EUS elastography combined with the strain ratio of tissue elasticity for diagnosis of solid pancreatic masses

Itokawa, Fumihide; Itoi, Takao; Kurihara, Toshio; Tsuchiya, Takayoshi; Ishii, Kentaro; Tsuji, Shujiro; Ikeuchi, Nobuhito; Umeda, Junko; Tanaka, Reina; Yokoyama, Naoyuki; Moriyasu, Fuminori; Kasuya, Kazuhiko; Nagao, Toshitaka; Kamisawa, Terumi; Tsuchida, Akihiko

doi:10.1007/s00535-011-0399-5

Cited by 149 publications

(110 citation statements)

References 22 publications

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“…First, the disease concept of NETs disseminated among general clinicians; that is, clinicians have become accustomed to keeping PNETs in mind when treating pancreatic tumors. Second, the availability of endoscopic ultrasonography (EUS), which is useful for the diagnosis of pancreatic diseases [9,10], has made endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) easy to perform for pancreatic tumors, which were merely being followed-up before; thus, the pathological diagnosis of PNETs has become more accurate [11,12].…”

Section: Discussionmentioning

confidence: 99%

Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis

et al. 2014

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Background Although neuroendocrine tumors (NETs) are rare, the number of patients with NET is increasing. However, in Japan, there have been no epidemiological studies on NET since 2005; thus, the prevalence of NET remains unknown. Methods We reported the epidemiology of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) [pancreatic neuroendocrine tumors (PNETs) and gastrointestinal neuroendocrine tumors (GI-NETs)] in Japan in 2005. Here, we conducted the second nationwide survey on patients with GEP-NETs who received treatment in 2010. Results A total of 3,379 patients received treatment for PNETs in 2010, representing a 1.2-fold increase in the number of patients from 2005 to 2010. The prevalence was estimated to be 2.69/100,000, with an annual onset incidence of 1.27/100,000 in 2010. Non-functioning tumor (NF)-PNETs comprised 65.5 % of cases followed by insulinoma (20.9 %) and gastrinoma (8.2 %). Interestingly, the number of patients with NF-PNETs increased *1.8 fold since 2005. A total of 19.9 % of patients exhibited distant metastasis at initial diagnosis; 4.3 % had complications with multiple endocrine neoplasia type 1 (MEN-1), and only 4.0 % had NF-PNETs associated with MEN-1. Meanwhile, an estimated 8,088 patients received treatment for GI-NETs, representing a *1.8-fold increase since 2005. The prevalence was estimated to be 6.42/100,000, with an annual onset incidence of 3.51/100,000. The locations of GI-NETs varied: foregut, 26.1 %; midgut, 3.6 %; and hindgut, 70.3 %. Distant metastasis and complications with MEN-1 were observed in 6.0 and 0.42 % at initial diagnosis, respectively. The frequency of carcinoid syndrome in patients with GI-NETs was 3.2 %. Conclusion We clarified the epidemiological changes in GEP-NETs from 2005 to 2010 in Japan.

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Section: Discussionmentioning

confidence: 99%

Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis

et al. 2014

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“…Itokawa et al (27) introduced the concept of strain ratio (SR) as a semiquantitative method to objectively evaluate tissue hardness, which is simply the ratio of the distortions produced by a force on two adjacent areas. In 2013, Iglesias-García et al (23) obtained a diagnostic accuracy of 91.1% by EUSelastography using the SR for CP with a cut-off of 2.25, describing a direct correlation between the SR and the different stages of CP according to the Rosemont classification.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of percutaneous elastography by acoustic radiation force impulse for the non-invasive diagnosis of chronic pancreatitis

