, Raoul JL, Rousseau F. How to treat pancreatic adenocarcinoma in elderly: How far can we go in 2017? J Geriatr Oncol 2017; 8:407-412. [PMID: 28888554 DOI: 10.1016/j.jgo.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/31/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
Abstract
Pancreatic adenocarcinoma is one of the most fatal cancers that frequently affects older patients. Limited data suggest that older patients are as likely to benefit from surgery, radiation, and chemotherapy as younger patients. The only potentially curative approach for pancreatic cancer is surgery but this is only performed in less than 20% of patients considered resectable. With improvements in surgical techniques, older patients without major comorbidities show a course of disease after resection similar to that of younger patients. The use of adjuvant chemotherapy in an attempt to prolong survival is therefore reasonable for this population of patients. Historically, patients with locally-advanced disease will be offered gemcitabine as standard chemotherapy, with radiotherapy considered at a later time. In the majority, metastatic patients will preferably be offered gemcitabine chemotherapy, which can be used at a lower dose in frail or very old patients. In some cases in patients in a very good health condition, two recent intensive chemotherapies can be proposed with modified doses and a close follow-up: the 5-fluoroucil, leucovorin, irinotecan, oxaliplatin (FOLFIRINOX) regimen and the combination of gemcitabine plus nab-paclitaxel. For older patients with terminal disease and palliative needs, which is the majority of cases, better use of pain control and palliative measures can be beneficial. Each of these issues will be examined in detail in this review.
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Affiliation(s)
- Marine Gilabert
- Medical Oncology, Paoli-Calmettes Institute, 13232 Cedex 09, Marseille, France.
| | - Jean Luc Raoul
- Medical Oncology, Paoli-Calmettes Institute, 13232 Cedex 09, Marseille, France
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Shim CS, Lee TY, Cheon YK. Clinical role of contrast-enhanced harmonic endoscopic ultrasound in differentiating pancreatic solid lesions. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii150016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Chan Sup Shim
- Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Yoon Lee
- Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea
| | - Young Koog Cheon
- Digestive Disease Center, Konkuk University School of Medicine, Seoul, Korea
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Abstract
Since its introduction into clinical practice in the 1980s, endoscopic ultrasound (EUS) has been described as a good imaging modality for the diagnosis of pancreatobiliary diseases. However, differential diagnosis of certain lesions based only on B-mode ultrasound images can be challenging. Clinical use of ultrasound contrast agents has expanded the utility of EUS from that of detection to characterization of pancreatobiliary lesions based on the enhancement features of contrast-enhanced EUS (CE-EUS). Current low mechanical index techniques for CE-EUS using second-generation contrast agents have a number of distinct advantages over conventional diagnostic modalities in evaluating pancreatobiliary lesions, including real-time assessment of perfusion pattern, availability, and the absence of exposure to radiation. This article describes the technical aspects of CE-EUS and reviews the expanding indications in pancreatobiliary diseases and further development of this technique.
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Affiliation(s)
- Jun-Ho Choi
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Dong Wan Seo
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wang Y, Yan K, Fan Z, Sun L, Wu W, Yang W. Contrast-Enhanced Ultrasonography of Pancreatic Carcinoma: Correlation with Pathologic Findings. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:891-8. [PMID: 26806440 DOI: 10.1016/j.ultrasmedbio.2015.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 06/05/2023]
Abstract
We concluded that contrast-enhanced ultrasound (CEUS) has clinical value in identifying the pathologic changes of pancreatic carcinomas. Forty-three patients diagnosed with pancreatic carcinoma through surgery were retrospectively investigated. CEUS examinations were performed on all patients before surgery. Enhancement patterns on CEUS were observed. Time-intensity curves of CEUS were generated for the regions of interest in the pancreas, and quantitative parameters were obtained. Resected cancer specimens were stained with hematoxylin and eosin for histologic analysis, and the microvascular density (MVD) of the specimens was determined by CD34 immunohistochemical staining. Enhancement patterns of CEUS were compared with histopathologic findings in pancreatic carcinomas. Correlations between time-intensity curve parameters and microvascular density were analyzed. Twenty cases manifested centripetal enhancement, and 23 cases, global enhancement. The amount of tumor necrosis or mucus in the centripetally enhanced pancreatic carcinomas was greater than that in the globally enhanced pancreatic carcinomas (p = 0.027). Thirty-eight of 43 (88.4%) pancreatic carcinomas manifested hypo-enhancement with a maximum intensity (IMAX) <90%. Contrast arrival time in pancreatic carcinoma was longer than that in adjacent pancreatic tissue (p < 0.05). IMAX was positively correlated with microvascular density (r = 0.577, p < 0.05). We concluded that CEUS manifestations could reflect the histologic changes of pancreatic carcinomas and CEUS can be used to evaluate blood perfusion of tumors, as IMAX is positively correlated with microvascular density.
