Contrast Harmonic-Endoscopic Ultrasound Is Useful to Identify Neoplastic Features of Pancreatic Cysts (With Videos)

Fusaroli, Pietro; Serrani, Marta; Giorgio, Roberto De; D'Ercole, Maria Cristina; Ceroni, Liza; Lisotti, Andrea; Caletti, Giancarlo

doi:10.1097/mpa.0000000000000441

Cited by 63 publications

(42 citation statements)

References 23 publications

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“…Liver abscess, since pus frequently is not anechoic[40]Intraductal papillary mucinous neoplasia with focal mucus accumulations which mimics neoplastic nodules[57]Gallbladder stones without calcification which could be misdiagnosed as polypsCardiac lesions mimicking thrombus but which are in fact neoplasms (unpublished data). …”

Section: Ultrasound Contrast Agents Imagingmentioning

confidence: 99%

Ultrasound contrast agents

et al. 2016

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Endoscopic ultrasound (EUS) plays an important role in imaging of the mediastinum and abdominal organs. Since the introduction of US contrast agents (UCA) for transabdominal US, attempts have been made to apply contrast-enhanced US techniques also to EUS. Since 2003, specific contrast-enhanced imaging was possible using EUS. Important studies have been published regarding contrast-enhanced EUS and the characterization of focal pancreatic lesions, lymph nodes, and subepithelial tumors. In this manuscript, we describe the relevant UCA, their application, and specific image acquisition as well as the principles of image tissue characterization using contrast-enhanced EUS. Safety issues, potential future developments, and EUS-specific issues are reviewed.

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Section: Ultrasound Contrast Agents Imagingmentioning

confidence: 99%

Ultrasound contrast agents

et al. 2016

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“…CHI-EUS has been used in cystic pancreatic lesions, due to the increased resolution and ability to image the wall, septa and mural nodules [174]. Thus, the differentiation between mural nodules as opposed to debris and intra-cystic mucus can be easily made [175].…”

Section: Contrast Harmonic Imaging Endoscopic Ultrasoundmentioning

confidence: 99%

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

et al. 2017

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Contrast-enhanced ultrasound (CEUS) allows a real-time assessment of the vascular pattern of different types of lesions, as it has no renal or liver toxicity, it lacks radiation exposure and it is also cheaper than other imaging methods, having a diagnostic capability that matches contrast-enhanced CT or MRI. In Romania CEUS is used more and more, especially by clinicians, and since some centres have extensive experience in this domain, we felt the need to disseminate our expertise in order to implement this method in as many centres as possible. These Guidelines present the clinical applications of CEUS in the liver, spleen, pancreas, kidney, testis, bowel, intra-cavitary and endoscopic ultrasound, as well as other applications.

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“…Comparable results were confirmed in later studies. In one study by Fusaroli et al [26], all hyperenhanced solid components during CH-EUS were malignant whereas non-enhanced ones were either mucous clots or internal debris.…”

Section: Contrast-enhanced Endoscopic Ultrasoundmentioning

confidence: 99%

“…90% of pseudocysts showed hypoenhancement (p = 0.000004 vs. serous cysts and p = 0.000005 vs. mucinous cysts). CH-EUS did not add any advantage to EUS alone for differentiating mucinous from non-mucinous cysts when the presence of mural nodules was considered as a sign of mucinous cysts (sensitivity 79 vs. 85%; specificity 96 vs. 46%) [26]. …”

Section: Contrast-enhanced Endoscopic Ultrasoundmentioning

confidence: 99%

The Role of Endoscopic Ultrasound in the Diagnosis of Cystic Lesions of the Pancreas

Lévy

Rebours

2018

Visc Med

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A precise diagnosis of the nature of pancreatic cystic neoplasm (PCN) is crucial since it determines the patients in need of rapid surgical resection as well as those who can be followed up, and, accordingly, the frequency and modalities of surveillance. Endoscopic ultrasound (EUS) and especially fine needle aspiration (FNA) are invasive methods, with specific adverse events occurring in 2.7-5%. Thus, they should only be used as a third-line tool in the absence of characteristic radiographic features on computed tomography (CT) scan and magnetic resonance imaging (MRI). The most difficult aspects of differential diagnosis are: intraductal papillary mucinous neoplasm (IPMN) versus chronic pancreatitis; unifocal IPMN versus serous cystic neoplasm (SCN); macrocystic SCN versus mucinous cystic neoplasm (MCN); cystic neuroendocrine tumors versus MCN; solid serous cystadenoma versus neuroendocrine tumors versus small solid pseudopapillary tumors; pseudocyst versus MCN; low-grade, high-grade, or invasive IPMN. When classical radiological and EUS features are not conclusive, EUS-FNA may be helpful by analyzing cytological, chemical, and/or molecular data. The addition of EUS-FNA to CT scan and MRI increased the overall accuracy for diagnosing PCN by 36 and 54%, respectively. Analysis of molecular markers in pancreatic cyst fluid might increase the limited accuracy of EUS-FNA by using cytology and chemical and/or tumor marker analysis alone. Current evidence suggests that contrast-enhanced EUS (CH-EUS) is highly accurate for distinguishing non-neoplastic cysts from neoplastic cysts. CH-EUS might also be useful for distinguishing mural epithelial nodules from mucinous clots. Needle-based confocal laser endomicroscopy (nCLE) images a target tissue at a subcellular level of resolution, providing real-time in-vivo optical biopsy. nCLE is feasible during EUS-FNA and allows in-vivo diagnosis of PCN with high accuracy. In conclusion, EUS is a third-line tool in the diagnosis of PCN. Clinical context as well as careful evaluation of CT scan and magnetic resonance cholangiopancreatography images by specialized radiologists are crucial in the diagnosis process. Nowadays it is inconceivable to skip these steps.

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Contrast Harmonic-Endoscopic Ultrasound Is Useful to Identify Neoplastic Features of Pancreatic Cysts (With Videos)

Cited by 63 publications

References 23 publications

Ultrasound contrast agents

Ultrasound contrast agents

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

The Role of Endoscopic Ultrasound in the Diagnosis of Cystic Lesions of the Pancreas

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