Gastrointestinal Endoscopy
Volume 72, Issue 4 , Pages 739-747 , October 2010

Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos)

Presented in part at Digestive Disease Week 2009, May 30–June 4, 2009, Chicago, Illinois (Gastrointest Endosc 2009;69:AB332).

Received 2 November 2009 ,Accepted 13 February 2010.

References 

  1. Harewood GC, Wiersema MJ. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol. 2002;97:1386–1391
  2. Eloubeidi MA, Chen VK, Eltoum IA, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol. 2003;98:2663–2668
  3. Ardengh JC, Lopes CV, de Lima LF, et al. Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration. World J Gastroenterol. 2007;13:3112–3116
  4. Möller K, Papanikolaou IS, Toermer T, et al. EUS-guided FNA of solid pancreatic masses: high yield of 2 passes with combined histologic-cytologic analysis. Gastrointest Endosc. 2009;70:60–69
  5. Fritscher-Ravens A, Brand L, Knöfel WT, et al. Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol. 2002;97:2768–2775
  6. Varadarajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc. 2005;62:728–736
  7. Ardengh JC, Lopes CV, Campos AD, et al. Endoscopic ultrasound and fine needle aspiration in chronic pancreatitis: differential diagnosis between pseudotumoral masses and pancreatic cancer. JOP. 2007;8:413–421
  8. Krishna NB, Mehra M, Reddy AV, et al. EUS/EUS-FNA for suspected pancreatic cancer: influence of chronic pancreatitis and clinical presentation with or without obstructive jaundice on performance characteristics. Gastrointest Endosc. 2009;70:70–79
  9. Eloubeidi MA, Varadarajulu S, Desai S, et al. Value of repeat endoscopic ultrasound-guided fine needle aspiration for suspected pancreatic cancer. J Gastroenterol Hepatol. 2008;23:567–570
  10. Hocke M, Schulze E, Gottschalk P, et al. Contrast-enhanced endoscopic ultrasound in discrimination between focal pancreatitis and pancreatic cancer. World J Gastroenterol. 2006;12:246–250
  11. Dietrich CF, Ignee A, Braden B, et al. Improved differentiation of pancreatic tumors using contrast-enhanced endoscopic ultrasound. Clin Gastroenterol Hepatol. 2008;6:590–597
  12. Sofuni A, Iijima H, Moriyasu F, et al. Differential diagnosis of pancreatic tumors using ultrasound contrast imaging. J Gastroenterol. 2005;40:518–525
  13. Săftoiu A, Iordache S, Gheonea DI, et al. Contrast-enhanced power Doppler endoscopic ultrasound used for the differential diagnosis of chronic pancreatitis and pancreatic cancer [abstract]. Gastrointest Endosc. 2009;69:AB332
  14. Dörffel Y, Wermke W. Neuroendocrine tumors: characterization with contrast-enhanced ultrasonography. Ultraschall Med. 2008;29:506–514
  15. Hirche TO, Ignee A, Barreiros AP, et al. Indications and limitations of endoscopic ultrasound elastography for evaluation of focal pancreatic lesions. Endoscopy. 2008;40:910–917
  16. Săftoiu A, Vilmann P, Gorunescu F, et al. Neural network analysis of dynamic sequences of EUS elastography used for the differential diagnosis of chronic pancreatitis and pancreatic cancer. Gastrointest Endosc. 2008;68:1086–1094
  17. Săftoiu A, Vilmann P, Gorunescu F, et al. Accuracy of endoscopic ultrasound elastography used for differential diagnosis of chronic pancreatitis and pancreatic cancer: a multicentric study [abstract]. Endoscopy. 2009;OP257:A55
  18. Harewood GC, Wiersema LM, Halling AC, et al. Influence of EUS training and pathology interpretation on accuracy of EUS-guided fine needle aspiration of pancreatic masses. Gastrointest Endosc. 2002;55:669–673
  19. Turner BG, Cizginer S, Agarwal D, et al. Diagnosis of pancreatic neoplasia with EUS and FNA: a report of accuracy. Gastrointest Endosc. 2010;71:91–98
  20. Claudon M, Cosgrove D, Albrecht T, et al. Guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS)—update 2008. Ultraschall Med. 2008;29:28–44
  21. Rasband W. ImageJ: Image Processing and analysis in JAVA (National Institutes of Health accessed). http://rsb.info.nih.gov/ij/Accessed October 4, 2009
  22. Thompson RS, Trudinger BJ, Cook CM. Doppler ultrasound waveform indices: A/B ratio, pulsatility index and Pourcelot ratio. Br J Obstet Gynaecol. 1988;95:581–588
  23. Hoskins PR. Quantitative techniques in arterial Doppler ultrasound. Clin Phys Physiol Meas. 1990;11:75–80
  24. Spier BJ, Johnson EA, Gopal DV, et al. Predictors of malignancy and recommended follow-up in patients with negative endoscopic ultrasound-guided fine-needle aspiration of suspected pancreatic lesions. Can J Gastroenterol. 2009;23:279–286
  25. Altman DG, Bland JM. Diagnostic tests. 1: Sensitivity and specificity. BMJ. 1994;308:1552
  26. Altman DG, Bland JM. Diagnostic tests 2: predictive values. BMJ. 1994;309:102