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Affiliation(s)
- Yanjie Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kun Yan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China.
| | - Zhihui Fan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Li Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Wu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Yang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
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Qi XY, Ma L, Lu Q, Yang LL, Li JW, Ling WW, Luo Y. Ultrasonographic features and differential diagnosis of solid pseudopapillary tumors of the pancreas. Shijie Huaren Xiaohua Zazhi 2016; 24:1269-1276. [DOI: 10.11569/wcjd.v24.i8.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the ultrasonographic features of solid pseudopapillary tumors of the pancreas (SPTP) and their differential diagnosis from pancreatic neuroendocrine tumors (PNET) and pancreatic cancer (PC).
METHODS: Clinical data including conventional ultrasonographic characteristics for 52 patients with pathologically confirmed SPTP, 63 patients with PNET, and 68 patients with PC and the patterns of contrast enhanced ultrasonography (CEUS) in 6 cases of SPTP, 10 cases of PNET and 21 cases of PC were retrospectively analyzed.
RESULTS: There were significant differences between the SPTP group and the PNET group in age, sex, jaundice, tumor size, shape, calcification, liquefaction, separation, blood flow, arterial phase and late phase enhancement mode and non-enhancement area in the lesions (P < 0.05), while presence of abdominal pain, elevated CA-199, number of tumors, location, expansion of the main pancreatic duct and recurrence or metastasis had no statistical significance (P > 0.05). There were significant differences between the SPTP group and the PC group in age, sex, abdominal pain, jaundice, elevated CA-199, tumor size, location, shape, calcification, liquefaction, expansion of the main pancreatic duct, recurrence or metastasis, arterial phase enhancement mode and non-enhancement area in the lesions (P < 0.05), while number of tumors, separation, blood flow and late phase enhancement mode had no statistical significance (P > 0.05).
CONCLUSION: A solid or cystic-solid pancreatic tumor which shows peripheral ring enhancement in the arterial phase, hypo-enhancement in the late phase and central non-enhancement area could be considered as an SPTP in young female patients without jaundice, elevated CA-199 or main pancreatic duct dilation. It should be differentiated from PNET and PC.
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D'Onofrio M, Canestrini S, De Robertis R, Crosara S, Demozzi E, Ciaravino V, Pozzi Mucelli R. CEUS of the pancreas: Still research or the standard of care. Eur J Radiol 2015; 84:1644-9. [PMID: 25796427 DOI: 10.1016/j.ejrad.2015.02.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/23/2015] [Accepted: 02/25/2015] [Indexed: 02/07/2023]
Abstract
Contrast-enhanced ultrasonography (CEUS) improves the characterization of pancreatic masses. CEUS is in fact a safe and accurate imaging method to evaluate the vascularity of pancreatic lesions. CEUS should be performed when possible immediately after the ultrasound (US) detection of a pancreatic mass. CEUS is accurate in the characterization of ductal adenocarcinoma. The use of CEUS in studying pancreatic lesions found at US, especially in the same session of ultrasound examination, is therefore recommendable to promote faster diagnosis mainly of pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Mirko D'Onofrio
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - Stefano Canestrini
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Riccardo De Robertis
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Stefano Crosara
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Emanuele Demozzi
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Valentina Ciaravino
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Roberto Pozzi Mucelli
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
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Utility of Contrast-Enhanced Transabdominal Ultrasonography to Diagnose Early Chronic Pancreatitis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:393124. [PMID: 26090406 PMCID: PMC4452241 DOI: 10.1155/2015/393124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 11/30/2014] [Accepted: 01/23/2015] [Indexed: 01/09/2023]
Abstract
Purpose. The purpose of this study was to establish the relationship between the grade of chronic pancreatitis (CP) and pancreatic blood flow as measured by contrast-enhanced transabdominal ultrasonography (CEUS) and to diagnose early CP easily. Methods. This pilot study was conducted in 8 patients with CP, 7 patients with early CP, and 6 control participants. After injecting 0.015 mL/kg of perflubutane by manual bolus, values in one region of interest (ROI) in pancreatic parenchyma and one ROI including the superior mesenteric artery (SMA) were measured. Results. The ratio of blood flow in the SMA and pancreatic parenchyma increased with grade of CP and was significantly higher in patients with CP (5.41; 2.10–11.02) than in patients with early CP (2.46; 1.41–5.05) and control participants (2.32; 1.25–3.04) (P = 0.0279, P = 0.0142, resp.). The ratio of blood flow in the SMA and pancreatic parenchyma correlated with grade of CP (rs = 0.5904, P = 0.0048). Conclusion. The ratio of blood flow correlates with grade of CP on CEUS. This safe and convenient method may be useful to diagnose early CP.
