Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the Differential Diagnosis of Gallbladder Wall Thickening

Imazu, Hiroo; Mori, Naoki; Kanazawa, Keisuke; Chiba, Masafumi; Toyoizumi, Hirobumi; Torisu, Yuichi; Koyama, Shoichi; Hino, Shoryoku; Ang, Tiing Leong; Tajiri, Hisao

doi:10.1007/s10620-014-3115-5

Cited by 64 publications

(45 citation statements)

References 25 publications

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“…20 In their report, the inhomogeneous enhanced pattern in CH-EUS was a strong predictive factor of malignant gallbladder wall thickening, and the overall accuracy for diagnosing malignant gallbladder wall thickening was significantly higher for CH-EUS (94.4%) than for conventional EUS (73.1%). 20 Choi et al assessed the utility of CH-EUS for differential diagnosis between benign and malignant polyps of the gallbladder. 21 An irregular vessel pattern determined by CH-EUS aided the diagnosis of malignant polyps with a sensitivity and specificity of 90.3% and 96.6%, respectively.…”

Section: Characterization Of Gallbladder Lesions With Ch-eusmentioning

confidence: 89%

“…[20][21][22] Imazu et al compared conventional EUS and CH-EUS for the differential diagnosis of gallbladder wall thickening. 20 In their report, the inhomogeneous enhanced pattern in CH-EUS was a strong predictive factor of malignant gallbladder wall thickening, and the overall accuracy for diagnosing malignant gallbladder wall thickening was significantly higher for CH-EUS (94.4%) than for conventional EUS (73.1%). 20 Choi et al assessed the utility of CH-EUS for differential diagnosis between benign and malignant polyps of the gallbladder.…”

Section: Characterization Of Gallbladder Lesions With Ch-eusmentioning

confidence: 99%

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Contrast‐enhanced harmonic endoscopic ultrasonography for pancreatobiliary diseases

Kitano

Kamata

Imai

et al. 2015

Digestive Endoscopy

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The combination of second-generation ultrasound contrast agents and an endoscopic ultrasonography (EUS) system with a broad-band transducer has allowed contrast-enhanced harmonic imaging in the field of EUS. In contrast-enhanced harmonic EUS (CH-EUS), diffuse homogeneous enhancement is obtained in normal parenchyma of the pancreas. The bile duct and pancreatic duct are depicted as non-enhanced ductal structures with strong contrast in comparison to the surrounding parenchyma. CH-EUS identifies pancreatic adenocarcinomas as solid lesions exhibiting hypo-enhancement with a sensitivity and specificity of 88-96% and 88-94%, respectively. In particular, 80-100% of falsenegative cases in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are correctly classified by CH-EUS, suggesting CH-EUS complements EUS-FNA. Moreover, CH-EUS improves depiction of some subtle lesions in conventional EUS, thus facilitating EUS-FNA. For quantitative perfusion analysis, a time-intensity curve (TIC) for the region of interest can be generated during CH-EUS. The maximum intensity gain and the echo intensity reduction rate from the peak at 1 min obtained by TIC can be used for differentiation of pancreatic adenocarcinoma from other tumors. CH-EUS is also useful for differentiation of invasive intraductal papillary mucinous neoplasms (IPMN) from non-invasive IPMN, identification of malignant lesions in the gallbladder, and T-and N-staging of pancreatobiliary tumors.

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Section: Characterization Of Gallbladder Lesions With Ch-eusmentioning

confidence: 89%

Section: Characterization Of Gallbladder Lesions With Ch-eusmentioning

confidence: 99%

Contrast‐enhanced harmonic endoscopic ultrasonography for pancreatobiliary diseases

Kitano

Kamata

Imai

et al. 2015

Digestive Endoscopy

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“…After target lesions are visualized on the monitor in the B and extended pure harmonic detection (ExPHD) modes, 0.015 mL/kg of the contrast medium (16 µg of Sonazoid in 2 mL of distilled water) is injected. Subsequently, the target lesions are evaluated in the arterial and early venous phases that occur approximately 90 seconds after these lesions are enhanced 15,29) .…”

Section: Methods Of Ch -Eusmentioning

confidence: 99%

Contrast-enhanced harmonic endoscopic ultrasonography in gallbladder cancer and pancreatic cancer