  27. DeWitt JM, Chappo J, Sherman S. Endoscopic ultrasound-guided fine-needle aspiration of melanoma metastatic to the pancreas: report of two cases and review. Endoscopy. 2003;35:219–222
  28. Eloubeidi MA, Jhala D, Chhieng DC, et al. Multiple late asymptomatic pancreatic metastases from renal cell carcinoma: diagnosis by endoscopic ultrasound-guided fine needle aspiration biopsy with immunocytochemical correlation. Dig Dis Sci. 2002;47:1839–1842
  29. Lin H, Li SD, Hu XG, et al. Primary pancreatic lymphoma: report of six cases. World J Gastroenterol. 2006;12:5064–5067
  30. Sakamoto H, Kitano M, Komaki T, et al. Small cell carcinoma of the pancreas: role of EUS-FNA and subsequent effective chemotherapy using carboplatin and etoposide. J Gastroenterol. 2009;44:432–438
  31. Gleeson FC, de la Mora Levy JG, Zhang L, et al. The differential broadens (EUS FNA appearance and cytological findings of pancreatic angiomyolipoma). JOP. 2008;9:67–70
  32. Jani N, Dewitt J, Eloubeidi M, et al. Endoscopic ultrasound-guided fine-needle aspiration for diagnosis of solid pseudopapillary tumors of the pancreas: a multicenter experience. Endoscopy. 2008;40:200–203
  33. Kitano M, Kudo M, Maekawa K, et al. Dynamic imaging of pancreatic diseases by contrast enhanced coded phase inversion harmonic ultrasonography. Gut. 2004;53:854–859
  34. Ohshima T, Yamaguchi T, Takeshi I, et al. Evaluation of bloody flow in pancreatic ducal carcinoma using contrast-enhanced, wide-band Doppler ultrasonography (Correlation with tumor characteristics and vascular endothelial growth factor). Pancreas. 2004;28:335–343
  35. Kobayashi A, Yamaguchi T, Ishihara T, et al. Evaluation of vascular signal in pancreatic ductal carcinoma using contrast enhanced ultrasonography: effect of systemic chemotherapy. Gut. 2005;54:1047
  36. Tawada K, Yamaguchi T, Kobayashi A, et al. Changes in tumor vascularity depicted by contrast-enhanced ultrasonography as a predictor of chemotherapeutic effect in patients with unresectable pancreatic cancer. Pancreas. 2009;38:30–35
  37. Nishida M, Koito K, Hirokawa N, et al. Does contrast-enhanced ultrasound reveal tumor angiogenesis in pancreatic ductal carcinoma? (A prospective study). Ultrasound Med Biol. 2009;35:175–185
  38. Kitano M, Sakamoto H, Matsui U, et al. A novel perfusion imaging technique of the pancreas: contrast-enhanced harmonic EUS (with video). Gastrointest Endosc. 2008;67:141–150
  39. Kudo M, Tochio H, Zhou P. Differentiation of hepatic tumors by color Doppler imaging: role of the maximum velocity and the pulsatility index of the intratumoral blood flow signal. Intervirology. 2004;47:154–161
  40. Shaharabany Y, Akselrod S, Tepper R. A sensitive new indicator for diagnostics of ovarian malignancy, based on the Doppler velocity spectrum. Ultrasound Med Biol. 2004;30:295–302
  41. del Cura JL, Elizagaray E, Zabala R, et al. The use of unenhanced Doppler sonography in the evaluation of solid breast lesions. AJR Am J Roentgenol. 2005;184:1788–1794
  42. Turgut AT, Olçücüoglu E, Koşar P, et al. Power Doppler ultrasonography of the feeding arteries of the prostate gland: a novel approach to the diagnosis of prostate cancer?. J Ultrasound Med. 2007;26:875–883
  43. Miyakawa M, Onoda N, Etoh M, et al. Diagnosis of thyroid follicular carcinoma by the vascular pattern and velocimetric parameters using high resolution pulsed and power Doppler ultrasonography. Endocr J. 2005;52:207–212
  44. Shirakawa T, Miyamoto Y, Yamagishi J, et al. Color/power Doppler sonographic differential diagnosis of superficial lymphadenopathy: metastasis, malignant lymphoma, and benign process. J Ultrasound Med. 2001;20:525–532
  45. Ho SS, Metreweli C, Ahuja AT. Does anybody know how we should measure Doppler parameters in lymph nodes?. Clin Radiol. 2001;56:124–126
  46. Eloubeidi MA, Varadarajulu S, Desai S, et al. A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer. J Gastrointest Surg. 2007;11:813–819

 DISCLOSURE: Săftoiu, Iordache, and Gheonea were supported by research grant number 154/2007, entitled “Utility of EUS and OCT for the minimal invasive evaluation of tumour neo-angiogenesis in the patients with digestive cancers” financed by the Romanian Ministry of Education and Research, National University Research Council (Ideas Program). All authors disclosed no financial relationships relevant to this publication.

 If you would like to chat with an author of this article, you may contact Dr. Săftoiu at adry@umcv.ro or adriansaftiou@aim.com.

PII: S0016-5107(10)01735-9

doi: 10.1016/j.gie.2010.02.056

Gastrointestinal Endoscopy
Volume 72, Issue 4 , Pages 739-747 , October 2010

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