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Lee VW, Tiong HY, Vathsala A, Madhavan K. Surgical Salvage of Partial Pancreatic Allograft Thrombosis Presenting as Ruptured Pancreatic Cyst: A Case Report. Transplant Proc 2014; 46:2019-22. [DOI: 10.1016/j.transproceed.2014.05.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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D’Onofrio M, Canestrini S, Crosara S, Robertis RD, Mucelli RP. Contrast enhanced ultrasound with quantitative perfusion analysis for objective characterization of pancreatic ductal adenocarcinoma: A feasibility study. World J Radiol 2014; 6:31-35. [PMID: 24765238 PMCID: PMC3986418 DOI: 10.4329/wjr.v6.i3.31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to determine whether contrast enhanced ultrasound (CEUS) quantitative perfusion analysis allows an objective characterization of ductal adenocarcinoma (ADK) of the pancreas. Patients with pancreatic ADK underwent CEUS. All examinations were performed on an Acuson S2000 system (Siemens, Erlangen, Germany) after the iv administration of 2.4 mL contrast agent (SonoVue®, Bracco, Milan, Italy). All lesions were pathologically proved. An operator manually drew different regions of interest within the tumor and the adjacent parenchyma to allow the quantitative perfusion analysis. The mean values of peak of enhancement, time to peak and ascending curve were calculated and compared using the Student’s t test. The quantitative perfusion analysis was possible in all lesions. The mean values of the peak of enhancement, time to peak and ascending curve were 17.19%, 7.97 s and 159.52% s within the tumor and 33.57%, 8.89 s and 355.29% s within the adjacent parenchyma. The peak of enhancement and the ascending curve values were significantly different within the tumor and the adjacent parenchyma. Thus, CEUS allows the quantitative perfusion analysis of pancreatic ductal adenocarcinoma.
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HIROOKA Y, ITOH A, KAWASHIMA H, ONO E, GOTO H. Contrast-enhanced ultrasonography and endoscopic ultrasonography in the diagnosis of pancreatic disorders. CHOONPA IGAKU 2014; 41:339-351. [DOI: 10.3179/jjmu.jjmu.r.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
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Abstract
The field of diagnostic and therapeutic endoscopic ultrasound (EUS) is growing rapidly. Although EUS has enhanced our ability to diagnose and treat a wide variety of GI conditions, there are many controversial issues regarding the appropriate application of EUS techniques. In this review we discuss five controversial topics in EUS: the utility of EUS in staging of esophageal and gastric cancer; selection of appropriate needle gauge for fine needle aspiration (FNA); use of the stylet in FNA; and the emerging role of contrast agents in endoscopic ultrasound.
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Affiliation(s)
| | - Tyler M. Berzin
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA., USA
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Fan Z, Li Y, Yan K, Wu W, Yin S, Yang W, Xing B, Li X, Zhang X. Application of contrast-enhanced ultrasound in the diagnosis of solid pancreatic lesions--a comparison of conventional ultrasound and contrast-enhanced CT. Eur J Radiol 2013; 82:1385-90. [PMID: 23727375 DOI: 10.1016/j.ejrad.2013.04.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/21/2013] [Accepted: 04/12/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) by comparison with conventional ultrasound (US) and contrast-enhanced CT (CECT) in solid pancreatic lesions. METHOD Ninety patients with solid pancreatic focal lesions were enrolled, including 36 cases of pancreatic carcinoma, 28 cases of pancreatitis, 6 cases of pancreatic neuroendocrine tumor, 12 cases of solid pseudopapillary tumor of the pancreas, 6 cases of pancreatic metastases, 1 case of cavernous hemolymphangioma and 1 case of lymphoma. US and CEUS were applied respectively for the diagnosis of a total of 90 cases of solid pancreatic lesions. The diagnostic results were scored on a 5-point scale. Results of CEUS were compared with CECT. RESULTS (1) 3-score cases (undetermined) diagnosed by CEUS were obviously fewer than that of US, while the number of 1-score (definitely benign) and 5-score (definitely malignant) cases diagnosed by CEUS was significantly more than that of US. There was a significant difference in the distribution of final scores using the two methods (p<0.001). The overall diagnostic accuracies of the 90 cases for CEUS and US were 83.33% and 44.44%, respectively, which indicated an obvious advantage for CEUS (p<0.001). (2) The diagnostic consistency among three ultrasound doctors: the kappa values calculated for US were 0.537, 0.444 and 0.525, compared with 0.748, 0.645 and 0.795 for CEUS. The interobserver agreement for CEUS was higher than that for US. (3) The sensitivity, specificity and accuracy of the diagnosis of pancreatic carcinoma with CEUS and CECT were 91.7% and 97.2%, 87.0% and 88.9%, and 88.9% and 92.2%, respectively, while for the diagnosis of pancreatitis, the corresponding indices were 82.1% and 67.9%, 91.9% and 100%, and 88.9% and 90%, respectively, showing no significant differences (p>0.05). CONCLUSION CEUS has obvious superiority over conventional US in the general diagnostic accuracy of solid pancreatic lesions and in the diagnostic consistency among doctors. The performances of CEUS are similar to that of CECT in the diagnosis of pancreatic carcinoma and focal pancreatitis.
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Affiliation(s)
- Zhihui Fan
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital & Institute, No. 52, Fucheng Road, Haidian District, Beijing 100142, China.
