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

Săftoiu, Adrian; Iordache, Sevastiţa; Gheonea, Dan Ionuţ; Popescu, Carmen; Maloş, Anca; Gorunescu, Florin; Ciurea, Tudorel; İordache, A.; Popescu, Gabriel Lucian; Manea, Cǎtǎlin

doi:10.1016/j.gie.2010.02.056

Cited by 112 publications

(95 citation statements)

References 45 publications

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“…Three recent meta-analyses found sensitivity of 95-99%, specificity of 69-76%, and accuracy of 89-96% [85][86][87]. The combination of power Doppler CEUS and elastography yielded global accuracy of 83%, with better specificity than elastography alone [88].…”

Section: Elastographymentioning

confidence: 99%

“…Hypoenhancement on CEUS is considered suggestive of adenocarcinoma, due to the presence of a high proportion of desmoplastic tissue within the tumors, with few microvessels. Using a high mechanical index and Doppler CEUS, the hypovascular aspect was suggestive of adenocarcinoma in 83-94% of patients [88,[90][91][92][93][94]. Motion artifacts and blooming effect are frequent, however, and this method has been replaced by harmonic CEUS.…”

Section: Contrast-enhanced Eusmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

Seicean¹

2014

Pancreatic Cancer - Insights Into Molecular Mechanisms and Novel Approaches to Early Detection and Treatment

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Section: Elastographymentioning

confidence: 99%

Section: Contrast-enhanced Eusmentioning

confidence: 99%

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

Seicean¹

2014

Pancreatic Cancer - Insights Into Molecular Mechanisms and Novel Approaches to Early Detection and Treatment

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“…It has two subtypes with similar performance: contrast-enhanced endoscopic Doppler ultrasound (which uses a high mechanical index for examination and no special software) and contrast-enhanced low mechanical index endoscopic ultrasound (in which the examination is made in contrast mode) [51]. CE-EUS in Doppler mode is useful to differentiate between ductal adenocarcinomas (in which only arterioles are seen] and pseudotumoral chronic pancreatitis (in which both arterioles and venules can be identified by CE-EUS Doppler) [52,53].…”

Section: Contrast-enhanced Endoscopic Ultrasound (Ce-eus)mentioning

confidence: 99%

Contrast‐Enhanced Ultrasound for the Assessment of Pancreatic Lesions

Şirli¹,

Popescu²

2017

Challenges in Pancreatic Pathology

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Transabdominal ultrasound (US) is the first-line imaging method used to diagnose pancreatic lesions, but contrast techniques are needed to differentiate among inflammatory and malignant lesions, as well as between pseudocysts and cystic tumors. Contrast-enhanced (CE) ultrasonography has been proven to be a useful tool in this regard with performance similar to contrast-enhanced computer tomography/magnetic resonance imaging (CT/MRI), being also safer and nonirradiant. According to the EFSUMB guidelines on the nonhepatic use of contrast-enhanced ultrasound (CEUS), this method is useful to improve characterization of ductal adenocarcinoma; to differentiate between pseudocysts and cystic tumors; to differentiate vascular (solid) from avascular (liquid/necrotic) components of a lesion; to better define the dimensions and margins of a lesion, including its relationship with adjacent vessels; and to help the choice for a next imaging technique.

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“…The high negative predictive value of the combination between elastography and contrast enhancement during EUS as reported [16] has raised hopes that these imaging methods might help the clinical decision making the process of differentiation between benign and malignant focal pancreatic masses, especially in patients with negative EUS-FNA samples.…”

Section: Introductionmentioning

confidence: 97%

“…Real-time elastographic EUS (RTE-EUS) and contrast-enhanced harmonic EUS (CEH-EUS) are two useful methods for the assessment of patients with focal pancreatic masses both reported to have a high sensitivity and specificity [11][12][13][14][15][16]. The high negative predictive value of the combination between elastography and contrast enhancement during EUS as reported [16] has raised hopes that these imaging methods might help the clinical decision making the process of differentiation between benign and malignant focal pancreatic masses, especially in patients with negative EUS-FNA samples.…”

Section: Introductionmentioning

confidence: 99%

Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA

Iordache

Costache

Popescu³

et al. 2016

Med Ultrason

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Aim: It is well known that endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has a high sensitivity (over 85%) and specificity (100%) for diagnosis of pancreatic cancer. The aim of the study was to establish a EUS based clinical diagnostic algorithm in patients with pancreatic masses and negative cytopathology after EUS-FNA, based on previously published results and cut-offs of real-time elastographic (RTE) EUS and contrast-enhanced harmonic (CEH) EUS. Material and methods: We included in the study a subgroup of 50 consecutive patients with focal pancreatic masses which underwent EUS examinations with negative EUS-FNA. RTE-EUS and CEH-EUS were performed sequentially in all patients. The sensitivity, specificity and accuracy of these methods were calculated separately. A clinical decision algorithm based on elastography followed by CEH was established. Results: For the diagnosis of possible malignancy, the sensitivity, specificity and accuracy of RTE-EUS were: 97.7%, 77.4%, and 84% respectively. CEH-EUS had similar results: 89.5%, 80.7%, and 84%, respectively. In 25 patients with soft/mixed appearance during elastography,sequential assessment using contrast-enhanced EUSwas performed. The specificity of CEH-EUS for detection of chronic pancreatitis in this sub-set of patients was excellent (100%). In other 25 patients with hard appearance in elastography (low strain) CEH-EUS had an excellent specificity (100%) and accuracy (93%) in the detection of pancreatic cancer. Conclusions: The proposed algorithm with sequential use of elastography followed by CEH could be a good clinical tool in the set of patients with negative EUS-FNA results for the differentiation between benign and malignant focal pancreatic masses.

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

Cited by 112 publications

References 45 publications

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

Contrast‐Enhanced Ultrasound for the Assessment of Pancreatic Lesions

Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA

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