et al. 2016

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Objective: To determine the accuracy of the acoustic radiation force impulse (ARFI) technique for the diagnosis of chronic pancreatitis. Materials and methods:We present an observational, single-center study that included patients with suspected chronic pancreatitis in the period between October 2012 and September 2015 who underwent endoscopic ultrasound (EUS) and were classified according to the standard and Rosemont criteria. The same group of patients was assessed by the ARFI technology using ACUSON S2000™ equipment with Virtual Touch™ Quantification software for the assessment of pancreatic stiffness by obtaining the shear wave velocity (SWV) in the head, body and tail of the pancreas. Data were analyzed using ANOVA and nonparametric correlation methods. Diagnostic accuracy was obtained by analyzing receiver operating characteristic (ROC) curve.Results: A total of thirty-three patients were studied (45.5% women); mean age was 58.3 ± 11.8 years. Seventeen with a diagnosis of chronic pancreatitis and sixteen classified as normal according to standard criteria. A significant difference was detected between the means of SWV in pancreatic body of patients without (SWV: 1.27 m/s) and with chronic pancreatitis (SWV 1.57 m/s), p = 0.037. The area under the ROC curve was 71.3% (95% CI 0.532-0.895) and the accuracy of ARFI for diagnosing chronic pancreatitis was 69.7% for a SWV of 1.4 m/s in the pancreatic body. The SWV means in head (r = 0.421, p < 0.05) and body (r = 0.455, p < 0.05) of the pancreas showed a significant correlation with the number of EUS criteria for chronic pancreatitis.Conclusion: Quantification of pancreatic stiffness with ARFI elastography technique has proven to be useful for the non-invasive diagnosis of chronic pancreatitis.

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“…However, there is no consensus where to set reference area for the pancreas instead of fat around the mammary gland for the breast. Some investigators set reference area on non tumorous area inside pancreatic parenchyma [33,34] , and the other investigators set reference area on red area around the pancreas which was estimated as fat [35,36] (Figure 4) . However, there is no evidence if red area around pancreas is really fat.…”

Section: Us-elastography -Shear Wave Elastograhymentioning

confidence: 99%

“…Itokawa et al [34] subjected 72 ductal adenocar cinomas and 7 tumor forming pancreatitis, and reported that strain ratio was significantly higher in ductal adenocarcinomas compared to that in tumor forming pancreatitis (39.08 ± 20.54 vs 23.66 ± 12.65, P < 0.05). Iglesias Garcia et al [35] subjected 86 pancreatic tumors including 49 ductal adenocarcinomas, 27 tumor forming pancreatitis, 6 endocrine carcinomas, and 2 metastatic carcinomas.…”

Section: Eus-elastography -Strain Elastographymentioning

confidence: 99%

Elastography for the pancreas: Current status and future perspective

Kawada¹,

Tanaka²

2016

WJG

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Elastography for the pancreas can be performed by either ultrasound or endoscopic ultrasound (EUS). There are two types of pancreatic elastographies based on different principles, which are strain elastography and shear wave elastography. The stiffness of tissue is estimated by measuring the grade of strain generated by external pressure in the former, whereas it is estimated by measuring propagation speed of shear wave, the transverse wave, generated by acoustic radiation impulse (ARFI) in the latter. Strain elastography is difficult to perform when the probe, the pancreas and the aorta are not located in line. Accordingly, a fine elastogram can be easily obtained in the pancreatic body but not in the pancreatic head and tail. In contrast, shear wave elastography can be easily performed in the entire pancreas because ARFI can be emitted to wherever desired. However, shear wave elastography cannot be performed by EUS to date. Recently, clinical guidelines for elastography specialized in the pancreas were published from Japanese Society of Medical Ultrasonics. The guidelines show us technical knacks of performing elastography for the pancreas. Core tip: Elastography for the pancreas had been considered to be difficult to perform with adequate accuracy and reproducibility because the pancreas is a small organ located deep in center of the human body. This review introduces the recent innovation of elastography for the pancreas, and makes recommendations on how to use various elastographic modalities for the pancreas. The review also shows us what we can know by performing elastography for the pancreas. Elastography may be a promising imaging modality for differential diagnosis between malignant and benign pancreatic tumors, for early diagnosis of chronic pancreatitis, and for identifying high-risk patients for pancreatic cancer. TOPIC HIGHLIGHTKawada N, Tanaka S. Elastography for the pancreas: Current status and future perspective.

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EUS elastography combined with the strain ratio of tissue elasticity for diagnosis of solid pancreatic masses

Abstract: Endoscopic ultrasound elastography is a promising diagnostic tool for defining the tissue characteristics of pancreatic masses. In addition, semiquantitative analysis of elasticity using the SR may allow the differentiation of MFP from PC.

Cited by 149 publications

References 22 publications

Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis

Epidemiological trends of pancreatic and gastrointestinal neuroendocrine tumors in Japan: a nationwide survey analysis

Usefulness of percutaneous elastography by acoustic radiation force impulse for the non-invasive diagnosis of chronic pancreatitis

Elastography for the pancreas: Current status and future perspective

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