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Diagnostic value of endoscopic ultrasound-guided directional eFLOW in solid pancreatic lesions. J Med Ultrason (2001) 2013; 40:211-8. [DOI: 10.1007/s10396-012-0412-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 10/15/2012] [Indexed: 12/15/2022]
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Dietrich CF, Sharma M, Hocke M. Contrast-enhanced endoscopic ultrasound. Endosc Ultrasound 2012; 1:130-6. [PMID: 24949350 PMCID: PMC4062228 DOI: 10.7178/eus.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 09/16/2012] [Indexed: 12/13/2022] Open
Abstract
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) introduced guidelines on the use of contrast-enhanced ultrasound (CEUS) in 2004. This EFSUMB-document focused mainly on liver applications. However, new applications extending beyond the liver were developed thereafter. Increased interest in recent years in CEUS technique and in the application of CEUS in novel fields like endoscopic ultrasound (EUS) has revolutionized indications and applications. As a result, the EFSUMB initiated a new update of the guidelines in 2011 to include this additional knowledge. Some of the contrast-enhanced EUS (CE-EUS) indications are established, whereas others are preliminary; these latter indications are categorized as emergent CEUS applications since the available evidence is insufficient for general recommendation. This article focuses on the use of CE-EUS in various clinical settings. The reader will get an overview of current indications and possible applications of CE-EUS. This involves the introduction of different contrast studies including color Doppler techniques (known as contrast-enhanced high mechanical index endosonography or CEHMI-EUS) as well as more modern high-resolution contrast-enhanced techniques (known as contrast-enhanced low mechanical index endosonography or CELMI EUS).
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Affiliation(s)
| | - M. Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, UP, India
| | - M. Hocke
- Department of Internal Medicine II, Hospital Meiningen, 97980, Germany
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Barreiros A, Galle P, Dietrich C, Ignee A. Neues zur Sonographie in der Gastroenterologie (Teil 1). DER GASTROENTEROLOGE 2012; 7:340-346. [DOI: 10.1007/s11377-012-0677-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
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Intra-/Interobserver Agreement of Enhancement Pattern for Pancreatic Head Lesions Using Contrast-Enhanced Ultrasound: According to EFSUMB Guidelines. Diagnostics (Basel) 2012; 2:2-9. [PMID: 26859393 PMCID: PMC4665461 DOI: 10.3390/diagnostics2020002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 03/22/2012] [Accepted: 03/29/2012] [Indexed: 12/12/2022] Open
Abstract
Objective: To evaluate the intra-/interobserver agreement of the visual interpretation of contrast-enhanced ultrasound (CEUS) of pancreatic head lesions and its concordance with the histological test results. Material and Methods: Two observers (A + B) evaluated by simple visual interpretation 40 consecutive CEUS examinations of pancreatic head lesions and one of the observers evaluated the examinations twice (A1 + A2). The examinations were evaluated according to the criteria outlined in EFSUMB guidelines. The two experienced observers were blinded to histological evidence and clinical information of tumor type and to each other’s results. Results: The kappa value for the intraobserver evaluation between observer A1 and A2 was 0.89, equating to almost perfect agreement. The kappa value for the interobserver evaluation between observer A1 and B was 0.76 and between observer A2 and B it was 0.75, both equating to substantial agreement. Evaluation of the visual interpretation compared to the histological test result showed a positive predictive value for A1, A2 and B versus biopsy of 97%, 94% and 90% respectively and an accuracy of 83%, 88% and 73% respectively. Conclusions: Visual interpretation for assessment of contrast enhancement of pancreatic head lesions seemed to be an accurate method with reproducible results and good concordance with the histological test results.
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Contrast-enhanced US of ampullary carcinoma: correlations with pathological findings. J Med Ultrason (2001) 2012; 39:53-9. [DOI: 10.1007/s10396-012-0343-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/19/2011] [Indexed: 12/23/2022]
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Dynamic quantitative evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic diseases. Pancreas 2011; 40:1073-9. [PMID: 21633317 DOI: 10.1097/mpa.0b013e31821f57b7] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study aimed to investigate the usefulness of contrast-enhanced endoscopic ultrasonography (EUS) with time-intensity curve (TIC) in differentiating pancreatic diseases. METHODS Patients who underwent contrast-enhanced EUS between January 2007 and June 2009 were analyzed retrospectively, including 48 with pancreatic ductal cancer (PC), 14 with autoimmune pancreatitis (AIP), 13 with mass-forming pancreatitis (MFP), and 16 with pancreatic endocrine tumor (PET). After intravenous injection of contrast agent, contrast imaging pattern, TIC-based quantitative evaluation, and diagnostic ability of EUS in combination with TIC to diagnose benignancy or malignancy were assessed. RESULTS Hypovascular and heterogeneous pattern (42/48) in PC, isovascular and homogenous (21/27) in AIP and MFP, and hypervascular and rapid stained (16/16) in PET were observed. The echo intensity reduction rate from the peak at 1 minute was the greatest in PC followed by MFP, AIP, and PET (P < 0.05). The diagnostic accuracies based on contrast imaging pattern (84.0%) and TIC (88.0%) were higher than those based on B-mode imaging (82.6%) and dynamic computed tomography (81.3%). In EUS in combination with TIC, sensitivity, specificity, and accuracy rose up to 95.8%, 92.6%, and 94.7%, respectively. CONCLUSIONS Contrast-enhanced EUS with the dynamic quantitative analysis preparing TIC increased the diagnostic accuracy for pancreatic diseases.