Sugimoto

Takagi

Suzuki

et al. 2017

FJMS

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Endoscopic ultrasonography (EUS) plays a major role in diagnosing gallbladder (GB) cancer and pancreatic cancer (PC). In cases of GB cancer, EUS allows for precise observations of morphology and wall layers. However, proficiency is required for the morphologic diagnosis of GB tumors. Therefore, contrast -enhanced harmonic EUS (CH -EUS) began to be performed to diagnose GB lesions. CH -EUS enables real -time observation of the hemodynamics of GB tumors. The enhanced patterns generated by CH -EUS improve precision in the diagnosis of such tumors. PC appears as a hypoechoic mass on EUS. However, distinguishing between PC and mass -forming pancreatitis or focal autoimmune pancreatitis (AIP) is difficult via conventional EUS. CH -EUS allows for differentiating among these diseases (PC is hypoenhanced and heterogeneously enhanced, pancreatitis is isoenhanced, and a pancreatic neuroendocrine tumor is hyperenhanced). EUS -guided fine needle aspiration (EUS -FNA) also contributes to pathological diagnoses of pancreatic lesions. However, certain PC patients cannot be diagnosed via EUS -FNA. PC is heterogeneously enhanced on CH -EUS, and unenhanced regions have been reported to be areas of fibrosis or necrosis. CH -EUS -guided fine needle aspiration (CH -EUS -FNA) permits puncturing of the enhanced area while avoiding necrotic and fibrotic regions. Moreover, as CH -EUS findings have been quantitatively analyzed, a time -intensity curve (TIC) has become usable for diagnosing solid pancreatic lesions. CH -EUS -related techniques have been developed and increasingly utilized in the pancreaticobiliary area.

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“…Contrast-enhanced endoscopic ultrasonography (EUS) is beneficial for the differential diagnosis of gallbladder wall thickening (5). High-resolution ultrasound is also advantageous for differentiating gallbladder cancers from ADM (6); however, the challenge of differentiating gallbladder cancer from ADM has yet to be resolved.…”

Section: Introductionmentioning

confidence: 99%

Negative signals for adenomyomatosis of the gallbladder upon diffusion-weighted whole body imaging with background body signal suppression/T2-weighted image fusion analysis

Tomizawa

Shinozaki

Fugo

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. Differentiation between adenomyomatosis (ADM) and cancer of the gallbladder is necessary during diagnosis. Diffusion-weighted whole body imaging with background body signal suppression (DWIBS) images are able to indicate cancer and inflammation. The fusion of a DWIBS with a T2 weighted image (DWIBS/T2) facilitates both functional and anatomical investigations. In the present study, patient records and images from patients with surgically confirmed ADM from April 2012 to October 2014 were analyzed retrospectively. The enrolled patients, including 6 men (64.2±13.1 years) and 4 women (57.3±12.4 years) were subjected to DWIBS/T2 during routine clinical practice. The diagnosis of ADM was based on magnetic resonance cholangiopancreatography, transabdominal ultrasonography, and endoscopic ultrasonography; ADM was diagnosed definitively when cystic lesions were observed, indicating the Rokitansky-Aschoff sinus. A single patient was indicated to be positive by DWIBS/T2 imaging. The Rokitansky-Aschoff sinus revealed a relatively high signal intensity; however, it was not as strong as that of the spleen. The signal intensity was also high on an apparent diffusion coefficient map, suggesting T2 shine-through. The thickened wall displayed low signal intensity. The aforementioned results indicate that ADM may be negative upon DWIBS/T2 imaging; one false positive case was determined to be ADM, accompanied by chronic cholecystitis. The majority of patients with ADM displayed negative findings upon DWIBS/T2 imaging, and chronic cholecystitis may cause false positives. IntroductionAdenomyomatosis of the gallbladder (ADM) is defined as the epithelial proliferation and hypertrophy of the muscles of the gallbladder wall (1). An outpouching of the gallbladder mucosa into the thickened muscular layer is termed Rokitansky-Aschoff sinus (2). ADM may be further divided into three subtypes: Fundal, segmental and diffuse (3). A major challenge in ADM diagnosis arises from the difficulty in distinguishing the disease from gallbladder cancer (4).Recent advances in diagnostic imaging have improved the distinction between ADM and gallbladder cancer. Contrast-enhanced endoscopic ultrasonography (EUS) is beneficial for the differential diagnosis of gallbladder wall thickening (5). High-resolution ultrasound is also advantageous for differentiating gallbladder cancers from ADM (6); however, the challenge of differentiating gallbladder cancer from ADM has yet to be resolved. A primary cause of the challenge is intratumoral cystic components, which create difficulty in discerning between gallbladder cancer and ADM (7).Diffusion-weighted whole body imaging with background body signal suppression (DWIBS) images are acquired through multiple-signal averaging, pre-pulse fat suppression, and heavy diffusion weighting during free breathing (8); DWIBS is based upon diffusion-weighted imaging (DWI), which visualizes and assesses the random movement of water at the molecular level (Brownian motion) (9,10). An advantage of DWIBS is that it provides...

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Contrast-Enhanced Harmonic Endoscopic Ultrasonography in the Differential Diagnosis of Gallbladder Wall Thickening

Abstract: CH-EUS has the potential to improve the preoperative diagnostic accuracy and inter-observer agreement in the differential diagnosis of GB wall thickening.

Cited by 64 publications

References 25 publications

Contrast‐enhanced harmonic endoscopic ultrasonography for pancreatobiliary diseases

Contrast‐enhanced harmonic endoscopic ultrasonography for pancreatobiliary diseases

Contrast-enhanced harmonic endoscopic ultrasonography in gallbladder cancer and pancreatic cancer

Negative signals for adenomyomatosis of the gallbladder upon diffusion-weighted whole body imaging with background body signal suppression/T2-weighted image fusion analysis

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