Background: Endoscopic ultrasonography (EUS) provides high-resolution images of the pancreas, and it is considered one of the most accurate methods for the diagnosis and staging of solid pancreatic lesions (SPL), EUS guided fine-needle aspiration (EUS–FNA) can obtain cytological samples of pancreatic lesions, making a pathologic diagnosis possible, however, it is associated with small, but not insignificant, morbidity. The aim of this work is to determine in a prospective study, the role of EUS in the diagnosis of SPL in comparison with different radiological studies and to determine the diagnostic value of EUS guided FNA and elastography in differentiation between benign and malignant pancreatic lesions. Patients and methods: A total of 50 patients with SPL identified by EUS after imaging studies were enrolled in the study. The qualitative elastography score was done, also the semi quantitative score of elastography was represented by the strain ratio (SR) method where two areas were selected, area (A) representing the region of interest and area (B) representing the normal area. Area (B) was then divided by area (A). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated by comparing diagnosis made by elastography, SR with the final diagnosis (by EUS-FNA, surgery, and/or follow up for 6 months). Results: SPL were found to be malignant in 38 patients and benign in 12 patients. SPL was diagnosed by different imaging modalities in 39 patients with a percentage of (78%), while it was diagnosed by EUS in all 50 patients with a percentage of (100%). Elastography score alone had a sensitivity of 89.4%, a specificity of 75%, a PPV of 91.8% and an NPV of 69.2% and an accuracy of 86%. The best cut-off level of SR to obtain the maximal area under the curve was 8.42 with a sensitivity of 92.1%, specificity of 83.3%, PPV of 94.6%, NPV of 76.9% and an accuracy of 93.1%. Adding both elastography score to SR resulted in a sensitivity of 94.7%, specificity of 83.3%, PPV of 94.7%, NPV of 83.3% and accuracy of 94.3% for the diagnosis of SPL. Conclusion: EUS has a role in diagnosis of SPL which may be superior to different radiological studies; also, EUS-elastography and SR can be a valuable complementary supplement for EUS-FNA.
Background MR enterography (MRE) has been increased in the last decade as a modality of choice in diagnosis and evaluation of small bowel diseases in both children and adults. Lacking ionizing radiation, non-invasiveness, excellent soft tissue resolution, adequate luminal distension of small bowel loops are the advantages of this technique. Acquisition of images was used to be: T2WI, steady-state free precession, and T1WI, fat-suppressed gadolinium contrast-enhanced sequences. Multipoint Dixon sequence was added recently to the routine MR enterography protocol. The current study aimed to evaluate the added value of multipoint Dixon sequence as a valuable modification of MR enterography protocol for better assessment of small bowel lesions as activity of Crohn’s disease, small bowel polyps, fibrotic strictures, with modification of MRE protocol in the future with less time consumption and better radiological evaluation. Methods The current research was a prospective cross-sectional study. Data were collected prospectively after getting ethical approval from the ethical committee of the faculty of medicine, in our university. Study population The sample size was 69 adult patients with suspected small bowel lesions, within the period from January 2022 to 30th December 2022. Written informed consent was obtained from all studied cases before the study, who were enrolled in this study. This number was calculated by using MedCalc 19 program by setting alpha error significance of 0.05%, 95% confidence level, and 80% power sample. Results This study enrolled 69 patients with recurrent abdominal pain and/or bleeding in stool. The patients’ age ranged from 18 to 50 years, with a mean of 32.6 ± 8.8. There is slightly higher female prevalence. The most common positive imaging findings in the studied patients were mucosal thickening in terms of submucosal fat deposition (36.23% of the MRE examination and 39.13% of the MRE with added Dixon sequence). Adding Dixon sequence yielded significantly higher AUC (97.2% vs. 90.5%, p = 0.047), higher sensitivity (100% vs. 92.16%), specificity (94.4% vs. 88.89%), accuracy (98.55% vs. 91.3%), positive predictive value (98.08% vs. 95.92%), and negative predictive value (100% vs. 80%). Conclusions MRE is an excellent imaging modality in the assessment of small bowel diseases without the use of ionizing radiation. Developing MR-based sequences as multi-point Dixon sequence have the potential to improve the ability of MRE to image the subtle changes as Crohn’s accompanying early inflammatory changes and fibrosis, as well as small intestinal polyps. Familiarity with MR enterography is essential for radiologists and gastroenterologists who participate in the clinical management of small intestinal diseases.
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