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Kersting S, Roth J, Bunk A. Transabdominal contrast-enhanced ultrasonography of pancreatic cancer. Pancreatology 2011; 11 Suppl 2:20-7. [PMID: 21464583 DOI: 10.1159/000323480] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since its introduction, contrast-enhanced ultrasonography (CEUS) has significantly extended the value of ultrasonography (US). CEUS can be used to more accurately determine pancreatic lesions compared to conventional US or to characterize lesions already detectable by US. Thus, CEUS can aid in the differential diagnosis of pancreatic tumors. Using US contrast media, it is possible to visually detect microvessels in the majority of pancreatic ductal adenocarcinomas. Thus, the use of quantitatively evaluated transabdominal CEUS can help in the differentiation of patients with mass-forming pancreatitis from patients with pancreatic adenocarcinomas. In neuroendocrine pancreatic tumors, different enhancement patterns can be observed in relation to the tumor mass: larger ones show a rapid early enhancement sometimes combined with necrotic central structures, and smaller ones disclose a capillary-blush enhancement. Pseudocysts, the most widespread cystic lesions of the pancreas, are not vascularized. They do not show any signal in CEUS and remain entirely anechoic in all phases, while true cystic pancreatic tumors usually have vascularized septa and parietal nodules. In summary, CEUS is effective for differentiating solid pancreatic tumors in most cases. CEUS is safe and cost effective and can better discriminate solid from cystic pancreatic lesions, thereby directing further imaging modalities.
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Affiliation(s)
- Stephan Kersting
- Department of General, Thoracic and Vascular Surgery, School of Medicine, Dresden University of Technology, Dresden, Germany. stephan.kersting @ uniklinikum-dresden.de
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D'Onofrio M, Barbi E, Dietrich CF, Kitano M, Numata K, Sofuni A, Principe F, Gallotti A, Zamboni GA, Mucelli RP. Pancreatic multicenter ultrasound study (PAMUS). Eur J Radiol 2011; 81:630-8. [PMID: 21466935 DOI: 10.1016/j.ejrad.2011.01.053] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 01/03/2011] [Indexed: 12/12/2022]
Abstract
AIM To describe the typical CEUS pattern of pancreatic lesions and to evaluate the diagnostic accuracy of Contrast-enhanced ultrasound (CEUS) in their characterization. MATERIALS AND METHODS All US and CEUS examinations of focal pancreatic masses performed in six centers during a period of five years were reviewed. Inclusion criteria were: focal pancreatic mass pathologically proved, visible at ultrasound (US) and studied with CEUS. All lesions were then evaluated for size, aspect and enhancement pattern. Sensitivity, specificity, positive and negative predictive values with 95% CIs were calculated to define diagnostic accuracy of CEUS in respect to pathology. Diagnostic confidence of US and CEUS, discerning between benign and malignant lesions, were represented by using ROC (receiver operating characteristics) curves. Agreement was evaluated by means of k statistics. RESULTS 1439 pancreatic lesions were included. At CEUS the lesions were divided into solid (89%) and cystic (12%) masses and classified into six and eight categories, respectively. Among the solid lesions, adenocarcinomas were characterized with an accuracy of 87.8%. Among the cystic lesions, cystic tumors were diagnosed with an accuracy of 97.1%. ROC curve area increased from 0.637 for US to 0.877 for CEUS (p<0.0001). Inter-observer agreement was slightly higher for solid (k=0.78) than cystic (k=0.62) lesions. In none of the centers side effects were reported. CONCLUSION CEUS is accurate in the characterization of pancreatic lesions. CEUS should be considered as a complementary imaging method for pancreatic lesions characterization.
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Affiliation(s)
- Mirko D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Italy.
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An L, Li W, Yao KC, Liu R, Lv F, Tang J, Zhang S. Assessment of contrast-enhanced ultrasonography in diagnosis and preoperative localization of insulinoma. Eur J Radiol 2010; 80:675-80. [PMID: 20965676 DOI: 10.1016/j.ejrad.2010.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 09/16/2010] [Accepted: 09/20/2010] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in the diagnosis and preoperative localization of insulinoma and explore the enhancement patterns of the tumors. METHODS Unenhanced and contrast-enhanced ultrasonographic examinations of 31 patients who underwent resection of insulinomas were retrospectively reviewed. The diagnosis sensitivity and localization specificity of CEUS for insulinomas were determined. Results of unenhanced ultrasonography and CEUS were compared by Chi-square test. RESULTS Unenhanced ultrasonography could display 9 of 37 (24.3%) surgically verified insulinomas in 31 patients, while the diagnosis sensitivity and localization specificity of preoperative CEUS was 33 (89.2%) and 32 (86.5%) of the 37 tumors, respectively. In contrast to the unenhanced ultrasonography, the improvement of CEUS in the diagnosis and preoperative localization of insulinomas was significant (p<0.0001). The enhancement pattern of insulinoma on CEUS was fast wash-in and slow wash-out. All the tumors were homogeneous hypervascularity in the earlier arterial phase, while the tumors still displayed hyperenhancing pattern in the late phase. CONCLUSION Our study demonstrates the great potential of CEUS in the diagnosis and preoperative localization of insulinomas. Since CEUS is a convenient, inexpensive, effective and non-invasive modality, the study supports the use of CEUS as a primary tool in the evaluation of patients with insulinomas.
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Affiliation(s)
- Lichun An
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, PR China.
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Grossjohann HS, Rappeport ED, Jensen C, Svendsen LB, Hillingsø JG, Hansen CP, Nielsen MB. Usefulness of contrast-enhanced transabdominal ultrasound for tumor classification and tumor staging in the pancreatic head. Scand J Gastroenterol 2010; 45:917-24. [PMID: 20441527 DOI: 10.3109/00365521003702718] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate contrast-enhanced ultrasound (CEUS) and compare it to ultrasound (US) and 64-slice-CT (64-CT) for diagnosing, staging and evaluation of resectability of pancreatic cancer. MATERIAL AND METHODS US, CEUS and 64-CT were performed in 49 consecutive patients with pancreatic head tumors and with suspected cancer. After evaluation 44 patients had pancreatic head adenocarcinoma and 5 had chronic pancreatitis, all confirmed by histology. RESULTS The sensitivity of US, CEUS and 64-CT for diagnosing malignant pancreatic head tumors was 89%, 86% and 93%, respectively, and the overall accuracy was 82%, 86% and 88% respectively. There was no significant difference in the malignant tumor size measurement between US and CEUS (p = 0.3619) or between US and 64-CT (p = 0.2129), but a significant difference was seen in the size measured by CEUS and 64-CT (p = 0.0197). The CEUS measurements on the tumor size were smaller. The overall accuracy for M staging of the patients who had surgery for adenocarcinoma was 86% and 90% for US + CEUS and 64-CT, respectively. By performing the CEUS and 64-CT we additionally found, respectively, 35% and 45% non-resectable patients of a group of patients, who were considered resectable on the primary radiological image material. CONCLUSIONS CEUS may be a useful diagnostic tool in the diagnosis and staging of pancreatic head tumors. For the assessment of resectability CEUS did not prove useful. However, CEUS seemed very useful as an additional instrument in the detection of non-resectable patients already considered resectable on primary radiological image material.
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Affiliation(s)
- Hanne Sønder Grossjohann
- Department of Radiology, Section of Ultrasound, Copenhagen University Hospital, Copenhagen, Denmark.
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D'Onofrio M, Gallotti A, Pozzi Mucelli R. Imaging techniques in pancreatic tumors. Expert Rev Med Devices 2010; 7:257-73. [PMID: 20214430 DOI: 10.1586/erd.09.67] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Conventional ultrasonography represents the first diagnostic imaging modality for the study of pancreatic tumors. Contrast-enhanced ultrasound has significantly improved the accuracy of first-line examination and may influence the choice of second-line investigations: multidetector computed tomography is considered the gold standard for studying pancreatic solid lesions and tumor staging, while MRI with magnetic resonance cholangiopancreatography allows better study of pancreatic cystic lesions and the ductal system. To definitely diagnose a pancreatic lesion, image-guided fine-needle-aspiration or biopsy are very often required. PET with 18-fluorodeoxyglucose, endoscopic ultrasound and intraoperative ultrasonography remain techniques often employed in the third line. This article reviews the imaging techniques generally used for diagnosing the main pancreatic tumors, and a work-up algorithm is finally proposed.
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Affiliation(s)
- Mirko D'Onofrio
- Department of Radiology, GB Rossi University Hospital, University of Verona, Verona, Italy.
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D’Onofrio M, Gallotti A, Principe F, Mucelli RP. Contrast-enhanced ultrasound of the pancreas. World J Radiol 2010; 2:97-102. [PMID: 21160942 PMCID: PMC2999316 DOI: 10.4329/wjr.v2.i3.97] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/08/2010] [Accepted: 03/15/2010] [Indexed: 02/07/2023] Open
Abstract
The introduction of contrast-enhanced ultrasonography (CEUS) has led to major improvements in the diagnostic capabilities of ultrasound (US). The innovative use of CEUS for study of the pancreas has created the need for a definition of the most frequent dynamic features of solid and cystic masses. CEUS is less expensive compared to computed tomography and magnetic resonance imaging and is able to significantly improve the accuracy of US, allowing better characterization and staging of pancreatic pathologies.
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D'Onofrio M, Zamboni GA, Malagò R, Mantovani W, Principe F, Gallotti A, Faccioli N, Falconi M, Capelli P, Mucelli RP. Resectable pancreatic adenocarcinoma: is the enhancement pattern at contrast-enhanced ultrasonography a pre-operative prognostic factor? ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1929-1937. [PMID: 19828234 DOI: 10.1016/j.ultrasmedbio.2009.06.1100] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 05/16/2009] [Accepted: 06/26/2009] [Indexed: 05/28/2023]
Abstract
The aim of our study was to determine whether the enhancement pattern of pancreatic adenocarcinoma at contrast-enhanced ultrasonography (CEUS) is related to patient prognosis after resection. CEUS of 42 resected adenocarcinomas were retrospectively reviewed. Tumors were divided into two groups: group A=poorly vascularized (presence of avascular areas) or group B=well vascularized (absence of avascular areas). All lesions were resected and underwent pathological examination assessing tumor differentiation as: undifferentiated (poorly differentiated) or differentiated (moderately and well differentiated). Mean vascular density (MVD) was also evaluated. CEUS enhancement and pathology were correlated (Spearman's test). Survival was analyzed with the Kaplan-Meier method. Multivariate analysis was performed with the Cox regression model. There were 30 differentiated and 12 undifferentiated adenocarcinomas at pathology. At CEUS, 10 lesions were poorly vascularized, whereas 32 lesions were well vascularized. Positive correlation was observed between CEUS groups and tumoral differentiation (rs=0.51; p=0.001) and between CEUS and MVD (rs=0.74; p<0.0001). Median survival in patients with group A vascularization at CEUS was significantly lower than in group B (p=0.015). Cox proportional hazard model revealed the presence of poorly vascularized tumor at CEUS (p=0.0001) as a predictor of higher mortality. In conclusion, CEUS enables accurate depiction of the vascularization of adenocarcinoma, with positive correlation to histology grade and MVD.
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Affiliation(s)
- M D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, Verona, Italy.
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Kersting S, Konopke R, Kersting F, Volk A, Distler M, Bergert H, Saeger HD, Grützmann R, Bunk A. Quantitative perfusion analysis of transabdominal contrast-enhanced ultrasonography of pancreatic masses and carcinomas. Gastroenterology 2009; 137:1903-11. [PMID: 19715694 DOI: 10.1053/j.gastro.2009.08.049] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 07/19/2009] [Accepted: 08/13/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Preoperative differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) and focal masses in patients with chronic pancreatitis (CP) can be challenging. There are fine differences in the vascularization of these lesions; ultrasound contrast agents can aid in their differentiation. We evaluated the value of software-aided quantitative analysis of transabdominal contrast-enhanced ultrasonography for differential diagnosis of PDAC vs focal masses. METHODS Sixty patients for whom it was not possible to differentiate between an inflammatory focal lesion of the pancreas and a pancreatic carcinoma underwent contrast-enhanced ultrasonography with a second-generation contrast agent. Time-intensity curves were obtained for all exams in 2 regions of interest within the lesion and within the normal pancreatic tissue. Images were processed using Axius ACQ software; the following parameters were obtained: maximum intensity, arrival time, time-to-peak, and area under the curve. Absolute values and differences between the lesion and the normal tissue were evaluated. RESULTS Histology analysis revealed 45 PDACs and 15 inflammatory masses in patients with CP. Time-dependent parameters (arrival time and time to peak) were significantly longer in PDACs compared to focal masses. Although markedly lower than in healthy pancreata, the maximum intensity and area under the curve parameters were not significantly different between PDACs and focal lesions in patients with CP. CONCLUSIONS In cases of CP, PDAC and focal masses exhibit different perfusion patterns at a capillary level that can be visualized using the small microbubbles of ultrasound contrast agents. Contrast quantification software supplements a subjective visual assessment with objective criteria to facilitate the differential diagnosis of focal lesions in pancreatic cancer and chronic pancreatitis.
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Affiliation(s)
- Stephan Kersting
- Department of General, Thoracic and Vascular Surgery, School of Medicine, Dresden University of Technology, Dresden, Germany.
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Boggi U, Morelli L, Amorese G, Bargellini I, Marchetti P, Mosca F. Contribution of contrast-enhanced ultrasonography to nonoperative management of segmental ischemia of the head of a pancreas graft. Am J Transplant 2009; 9:413-8. [PMID: 19067661 DOI: 10.1111/j.1600-6143.2008.02475.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 32-year-old recipient of a pancreas transplant (PTx) alone was diagnosed with segmental graft ischemia, involving the head of the pancreas graft (HPG), based on color Doppler ultrasonography (CDU) and computed tomography (CT) angiography. For investigational purposes, graft supply was further checked by contrast-enhanced ultrasonography (CEU). Surprisingly, CEU showed collateral blood supply to the HPG starting from 40 s after contrast injection and resulting in homogenous parenchymography at 90 s. Full-dose heparin infusion, followed by long-term oral anticoagulation, allowed graft salvage without reoperation. At the longest follow-up of 18 months, the patient is insulin independent. This case report shows that CEU may be employed in PTx recipients suspected to harbor vascular complications. To the best of our knowledge, this is the first description of the use of CEU in PTx and the first description of graft salvage, without partial pancreatectomy after CDU and CT diagnosis of segmental graft ischemia.
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Affiliation(s)
- U Boggi
- Divisione di Chirurgia Generale e Trapianti nell'Uremico e nel Diabetico, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
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Correas J, Tranquart F, Claudon M. Nouvelles recommandations pour l’utilisation des agents de contraste ultrasonores : mise à jour 2008. ACTA ACUST UNITED AC 2009; 90:123-38; quiz 139-40. [DOI: 10.1016/s0221-0363(09)70090-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Săftoiu A, Vilmann P. Role of endoscopic ultrasound in the diagnosis and staging of pancreatic cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:1-17. [PMID: 18932265 DOI: 10.1002/jcu.20534] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Early diagnosis of pancreatic cancer remains a difficult task, and multiple imaging tests have been proposed over the years. The aim of this review is to describe the current role of endoscopic ultrasound (EUS) for the diagnosis and staging of patients with pancreatic cancer. A detailed search of MEDLINE between 1980 and 2007 was performed using the following keywords: pancreatic cancer, endoscopic ultrasound, diagnosis, and staging. References of the selected articles were also browsed and consulted. Despite progress made with other imaging methods, EUS is still considered to be superior for the detection of clinically suspected lesions, especially if the results of other cross-sectional imaging modalities are equivocal. The major advantage of EUS is the high negative predictive value that approaches 100%, indicating that the absence of a focal mass reliably excludes pancreatic cancer. The introduction of EUS-guided fine needle aspiration allows a preoperative diagnosis in patients with resectable cancer, as well as a confirmation of diagnosis before chemoradiotherapy for those that are not. This comprehensive review highlighted the diagnostic capabilities of EUS including the newest refinements such as contrast-enhanced EUS, EUS elastography, and 3-dimensional EUS. The place of EUS-guided biopsy is also emphasized, including the addition of molecular marker techniques.
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Affiliation(s)
- Adrian Săftoiu
- Department of Gastroenterology, University of Medicine and Pharmacy Craiova, Craiova, Dolj, 200490, Romania
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Abstract
UNLABELLED To evaluate if contrast-enhanced ultrasonography (CEUS) improves the depiction of tumoral margins of pancreatic adenocarcinoma in relation to tumor enhancement, using pathology as criterion standard. METHODS Two hundred forty-one patients affected by pancreatic ductal adenocarcinoma were investigated at CEUS with a second-generation contrast medium of sulfur-hexafluoride microbubbles. Sixty-seven (27.8%) of 241 tumors were resected. By consensus, 2 radiologists reviewed the CEUS examination results of the 67 tumors judging the enhancement as low (hypovascular lesions, hypoechoic tothe adjacent parenchyma) or high (iso- or hypervascular lesions, iso- or hyperechoic to the adjacent parenchyma). The resected tumors were evaluated at pathology for the presence of positive neoplastic (R+) or negative neoplastic (R-) resected margins. RESULTS Of the 67 resected tumors, 35 (52.3%) were R-, whereas 32 (47.7%) were R+. Moreover, at CEUS, of the 67 resected tumors, 43 (64.1%) were hypovascular with low enhancement and 24 (35.8%) were iso-hypervascular with high enhancement. In the R- group, 27 (77.1%) of 35 tumors were hypovascular. In the R+ group, 16 (50%) of 32 lesions were hypovascular. CONCLUSIONS At CEUS the depiction of tumoral margins of pancreatic adenocarcinoma is more accurate in low enhancement than in high enhancement. The pattern of enhancement of pancreatic adenocarcinoma influences the depiction of tumoral margins at CEUS.
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Preliminary study of contrast-enhanced harmonic endosonography with second-generation contrast agents. J Med Ultrason (2001) 2008; 35:11-8. [DOI: 10.1007/s10396-007-0167-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 09/04/2007] [Indexed: 01/09/2023]
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Kitano M, Sakamoto H, Matsui U, Ito Y, Maekawa K, von Schrenck T, Kudo M. A novel perfusion imaging technique of the pancreas: contrast-enhanced harmonic EUS (with video). Gastrointest Endosc 2008; 67:141-50. [PMID: 18155437 DOI: 10.1016/j.gie.2007.07.045] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 07/30/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Contrast-enhanced harmonic-imaging techniques have been unavailable for EUS because of the limited frequency bandwidth and acoustic power output of current echoendoscopes. OBJECTIVE To investigate the contrast harmonic imaging technique by using a prototype echoendoscope equipped with an adequate broad-band transducer that can detect harmonic signals from the US contrast agents. DESIGN Identification of optimal settings (study I) and preliminary clinical investigations (study II). SETTING Bethesda General Hospital Bergedorf. PATIENTS A total of 104 patients undergoing standard EUS examinations. INTERVENTIONS Contrast-enhanced harmonic EUS (CEH-EUS) was performed by using a prototype echoendoscope and extended pure harmonic detection mode, a specific mode for contrast harmonic imaging. MAIN OUTCOME MEASUREMENTS In study I, time-intensity curves for peak signal intensity were calculated after infusion of a contrast agent, SonoVue, and the changes in echo intensity were compared for different mechanical indices and interval times. In study II, intermittent and real-time continuous images of pancreatobiliary and gastroduodenal diseases obtained by CEH-EUS were evaluated in comparison with contrast-enhanced power-Doppler EUS (CED-EUS). RESULTS In study I, with the optimal mechanical index (0.4), homogeneous parenchymal perfusion images of the pancreas were obtained by intermittent imaging, and finely branching vessels of the pancreas were obtained with real-time continuous imaging. In study II, apparent perfusion and vessel images were observed in pancreatobiliary carcinomas, GI stromal tumors, and lymph-node metastases. CED-EUS failed to depict images of the fine vessels and parenchymal perfusion. LIMITATIONS The subjective nature of the findings, with a limited number of patients. CONCLUSIONS CEH-EUS successfully visualized parenchymal perfusion and microvasculature in the pancreas and may play an important role in the differential diagnosis of digestive diseases.
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